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

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Guidelines <strong>for</strong> Treatment • Treatment (Airway/Breathing) – Maintain an open airway – High flow Oxygen (4-10 l/m) with pulse oximetry monitoring – Intubation when PaCO 2 > 65 mm Hg. / SaO 2 < 90% on O 2 • Treatment (Circulation) – Keep Systolic BP > 90 mm Hg – Place patient in Trendelenburg position as appropriate. – Insertion of large-bore IV • 0.9% saline or lactated ringer’s – Severe Hypotension • Dextran, Hetastarch
Guidelines <strong>for</strong> Treatment • Treatment (Drugs - ABC) – EPINEPHRINE (Adrenalin) • α and β adrenergic effects • 0.3-0.5 cc 1:1,000 IM q 5-15 min – Antihistamines (Benadryl) • H1 - diphenhydramine (Benadryl): 50 - 75 mg IM/IV • H2 - ranitidine (Zantac): 150mg q8-12 hr PO, 50mg q6-8 IV – Corticosteroids • Methylprednisolone IV 60 - 80 mg followed by predinsone Kemp S and Lockey R. J Allergy Clin Immunol 2002;110:341-8 Simons FER et al. J Allergy Clin Immunol 1998;101:33-7 Simons FER et al. J Allergy Clin Immunol 2001;108:871-3
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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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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 146 and 147: 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 198 and 199: Guidelines for Treatment • Treatm
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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Page 212 and 213: Antihistamines H1 antihistamines (B
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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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