Immunotherapy Safety for the Primary Care ... - U.S. Coast Guard

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Immunotherapy Safety for the Primary Care Provider Self-Assessment Test 1. Allergen immunotherapy is NOT indicated for: a. Allergic asthma b. Chronic urticaria c. Venom hypersensitivity d. Allergic rhinitis 2. Anaphylaxis can be triggered by bee stings, foods, allergy shots, and vaccines. a. True b. False 3. Patients should remain in the physician’s office at least ____ minutes after an allergen injection. a. 10 minutes b. 30 minutes c. 60 minutes d. 120 minutes 4. Who can NOT initiate treatment with Epinephrine during anaphylaxis? a. Any trained technician (trained Corpsman/Medic) or licensed provider b. Any Corpsman/Medic under the “Ferris Doctrine” c. Any trained friend or family member under the “Good Samaritan Law” d. The trained patient to themselves 5. Risk factors associated with immunotherapy include all of the following EXCEPT: a. Concurrent beta blocker use b. Poorly controlled asthma c. Concurrent use of antihistamines which may mask systemic reactions d. Injections given from a new vial 6. When starting an AEROALLERGEN REFILL vial, by how much should you decrease the dose? a. 10% b. 90% c. 50% d. 25% 7. What was the recommended color of the cap for the maintenance (1:1 v/v) AIT vial? a. Red b. Yellow c. Blue d. Silver
8. Allergy shots are administered: a. Intramuscular (IM) b. Subcutaneous (SQ) c. Intradermal (ID) d. Oral (PO) 9. A patient reports to you 10 minutes after her allergy injection that she is sneezing, having itchy eyes, and chest congestion with coughing. What is the treatment of choice? a. Administer epinephrine intravenously b. Administer epinephrine intramuscularly c. Administer steroids by injection d. Administer albuterol by nebulizer 10. A patient is on his monthly maintenance (0.5 cc of 1:1 v/v) aeroallergen immunotherapy. He comes 4 weeks after his last shot, but now has a new (just refilled) vial. What dose should he get today? a. 0.50 cc of the renewed maintenance (1:1) vial b. 0.25 cc of a diluted (1:10) step-down vial c. 0.05 cc of the renewed maintenance (1:1) vial d. 0.25 cc of the renewed maintenance (1:1) vial 11. All of the following are ABSOLUTE contraindications for initiating venom immunotherapy EXCEPT: a. Pregnancy b. Severe COPD c. Unstable angina d. Patient taking a beta-blocker 12. After the initiation of AIT, when should the patient be routinely re-evaluated by the Allergist? a. Monthly b. Quarterly c. Annually d. At the conclusion of his/her AIT (i.e., 3-5 years) 13. A patient reports that he had swelling down to his elbow after the last allergy shot and it lasted for greater than 12 hours. What adjustments should be made? a. No adjustment required – advance per routine advancement protocol b. Make adjustments as directed by the Allergist’s dose adjustment instructions c. Do not give a shot today and advise the patient to return after having taken ibuprofen d. Treat the reaction as a systemic considering the size of the swelling 14. Can a trained technician administer epinephrine in the absence of a physician? a. Yes b. No
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Immunotherapy Safety for the Primar
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Welcome to “Immunotherapy Safety
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Click the ⌧ next to the topic to
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Immunotherapy at Remote Sites Stand
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What Immunotherapy Is Not • Not p
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How Does Immunotherapy Work? • De
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Who Benefits? •Those with… - Al
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Immunotherapy Efficacy • Effectiv
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Not Efficacious For… • Atopic d
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The Extracts/Vaccines • Bioequiva
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Lots of Numbers! Vial v/v W/V (exam
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Immunotherapy Phases • Maintenanc
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Reaction Prevention - Avoidance •
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Reaction Therapy - BLS+ Level • T
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Treatment Guidelines • Treatment
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Frequency of Systemic Reactions •
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Immunotherapy Safety • To lessen
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Immunotherapy Safety • To lessen
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Immunotherapy Safety • After Inje
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Immunotherapy Safety • Equipment:
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What To Expect (Demand) from the Al
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Summary • Risk factors for advers
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End of Selection Go to Bookmarks &
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• Allergen immunotherapy (allergy
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BEFORE EACH SHOT!!! • Screen pati
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instruct patient to report any abno
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• Negative (swelling up to 15mm;
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Epi-Pen Adult Epi-Pen JR TwinJect
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How to dilute from available vials:
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Vial v/v W/V AU/ML BAU/ML 5 Red 4 G
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Summary • Pull the patient's alle
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a. Medical conditions that reduce t
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Allergen immunotherapy should be gi
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patient’s peak expiratory flow ra
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7. Neilson L, Johnsen C, Mosbech H,
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Click the ⌧ next to the heading t
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a common practice to alternate the
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ALLERGY IMMUNOTHERAPY (AIT) PROBLEM
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10. Those patients having their dos
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SPECIFIC INSTRUCTIONS A. PHYSICIAN
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ALLERGY IMMUNOTHERAPY RECORD NNMC,
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Immunotherapy Pre-Injection Questio
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Aeroallergen Dose Adjustment Schedu
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NATIONAL NAVAL MEDICAL CENTER: Alle
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ONGOING COMPETENCY ASSESSMENT OF UN
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eflecting current robust documentat
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Allergen immunotherapy: A practice
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J ALLERGY CLIN IMMUNOL VOLUME 120,
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Page 168 and 169: Site Under Construction
Page 170 and 171: Introduction • “Anaphylaxis”
Page 172 and 173: Revised Nomenclature For Anaphylaxi
Page 174 and 175: Anaphylaxis* Is Not Rare Estimated
Page 176 and 177: Pathophysiology
Page 178 and 179: Pathophysiology
Page 180 and 181: Pathophysiology • Histamine acts
Page 182 and 183: IgE Mediated Reactions • Most Ant
Page 184 and 185: Complement-mediated • C5a, C3a, C
Page 186 and 187: Unknown Mechanisms • Exercise-ind
Page 188 and 189: Anaphylaxis Summary of Signs & Symp
Page 190 and 191: Differential Diagnosis • Pulmonar
Page 192 and 193: Anaphylaxis Grading Scale II • An
Page 194 and 195: Laboratory Studies • IgE antibodi
Page 196 and 197: Guidelines for Treatment • Treatm
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Page 200 and 201: How the Allergist/Immunologist Can
Page 202 and 203: Summary • Anaphylaxis: release of
Page 204 and 205: ANAPHYLAXIS • First reported case
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Antihistamines H1 antihistamines (B
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The diagnosis and management of ana
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c. The patient will be counseled co
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skin testing typically is performed
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TABLE 3 Required Information on Vac
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TABLE 6 Checklist for Safe Vaccine
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Strength of Recommendations Key cli
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Original articles Evaluation of nea
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Allergy Treatment Record Review Cha
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References Acknowledgment: Linda Co
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Immunotherapy Safety for the Primary Care ... - U.S. Coast Guard

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