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

Date _______________
______________ CLINIC
Standard Operating Procedures
IMMUNOTHERAPY
1. Purpose: This operating instruction provides procedures to follow when administering
immunotherapy.
2. Responsibility: All assigned Clinic personnel.
3. References:
a. Allergen immunotherapy: a practice parameter. Ann Allergy Asthma Immunol. 2003
Jan;90(1 Suppl 1):1-40.
b. The diagnosis and management of anaphylaxis: an updated practice parameter. J Allergy
Clin Immunol. 2005 Mar;115(3 Suppl 2):S483-523
4. General:
a. Immunotherapy (AIT) is initiated by the prescribing Allergist whose name and contact
information will be readily available to all clinic staff. By design, the patient will arrive at the
clinic with an allergen extract kit (allergy shot vials) that has originated from another
facility/provider. The vials and accompanying documentation will be reviewed by the ____
Clinic’s Physician-In-Charge assuring adherence to established standards to ensure
appropriateness and safety before the patient receives his/her AIT. The prescribing Allergist is
responsible for providing AIT extracts labled IAW Ref. (a), protocols for AIT administration and
alteration in dosing in the event of an adverse reaction or missed doses, and for providing point
of contact information. Allergen immunotherapy can be temporarily withheld without placing
the patient at undue risk.
b. An Allergy Treatment Record will be maintained on all patients receiving AIT in the
Clinic. All AIT injections, reactions (immediate and delayed), and alterations in dosing will be
recorded in this record. This record will contain the signed informed consent, Problem Summary
List, AIT prescription, AIT administration instructions, AIT Adjustment protocol, name and
contact information of the prescribing Allergist.
c. Prior to beginning AIT, all patients or, in the case of a minor, the parent or legal guardian,
will review/complete and sign all required forms including the informed consent, patient
instruction sheet, and the problem list. In general, allergy shots will not be administered to
patients on Beta blockers. Any patient on Beta blockers will have their shots withheld and will
be referred to the Physician-In-Charge for further consultation with the prescribing Allergist.
d. All persons under 18 years of age must be accompanied by a parent/legal guardian.
5. Patient Instructions:
a. The Clinic’s nurse/technician will instruct the patient about what is expected when AIT is
begun.
b. The patient will be informed that the allergen extract(s) will be maintained at the ________
Clinic. Patients will not be allowed to maintain their allergy extracts in their home.