About Allergy Desensitization Injections

READ ALL OF THIS INFORMATION CAREFULLY
BEFORE STARTING TREATMENT

• Who can give Shots: Injections outside of our office may be given by your family physician (with their agreement), or, with proper precautions, by a trained, responsible adult. If you give your own injection, another responsible adult must always be present. For your protection, both you and each person giving or observing injections must know about injection safety precautions.
   
• When giving any Allergy Injection: A responsible adult must be present, and injectable Adrenalin (epinephrine), either an EpiPen, Ana-Kit, or 1:1000 Adrenalin, must be available for use in case of a serious reaction.

• Properly store Allergy Treatment Extracts: Do refrigerate, but don't freeze or expose to heat or light. Keep the silicone rubber top seal clean. If you think an extract has been damaged or contaminated, do not use it, and call our allergy nurses.
   
• You are Responsible for Checking YOUR dose: Review your written Treatment Record and determine the proper dose of each vial. Inspect the Treatment Vial - is your name on it? Mix vials very gently before using. Wipe vial seals with alcohol, then withdraw each dose using a disposable allergy-type syringe with 3/8 or 1/2 inch long 26 or 27 gauge fixed-hub needle (use of syringes with detachable needles will waste extract). Double check correct dose from correct vial. Be especially careful if more than one person in the family is being treated. Record dose, vial, and date of shot on the Treatment Record. Common errors: 1. wrong person's vial, 2. dose ten times too much (0.50 cc instead of 0.05 cc).
   
• Injection Site: Use middle third of the side of the upper arm, or front of the thigh, or upper, outer quadrant of the buttocks. Patients wishing to go on home treatment must be trained by our nurses.
   
• Injection Technique: Wipe skin with alcohol. Tense skin, and insert needle at a 90 degree angle into the fat layer just beneath skin. Avoid visible veins. After inserting needle, pull back on the syringe piston. If blood appears, withdraw needle and insert at a different site (repeat pulling back on piston before injection).
   
• Observe for Reactions: Always observe patient at least 20 minutes.
   
• Normal Injection: When given with good technique and correct dose, there is usually no significant reaction. You may have minor stinging, local itching, or a small area of swelling. This type of small reaction can be minimized by taking an antihistamine an hour before the injection.
   
• Delayed reaction: As a normal variation, some persons develop swelling, itching, or discoloration several hours to 2 days after injection. If this occurs, it can be minimized by taking a long-lasting antihistamine before and after injections. If a reaction is very large, talk with our allergy nurses.
   
• Large local reaction: Immediate swelling larger than a half-dollar is most likely to happen during a bad allergy season. You should apply ice and take an antihistamine. DO NOT advance the dose for the next injection, but do repeat the same dose. For repeated large reactions, ALWAYS talk with our allergy nurses.
   
• General or systemic reaction: These reactions are extremely rare, but may be serious. Usually they occur within minutes, but sometimes begin up to an hour after a shot. Hives, generalized itching or flushing, repeated sneezing or coughing, wheezing, chest tightness or breathing difficulty, mouth or throat swelling, severe headache, nausea/vomiting, fainting, or collapse, are all potentially dangerous symptoms. Treatment: use IMMEDIATE Adrenalin injection. First, use your EpiPen, or Ana-Kit. If not available, use any other source of Adrenalin (epinephrine). The usual adult dose of Adrenalin 1:1000, is 0.30 cc, for injection into an arm or leg muscle. Persons with a history of heart disease, or weighing under 100 pounds, should use only 0.15 cc (EpiPen Jr.). The few people taking an MAO type antidepressant medicine should not use Adrenaline, but should immediately call an ambulance.
   
• Always, after using Adrenalin, call 911 for an ambulance to the Cape Cod Hospital Emergency Center, or to your nearest Hospital, and then notify one of our physicians. Finally, after the 911 call, always take an antihistamine tablet.
   
• Dose Adjustments: Allergy desensitization treatment is most effective if given year-round. The usual spacing between injections is about every 7 days for buildup, and from 7 to 30 days for maintenance. When an effective dose is reached, allergy symptoms will decrease after an injection, then start to return when the next injection is due. During the first few weeks of treatment, some patients temporarily get increased allergy symptoms, but most patients notice some symptom relief in the first 3 months of treatment.
   
• When a stable maintenance dose has been reached after one or more years of treatment, injections may be spaced further apart, as long as symptom relief continues. The goal is to gradually stretch the shot interval to monthly, but usually, injections are needed more frequently during peak allergen seasons. Remember that your maintenance dose may also need adjustment as stresses, illness, the pollen/mold/pollution levels, and changes in your diet occur.
   
• Improvement continues for at least 4 subsequent years. Persons with simple nasal allergy may be able to stop shots after 4 years, but persons with complex allergies or asthma usually do better if they stay on long term monthly maintenance injections.
   
• Communication by each patient with their nurses and physician is a vital part in treatment success, so always talk with us about your progress. If relief is not long-lasting, if there is limited relief, or if you feel worse after an injection, discuss this with our allergy nurses so we can change your treatment dose. Sometimes the original bothersome symptoms improve, but new symptoms are unmasked. There may also be important unsuspected allergies such as foods, chemicals, or airborne allergens just coming into season, or another medical condition may interfere. If dose adjustment is not effective, then it is important to have a consultation with your allergy physician.
   
• When having Allergy or Asthma Symptoms: Allergy injections often may be given, but the usual dose MUST be reduced when symptoms are severe. We recommend asthma patients always check a peak flow reading before any injection - a drop of 20% or more below normal peak flow is reason for concern. A peak flow meter prescription can be obtained from our office. If in doubt, always call our allergy nurses.
   
• Illness or Immunization: Allergy injections may be given when you have a cold, but may not be fully effective. We suggest postponing injections when you feel sick. Allergy injections are not known to interfere with any immunizations, but as a precaution, we recommend that you allow several days between allergy injections and any immunization.
   
• Too Long between Shots: If you forget and go over 4 weeks between injections, the next dose MUST be reduced. DO NOT give another injection until you talk with our allergy nurses.
   
• Pregnancy: If you become pregnant while under allergy treatment, please inform both our office and your Obstetrician. Your Obstetrician will want to make decisions about medications you may safely use. Allergies may worsen during pregnancy, but allergy desensitization is known to be safe, can be continued, and will often help you feel better. You may also wish to have a consultation with your allergy physician regarding post-natal care of your potentially allergic infant.
   
• Beta-Blocker Drugs: These are medicines commonly prescribed for high blood pressure or heart conditions, and for control of migraine, glaucoma, and tremors. Examples are: Acebutolol (Sectral), Atenolol (Tenormin), Carteolol (Cartrol), Labetalol, (Normodyne, Trandate), Metoprolol (Lopressor), Naldolol (Corgard), Pindolol (Visken), Propranolol (Inderal), and Timolol (Blocadren).
• Beta-blockers often increase allergy and asthma symptoms. Beta-blockers may increase the risk of serious allergic reactions. Finally, beta-blockers may make medical treatment of allergic reactions more difficult.
• If you take one of these drugs, notify our allergy nurses, then talk with your doctor who prescribed it. If good alternates (such as calcium blockers) are available, a change in medicines will usually be recommended. Changes in your allergy treatments may also be necessary. DO NOT STOP TAKING YOUR BETA-BLOCKER WITHOUT TALKING TO YOUR MEDICAL DOCTOR. Stopping these drugs without instructions from your medical doctor is not safe.
   
• AIDS Information: As the Human Immunodeficiency Virus (HIV) spreads in the world, you need facts to help you prevent infection. Our modern allergy treatment uses all sterilized and disposable supplies and equipment, so there is NO RISK for causing HIV infection. Because allergy treatments are not known to be risk free for persons who are infected with the HIV virus, if you are at risk, and would like to be tested to see if you have been exposed, we will, upon request, arrange confidential testing.
   
• Allergy Followup Exams: Be sure to see your allergy physician at least yearly to review your progress and to discuss any new treatments which have become available since your last visit. ANNUAL VISITS ARE REQUIRED for desensitization treatment to continue and for prescriptions to be refilled. More frequent visits are recommended for persons not yet on maintenance, or who are having uncontrolled symptoms.
   
• Allergy Extract Expiration and Ordering: Allergy treatment extracts have a three month expiration date when refrigerated. Allow two weeks for delivery and DO NOT wait to order until you are out of extract ! When ordering new extracts, you must return the completed Treatment Record sheet that documents your injections. We strongly recommend that the first shot from every new treatment vial be given in our office.