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

a common practice to alternate the arm into which a particular vaccine is given, there
is no evidence that this is necessary.
● In patients with asthma (unstable asthma in particular), peak expiratory flow rate
measurements may be considered before an injection. If a patient’s peak expiratory
flow rate is significantly below baseline, the clinical condition of the patient should be
evaluated before administration of the injection.
● Description of any reactions. Dose adjustments may be necessary if reactions are
frequent or severe.
● Details of any treatment given in response to a reaction should be documented in the
medical record and referenced on the administration form.
● Any adjustment from the standard schedule and the reason for the adjustment (e.g.,
missed appointments).
● Clinical status of the patient before the injection. In general, patients who have high
fever or any significant systemic illness should not receive an injection. It is desirable
to document the patient’s clinical condition before each injection, particularly if the
patient is symptomatic.
● Whether the patient has taken an antihistamine that day
● Whether any new medication has been taken since the last immunotherapy injection
Labels for Vaccine Vials
Each vial of vaccine should be labeled in a way that permits easy identification. Each label
should include the following information:
● Appropriate patient identifiers, including patient name, prescription or social security
number, or birth date
● General description of the vaccine contents. Because of space limitations, it may be
necessary to abbreviate the antigens. Possible abbreviations are as follows: tree, T;
grass, G; bermuda, B; weeds, W; ragweed, R; mold, M; Alternaria, Alt;
Cladosporium, Cla; Penicillium, Pcn; cat, C; dog, D; cockroach, Cr; dust mite, DM; D.
farinae, Df; D. pteronyssinus, Dp; mixture, Mx. A full and detailed description of vial
contents should be recorded on the prescription/content form.
● The dilution from the maintenance concentrate in volume per volume. If colors,
numbers, or letters are used to identify the dilution, they also should be included.
● Vaccine expiration date
Instruction Form for Use at an Outside Facility
An instruction form should accompany all patients who go to an outside facility for
immunotherapy injections. It should include:
● General instructions for administration of immunotherapy
● Directions for adjusting the dose if there is a reaction
● Directions for adjusting the dose after an unexpected interval between injections
● Instructions for treating reactions if they occur
● Name and contact information of the prescribing Allergist.