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

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The diagnosis and management of anaphylaxis: An updated practice parameter Chief Editors: Phillip Lieberman, MD, Stephen F. Kemp, MD, John Oppenheimer, MD, David M. Lang, MD, I. Leonard Bernstein, MD, and Richard A. Nicklas, MD * Workgroup Contributors: John A. Anderson, MD, David I. Bernstein, MD, Jonathan A. Bernstein, MD, Jordan N. Fink, MD, Paul A. Greenberger, MD, Dennis K. Ledford, MD, James Li, MD, PhD, Albert L. Sheffer, MD, Roland Solensky, MD, and Bruce L. Wolf, MD Task Force Reviewers: Joann Blessing-Moore, MD, David A. Khan, MD, Rufus E. Lee, MD, Jay M. Portnoy, MD, Diane E. Schuller, MD, Sheldon L. Spector, MD, and Stephen A. Tilles, MD These parameters were developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology; the American College of Allergy, Asthma and Immunology; and the Joint Council of Allergy, Asthma and Immunology. The American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI) have jointly accepted responsibility for establishing ‘‘The diagnosis and management of anaphylaxis: an updated practice parameter.’’ This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma and Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion. This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Published practice parameters of the Joint Task Force on Practice Parameters for Allergy & Immunology include the following: 1. Practice parameters for the diagnosis and treatment of asthma. J Allergy Clin Immunol 1995;96(suppl): S707-S870. 2. Practice parameters for allergy diagnostic testing. Ann Allergy 1995;75:543-625. 3. Practice parameters for the diagnosis and management of immunodeficiency. Ann Allergy 1996;76: 282-94. 4. Practice parameters for allergen immunotherapy. J Allergy Clin Immunol 1996;98:1001-11. 5. Disease management of atopic dermatitis: a practice parameter. Ann Allergy 1997;79:197-211. 6. The diagnosis and management of anaphylaxis. J Allergy Clin Immunol 1998;101(suppl):S465-S528. 7. Algorithm for the diagnosis and management of asthma: a practice parameter update. Ann Allergy 1998;81:415-20. 8. Diagnosis and management of rhinitis: parameter documents of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. Ann Allergy 1998;81(suppl):S463-S518. *This parameter was edited by Dr Nicklas in his private capacity and not in his capacity as a medical officer with the Food and Drug Administration. No official support or endorsement by the Food and Drug Administration is intended or should be inferred. Disclosure of potential conflict of interest: P. Lieberman—none disclosed. S. F. Kemp has consultant arrangements with MedPointe Pharmaceuticals. J. Oppenheimer—none disclosed. D. M. Lang—none disclosed. I. L. Bernstein—none disclosed. R. A. Nicklas—none disclosed. J. A. Anderson—none disclosed. D. I. Bernstein—none disclosed. J. Bernstein is on the Speakers’ Bureau for Merck, GlaxoSmithKline, AstraZeneca, Aventis, Medpointe, Pfizer, Schering-Plough, and IVAX. J. N. Fink—none disclosed. P. A. Greenberger—none disclosed. D. K. Ledford—none disclosed. J. Li—none disclosed. A. L. Sheffer—none disclosed. R. Solensky—none disclosed. B. L. Wolf—none disclosed. J. Blessing- Moore—none disclosed. D. A. Khan has consultant arrangements with Pfizer; receives grants/research support from AstraZeneca; and is on the Speakers’ Bureau for Pfizer, Merck, Aventis, and GlaxoSmithKline. R. E. Lee—none disclosed. J. M. Portnoy—none disclosed. D. E. Schuller is on the Speakers’ Bureau for Boehringer-Ingelheim. S.L. Spector has had consultant arrangements with, has received grants/research support from, and has been on the Speakers’ Bureau for Abbott, Allen & Hanburys, AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Fisons, Forest, ICN, Key, Eli-Lilly, 3M, Miles, Muro, Pfizer, Purdue Frederick, Schering-Plough, Wallace, and Witby. S. A. Tilles—none disclosed. Reprint requests: Joint Council of Allergy, Asthma & Immunology, 50 N Brockway St, #3-3, Palatine, IL 60067. J Allergy Clin Immunol 2005;115:S483-523. 0091-6749/$30.00 Ó 2005 American Academy of Allergy, Asthma and Immunology doi:10.1016/j.jaci.2005.01.010 S483
S484 Lieberman et al J ALLERGY CLIN IMMUNOL MARCH 2005 9. Parameters for the diagnosis and management of sinusitis. J Allergy Clin Immunol 1998;102(suppl) S107-S144. 10. Stinging insect hypersensitivity: a practice parameter. J Allergy Clin Immunol 1999;103:963-80. 11. Disease management of drug hypersensitivity: a practice parameter. Ann Allergy 1999;83(suppl):S665- S700. 12. Diagnosis and management of urticaria: a practice parameter. Ann Allergy 2000;85(suppl):S521-S544. 13. Allergen immunotherapy: a practice parameter. Ann Allergy 2003;90(suppl):SI-S540. 14. Symptom severity assessment of allergic rhinitis: Part I. Ann Allergy 2003;91:105-114. 15. Stinging insect hypersensitivity: a practice parameter update. J Allergy Clin Immunol 114;4:869-86. These parameters are also available on the Internet at http://www.jcaai.org. CONTRIBUTORS The Joint Task Force has made a concerted effort to acknowledge all contributors to this parameter. If any contributors have been excluded inadvertently, the Task Force will ensure that appropriate recognition of such contributions is made subsequently. CHIEF EDITORS Phillip Lieberman, MD Departments of Medicine and Pediatrics University of Tennessee College of Medicine Memphis, Tennessee Stephen F. Kemp, MD Departments of Medicine and Pediatrics University of Mississippi Medical Center Jackson, Mississippi John Oppenheimer, MD Department of Internal Medicine New Jersey Medical School Pulmonary and Allergy Associates Morristown, New Jersey David M. Lang, MD Allergy/Immunology Section Division of Medicine Director, Allergy and Immunology Fellowship Training Program Cleveland Clinic Foundation Cleveland, Ohio I. Leonard Bernstein, MD Departments of Medicine and Environmental Health University of Cincinnati College of Medicine Cincinnati, Ohio Richard A. Nicklas, MD Department of Medicine George Washington Medical Center Washington, DC WORKGROUP CONTRIBUTORS John Anderson, MD Aspen Medical Center Fort Collins, Colorado David I. Bernstein, MD Department of Clinical Medicine Division of Immunology University of Cincinnati College of Medicine Cincinnati, Ohio Jonathan A. Bernstein, MD University of Cincinnati College of Medicine Department of Internal Medicine Division of Immunology/Allergy Section Cincinnati, Ohio Jordan N. Fink, MD Allergy-Immunology Departments of Pediatrics and Medicine Medical College of Wisconsin Milwaukee, Wisconsin Paul A. Greenberger, MD Division of Allergy and Immunology Northwestern University Feinberg School of Medicine Chicago, Illinois Dennis K. Ledford, MD Department of Medicine University of South Florida College of Medicine and the James A. Haley V.A. Hospital Tampa, Florida James T. Li, MD, PhD Mayo Clinic Rochester, Minnesota Albert L. Sheffer, MD Brigham and Women’s Hospital Boston, Massachusetts Roland Solensky, MD The Corvallis Clinic Corvallis, Oregon Bruce L. Wolf, MD Vanderbilt University Nashville, Tennessee TASK FORCE REVIEWERS Joann Blessing-Moore, MD Department of Immunology Stanford University Medical Center Palo Alto, California David A. Khan, MD Department of Internal Medicine University of Texas Southwestern Medical Center Dallas, Texas
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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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15. A 12 yo male presents for his a
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Site Under Construction
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Introduction • “Anaphylaxis”
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Revised Nomenclature For Anaphylaxi
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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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