Podcast - NICE News - August 2026

The video version of this podcast can be found here:

·       https://youtu.be/HJBi-1DAS60

This episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by NICE.

NICE stands for "National Institute for Health and Care Excellence" and is an independent organization within the UK healthcare system that produces evidence-based guidelines and recommendations to help healthcare professionals deliver the best possible care to patients, particularly within the NHS (National Health Service) by assessing new health technologies and treatments and determining their cost-effectiveness; essentially guiding best practices for patient care across the country.

My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode I go through new and updated recommendations published in August 2026 by the National Institute for Health and Care Excellence (NICE), focusing on those that are relevant to Primary Care only.

I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement.  

Disclaimer:

The Video Content on this channel is for educational purposes and not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen on this YouTube channel. The statements made throughout this video are not to be used or relied on to diagnose, treat, cure or prevent health conditions.

In addition, transmission of this Content is not intended to create, and receipt by you does not constitute, a physician-patient relationship with Dr Fernando Florido, his employees, agents, independent contractors, or anyone acting on behalf of Dr Fernando Florido.

Intro / outro music: Track: Halfway Through — Broke In Summer [Audio Library Release] 

• Music provided by Audio Library Plus 
• Watch: https://youtu.be/aBGk6aJM3IU 
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Tracks:

00:00 – Introduction and welcome

00:25 – Allergic rhinitis

03:22 – Acne vulgaris

07:21 – Thank you and good-bye

There is a podcast version of this and other videos that you can access here:

Primary Care guidelines podcast:

·       Redcircle: https://redcircle.com/shows/primary-care-guidelines

·       Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK

·       Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148

There is a YouTube version of this and other videos that you can access here: 

• The Practical GP YouTube Channel: 

https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk

The Full NICE News bulletin for August 2026 can be found here:

·       https://www.nice.org.uk/guidance/published?from=2026-08-01&to=2026-08-31

The updated NICE technology appraisal on 12 SQ-HDM SLIT for treating allergic rhinitis and allergic asthma caused by house dust mites [TA1045] can be found here:

·       https://www.nice.org.uk/guidance/ta1045/

The updated NICE technology appraisal on 12 SQ-Bet SLIT for treating moderate to severe allergic rhinitis or conjunctivitis caused by tree pollen in people 5 years and over [TA1087] can be found here:

·       https://www.nice.org.uk/guidance/ta1087

The updated NICE guideline on Acne vulgaris: management [NG198] can be found here:

·       https://www.nice.org.uk/guidance/ng198

The new updated NICE guideline on Heavy menstrual bleeding: assessment and management [NG88] can be found here:

·       https://www.nice.org.uk/guidance/ng88

Transcript

If you are listening to this podcast on YouTube, for a better experience, switch to the video version. The link is in the episode description.

Hello and welcome! I’m Fernando, a GP in the UK. In today’s episode, we’ll look at the NICE updates published in August 2026, focusing on what is relevant in Primary Care only.

This month, we have only two areas to cover: updated guidance allergic rhinitis and conjunctivitis, and an update on acne vulgaris.

Right, let’s jump into it.

There are two updates on allergic rhinitis that are very similar, so let’s take them together.They both involve sublingual immunotherapy for allergic rhinitis, and both updates expand the eligible population to include younger children.

The first one is Acarizax, for house dust mite allergic rhinitis.

It was recommended for people aged 12 to 65 and it now also includes children aged 5 to 11 years.

The second is Itulazax, for allergic rhinitis or conjunctivitis caused by tree pollen from the birch group.It was recommended for adults and it now includes people aged 5 years and over.

In both cases, the symptoms need to be moderate to severe, the diagnosis needs to be supported by a positive sensitisation test, such as skin prick testing or specific IgE, and symptoms must persist despite symptom-relieving treatment.

So, what are these treatments?

As we said Acarizax is for house dust mite allergic rhinitis, while Itulazax is for birch-related tree pollen allergic rhinitis or conjunctivitis.

Both are sublingual immunotherapy tablets.

Acarizax contains house dust mite allergen extract and Itulazax contains birch pollen allergen extract.

Both are placed under the tongue and work by gradually desensitising the immune system to the relevant allergen.

So these are not just another antihistamine or nasal spray.

They are allergen immunotherapy treatments, aiming to modify the immune response itself rather than simply providing temporary symptom relief.

In usual care, allergic rhinitis, with or without conjunctivitis, is treated first with standard medicines, such as antihistamines and intranasal corticosteroids.

These immunotherapy treatments come later, when symptoms remain moderate to severe and persistent despite standard treatment.

It is worth saying that Acarizax is not recommended for allergic asthma, even when house dust mite allergy may be triggering it.

Having asthma does not necessarily prevent someone from receiving Acarizax for rhinitis, but the NICE recommendation is not for asthma treatment itself.

Itulazax is for tree pollen allergy from the birch group, and it can be given for allergic rhinitis, conjunctivitis, or both.

Although these may not be treatments that GPs routinely prescribe, they are useful to know about because we will see children and adults with persistent allergic rhinitis despite antihistamines and nasal steroids, and , in those cases, these options may be relevant for specialist referral or discussion.

Let’s now look at the updated NICE guideline on acne vulgaris.

This update is quite focused and NICE has amended references to polycystic ovarian syndrome, because this condition is now called polyendocrine metabolic ovarian syndrome, or PMOS. This name change was agreed by global consensus and reflects that this is a whole-body metabolic and hormonal condition, not a disease defined by ovarian cysts.

Additionally the recommendation on triamcinolone injections has been withdrawn, but this is relevant to specialist care.

For us in primary care, the main acne management is otherwise unchanged so let’s give it a very quick overview.

For drug treatment, NICE recommends a 12-week course of one first-line treatment option, depending on severity and patient preference.

For many patients, we can use a fixed-combination topical treatment, such as adapalene with benzoyl peroxide, or tretinoin with clindamycin.

Adapalene with benzoyl peroxide has the advantage that it does not contain an antibiotic, but for mild to moderate acne, we can also consider benzoyl peroxide with clindamycin.

For moderate to severe acne, we should usually use a topical treatment together with an oral antibiotic, either lymecycline or doxycycline.

If the person cannot use lymecycline or doxycycline, we can consider trimethoprim or an oral macrolide, such as erythromycin.

Topical benzoyl peroxide alone can also be considered if the other options are contraindicated, or if the person wants to avoid topical retinoids or antibiotics.

We should not use topical antibiotic monotherapy, oral antibiotic monotherapy, or a combination of topical and oral antibiotics, because of the risk of antimicrobial resistance.

We should also explain that treatment can take 6 to 8 weeks before improvement become noticeable.

Topical retinoids and oral tetracyclines are contraindicated during pregnancy and when planning pregnancy, so effective contraception or an alternative treatment is needed for people of childbearing age.

If hormonal contraception is wanted, we should consider the combined oral contraceptive pill in preference to the progestogen-only pill.

We should then review first-line treatment at 12 weeks.

If the treatment includes an oral antibiotic and the acne has cleared, we should consider stopping the antibiotic but continuing the topical treatment.

If the acne has improved but has not completely cleared, we should consider continuing the oral antibiotic with the topical treatment for up to 12 more weeks.

We should only continue antibiotic-containing treatment for more than 6 months in exceptional circumstances, with review every 3 months, and we should stop the antibiotic as soon as possible.

We should refer if there is diagnostic uncertainty, acne conglobata, or nodulo-cystic acne. We should also consider referral if acne is not responding to treatment, or if acne is causing scarring, persistent pigmentary change, or significant psychological distress.

For PMOS and acne, we should use a first-line acne treatment option first.

If that is not effective, we should consider adding co-cyprindiol or an alternative combined oral contraceptive pill.

For people using co-cyprindiol, we should review at 6 months and discuss continuation or alternative options.

We should consider specialist referral if acne and PMOS are associated with hyperandrogenism, or if there is severe acne resistant to standard treatment.

So that is it, a review of the NICE updates relevant to primary care.

We have come to the end of this episode.

Remember that this is not medical advice, but only my summary and interpretation of the guidelines.

You must always use your clinical judgement.

Thank you for listening and goodbye.