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

prescribed schedule on the Allergen Extract Prescription. Any questions will be directed to the
Physician-In-Charge before administering the shot.
k. No patient will be permitted to administer their own injections.
7. Anaphylaxis Guidelines
a. In the event of signs or symptoms of anaphylaxis in a patient receiving AIT, the following
guidelines will be initiated:
(1) Administer 0.3 cc of 1:1,000 Epinephrine IM (lateral thigh) if the patient
complains of spreading hives, throat or chest tightness, cough, wheeze, vomiting,
abdominal cramping, or lightheadedness (hypotension).
(2) Alert the medical provider (physician).
(3) Establish/maintain the airway.
(4) If difficulty in breathing occurs, administer oxygen 6-8 liters/min. via face mask.
(5) Monitor blood pressure, heart rate, O2 saturation (Pulse Oxymetry), and level of
consciousness every 5 minutes until stable.
(6) If cardiopulmonary comprominse persists after 10-15 minutes have elaspsed since
epinephrine was given, repeat 0.3 cc of 1:1,000 epinephrine (IM). Epinephrine may
be repeated every 10-15 minutes if symptoms do not diminish or cease.
(7) If a second dose of epinephrine is required, notify the next echelon of care/EMS
and expidite the transfer of the patient to a higher level of care.
b. This guideline is based upon the recognition of, but not limited to the following signs
and/or symptoms:
(1) Generalized hives.
(2) Wheezing or chest tightness.
(3) Stridor.
(4) Erythema (redness of the face, trunk, and/or extremities).
(5) Edema (swelling of the face, tongue, and/or throat).
(6) Apprehension, weakness, or syncope (fainting).
(7) Nausea, vomiting, or abdominal cramping.
c. Any systemic reaction to AIT will be annotated in the patient’s record. The patient will
undergo re-assessment by an Allergist before AIT is resumed.
8. Training/Certification:
Those providing allergen immunotherapy in the _____ Clinic will be trained personnel. It is
highly desirable that physicians, nurses, and technicians be certified by either the US Air Force’s
Introduction to Allergy/Allergy Extender Program or through the US Army’s Walter Reed
Immunization Technicians’ Course. If this is not operationally feasible, then for the purpose of
providing allergen immunotherapy only, the Navy’s “Remote Site Allergen Immunotherapy
Administration Course” (via electronic media) coupled with diligent oversight by the Clinic’s
Physician-In-Charge must suffice.
All personnel involved in the administration of allergen immunotherapy will be expected to
participate in annual refresher training. Documentation of annual competency assessment and
quarterly allergy treatment record review is mandatory.