Typical Injection Regimes

GENERAL INSTRUCTIONS FOR INJECTIONS OF ALLERGENIC EXTRACTS - Please See Individual Schedule For Specific Instructions

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1. Health & Welfare Canada cautions that patients treated with beta-blocking agents might be more liable to react to allergenic drugs and that those reactions might not be controllable with epinephrine.

2. Refrigerate the allergen extract set. Do not freeze.

3. CHECK AND DOUBLE-CHECK ALL LABELS ON ALLERGEN BOTTLES BEFORE EACH INJECTION. HAVE THE PATIENT CONFIRM THAT THE EXTRACT BEARS THEIR NAME AND THAT YOU HAVE SELECTED THE CORRECT VIAL AND DOSE.

4. RECORD THE DATE OF THE INJECTION ON THE IMMUNOTHERAPY DOSAGE SCHEDULE (DURING THE BUILD-UP TO MONTHLY MAINTENANCE DOSES). AND ALSO RECORD FULL DETAILS OF INJECTIONS ON THE TREATMENT RECORD SHEET. DO INVOLVE THE PATIENT IN THIS - IT WILL MINIMIZE THE RISK OF A SERIOUS DOSAGE ERROR.

5. Check the expiry date on the vial.

6. Shake the vial well before using it.

7. Make proper adjustments for missed doses:

A. If patient is receiving weekly injections and misses the scheduled injection by:

1. One to two weeks, increase according to the schedule.
   
   
2. Three to four weeks, repeat the last dose.
   
   
3. Five to seven weeks, reduce by one dose on the injection schedule for each week over four weeks.
   
   
4. More than seven weeks, contact the prescribing physician.

B. If patient is receiving monthly injections and misses schedule injection by:

1. Six weeks or less, repeat maintenance dose.
   
   
2. Six to ten weeks, reduce maintenance dose by one-half and then increase according to schedule.
   
   
3. Greater than ten weeks, contact the prescribing physician.

8. THE FIRST DOSE FROM A REFILL MAINTENANCE VIAL SHOULD BE ONE-HALF OF THE LAST DOSE GIVEN AND SHOULD THEN BE INCREASED ACCORDING TO SCHEDULE. New extracts are more potent than aged extracts.

9. Use a 1cc tuberculin syringe with a 26 - 27 gauge needle. Give injections subcutaneous to the posterolateral surface of the middle of the upper arm, staying away from the joints. Always pull back the plunger before injecting the extract: if blood returns, withdraw the needle and choose another site.

10. Do not massage the injection site and warn the patient not to do it either; massage may cause unduly rapid absorption of the allergens.

11. PATIENT MUST REMAIN IN THE OFFICE OR CLINIC FOR 30 MINUTES AFTER THE INJECTION, WITH A PHYSICIAN AVAILABLE.

12. BE AWARE OF HOW TO RECOGNIZE AND TREAT SYSTEMIC REACTIONS, AND OF HOW YOU MUST ADJUST DOSES FOR SIGNIFICANT LOCAL REACTIONS AND SYSTEMIC REACTIONS.

13. Patients should be warned not to eat a heavy meal just before an injection is to be given.

14. The patient should not take any strenuous physical exercise for several hours following the injection.

15. Do not start immunotherapy during pregnancy. If the patient is on maintenance immunotherapy she can continue.

16. Patients should be REASSESSED ANNUALLY by a qualified consultant or more frequently if problems are encountered.

17. IMPROVEMENT may be delayed for up to 2 years.

18. Consideration should be given to STOPPING INJECTION THERAPY after a period of 5 years.