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

patient’s peak expiratory flow rate is 20% below baseline, the clinical condition of
the patient should be evaluated before administration of the injection.
• Obtain peak flow measurement in asthmatic patients before
administering
• If 20 % below best baseline withhold allergy injection until further
evaluation
• Antihistamine use: Ask whether the patient has taken an antihistamine that
day to improve consistency in interpretation of reactions:
• May reduce adverse reactions: a concern with the use of
premedication is that it may mask milder systemic reactions allowing the
build-up to proceed to a subsequent more serious systemic reaction. To
the contrary, the published literature on studies utilized accelerated
schedules for inhalant and venom allergen immunotherapy have
demonstrated less incidence of local and systemic reactions with
antihistamine premedication 6,7
VI. Allergen Immunotherapy Administration Supervision: practical tips to enhance
safety
1. Review all documents carefully
2. Inspect the allergy vaccine vials and familiarize yourself with the nomenclature
and dosing schedule
3. Vials in transit should be not be exposed to temperature extremes (freezing or
extreme heat) because this could decrease extract potency
4. Storage of allergy vaccine vials: keep refrigerated at 4° .Prolonged exposure of
allergy vaccine vials to room temperature over time may diminish extract
potency: one study found loss of potency pollen extracts exposed to room
temperature for 13 hours a week for longer than 3 months 8
5. Do not administer injection unless you have written verification of the last
injection dose and date
6. Interview the patient about current health status including medication changes
7. Have the patient wait in the office for 30 minutes after the injection and instruct
them to immediately report to the staff any symptoms suggestive of an allergic
reaction.
Do not hesitate to contact prescribing allergist if you have ANY questions or concerns!
VII. Allergen immunotherapy adverse reactions: measures that can minimize the
risk:
Serious reactions to immunotherapy are uncommon. Appropriate safety measures
based on the known risk factors may prevent or reduce incidence of serious reactions.