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

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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.
Risk factors for immunotherapy and some measures that may help prevent include: 1. Error in dosage: check and double-check: vials, patient name and dosing record, have patient confirm vials 2. Presence of symptomatic asthma: do not administer injection until asthma stabilize 3. High degree of hypersensitivity: consider premedication, consult prescribing allergists if recurrent and persistent large local reactions 4. Use of beta-blockers: ask about new medications each visit 5 Injections from new vials: dosage adjustment per prescribing allergist 6. Injections made during periods of exacerbation of symptoms: consider consulting prescribing allergist before administering Remember: Take your time and review the records to ensure that: You are giving the right dose of the right allergy immunotherapy vial to the right patient because…. No patient ever died from an allergy shot waiting to receive the injection … The extra time and wait will not harm you or the patient but dosing errors and allergy injections to actively symptomatic patients may seriously harm References For Optimizing The Safety Of Immunotherapy Administration Outside Of The Prescribing Allergist’s Office 1. Li JT et al Joint Task Force On Practice Parameter: Allergen immunotherapy: A practice parameter. Ann Allergy Asthma Immunol 2003; 90(suppl). 2. What are “Allergy Shots?” Tips to Remember are created by the Public Education Committee of the American Academy of Allergy, Asthma and Immunology. This brochure was updated in 2003 available at AAAAI website (www.aaaai.org) http://www.aaaai.org/patients/publicedmat/tips/whatareallergyshots.stm 3. Bousquet J., Lockey R., Malling H.J. WHO Position Paper Allergen immunotherapy: therapeutic vaccines for allergic diseases Allergy Eur. J of Allergy Clin Immunol 1998; Number 44 Volume 53 4. Stewart GE, Lockey, RE: Systemic reaction to Allergen Immunotherapy, J Allergy and Clin Immunol 1992:90; 567-78. 5. Position Statement on administration of immunotherapy outside of the prescribing allergist facility. Drug and Anaphylaxis Committee of ACAAI. Ann Allergy Asthma and Immunol 1998;81:101-102 6. Muller U, Hari Y, Berchtold E, Premedication with antihistamines may enhance efficacy of specific-allergen immunotherapy. J Allergy Clin Immunol 2001;107 (1):81- 861
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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
Page 19 and 20: The Extracts/Vaccines • Bioequiva
Page 21 and 22: Lots of Numbers! Vial v/v W/V (exam
Page 23 and 24: Immunotherapy Phases • Maintenanc
Page 25 and 26: Reaction Prevention - Avoidance •
Page 27 and 28: Reaction Therapy - BLS+ Level • T
Page 29 and 30: Treatment Guidelines • Treatment
Page 31 and 32: Frequency of Systemic Reactions •
Page 33 and 34: Immunotherapy Safety • To lessen
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Page 37 and 38: Immunotherapy Safety • After Inje
Page 39 and 40: Immunotherapy Safety • Equipment:
Page 41 and 42: What To Expect (Demand) from the Al
Page 43 and 44: Summary • Risk factors for advers
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Page 48 and 49: • Allergen immunotherapy (allergy
Page 50 and 51: BEFORE EACH SHOT!!! • Screen pati
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Page 62 and 63: Summary • Pull the patient's alle
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Page 66 and 67: a. Medical conditions that reduce t
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J ALLERGY CLIN IMMUNOL VOLUME 120,
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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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Anaphylaxis* Is Not Rare Estimated
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Pathophysiology
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Pathophysiology
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Pathophysiology • Histamine acts
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IgE Mediated Reactions • Most Ant
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Complement-mediated • C5a, C3a, C
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Unknown Mechanisms • Exercise-ind
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Anaphylaxis Summary of Signs & Symp
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Differential Diagnosis • Pulmonar
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Anaphylaxis Grading Scale II • An
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Laboratory Studies • IgE antibodi
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Guidelines for Treatment • Treatm
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Guidelines for Treatment • Treatm
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How the Allergist/Immunologist Can
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Summary • Anaphylaxis: release of
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ANAPHYLAXIS • First reported case
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4) Hymenoptera stings Although almo
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• Sulfites are added to all the b
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mastocytosis on bone marrow biopsy.
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Antihistamines H1 antihistamines (B
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End of Selection Go to Bookmarks &
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The diagnosis and management of ana
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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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