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

10. Those patients having their doses increased towards maintenance
are most likely to have reactions, but even long term patients
occasionally have serious reactions.
11. Serious local or generalized reactions may require prompt
treatment. If you should experience a serious reaction (hives, trouble
breathing or swallowing) while in the clinic we will implement
treatment as far as possible to stabilize or resolve the problem. Be
aware that should this situation occur, you would be required to be
observed for several hours to be sure that you do not develop a delayed
reaction to your allergens requiring further treatment. You may be
observed in this clinic, or you may be transferred emergently to a
higher level of care for ongoing treatment depending on the severity of
your reaction.
12. Should you have a history of systemic reactions, you need to
inform the staff promptly. Please make the staff aware if you do not
have an epinephrine autoinjector (Epi-Pen or TwinJect) or do not have a
ready knowledge of when and how to use it.
13. If you should experience a delayed reaction after leaving the
clinic, notify the staff on your next visit. This is required to
assure that you receive the correct amount of extract and prevent
worsening reactions.
14. If you have started on any new medications, notify the staff
immediately. The medications we use to treat a severe allergic
reaction may NOT work as efficiently if you are on a class of drugs
known as beta-blockers or ACE inhibitors. This could be a lifethreatening
situation. If your primary physician feels you absolutely
must be on beta blockers, your prescribing Allergist must review this
fact with you and your primary care provider/specialist before we can
continue your allergy shots.
15. Significant illness with fevers over 100 degrees, respiratory
illnesses, and worsened asthma symptoms are all conditions that require
you notify staff of before receiving your allergy shot. These
conditions may precipitate serious reactions after allergy shots. It
is best to wait until these conditions resolve or stabilize before
continuing.
I understand the above information and will comply with the clinic
policies.
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Patient's Signature
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Date
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Witness
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Date