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IMMUNOTHERAPY

  Immunotherapy (scit) (Allergy Injections)

  PURPOSE
  The purpose of subcutaneous immunotherapy (SCIT / allergy injections) is to decrease your sensitivity to allergy
   -causing substances, so that exposure to the offending allergen (pollen, mold, mites, animal danders, stinging
   insects, etc.) will result in fewer and less severe symptoms. This does not mean that immunotherapy is a
   substitute for avoidance of known allergens or for the use of allergy medications, but rather is a supplement to
   those treatment measures.  Allergy injections have been shown to lead to an alteration of your immune system's
   response to naturally occurring allergens. These alterations may permit you to tolerate exposure to the allergen
   with fewer symptoms. You, in effect, become "immune" to the allergen. The amount of this immunization is
   different for each person and is, therefore, somewhat unpredictable.

  INDICATIONS
  To qualify for immunotherapy, there must be documented allergy to substances in the environment that cannot be
   avoided. Documentation of allergy can be either in the form of a positive skin test or a positive blood test. In
   addition to demonstrable allergy by one of the above tests, problems such as hayfever or asthma should occur
   upon exposure to the suspected allergen, or you may have a history of a severe reaction to an insect sting. Due to
   the inherent risks of immunotherapy, avoidance measures and medical management should usually be
   attempted first.

  EFFICACY
   Improvement in your symptoms will not be immediate. It usually requires 3 to 6 months before any relief of allergy
   symptoms is noted, and it may take 12-24 months for full benefits to be evident. About 85-90% of allergic patients
   on immunotherapy note significant improvement of their symptoms. This means that symptoms are reduced,
   although not always completely eliminated.

  PROCEDURE
   Allergy injections are usually begun at a very low dose. This dosage is gradually increased on a regular basis
   {usually 1-2 times per week) until a therapeutic dose (often called the "maintenance dose") is reached. The
   maintenance dose will differ from person to person. Injections typically are given once or twice per week while the
   vaccine dose is being increased. This frequency reduces the chances of a reaction and permits the maintenance
   dose to be reached within a reasonable amount of time. After the maintenance dose is determined, the injections
   can usually be given every one to three weeks.

  DURATION OF TREATMENT
  It usually takes 3 to 6 months to reach a maintenance dose. The time may be longer if there are vaccine reactions
   or if the injections are not received on a regular basis. For this reason, it is important that the recommended
   schedule be followed. If you anticipate that regular injections cannot be maintained, immunotherapy should not
   be started. Immunotherapy may be discontinued at the discretion of your Allergist, if the injections are
   frequently missed, as there is an increased risk of reactions under these circumstances. Most immunotherapy
   patients continue treatment for 3-5 years, after which the need for continuation is reassessed.

  ADVERSE REACTIONS
   Immunotherapy is associated with some widely recognized risks. Risk is present because a substance to which
   you are known to be allergic is being injected into you. Some adverse reactions may be life-threatening and may
   require immediate medical attention. In order of increasing severity, the following brief descriptions explain the
   nature of these potential reactions:

  A. LOCAL REACTIONS:
   Local reactions are common and are usually restricted to a small area around the site of the injection. However,
   they may involve the entire upper arm, with varying degrees of redness, swelling, pain, and itching. These
   reactions are more likely to occur as you reach the higher concentrations and higher volume injections. The
   reactions may occur several hours after the injection. You should notify the nurse if your local reaction exceeds
   two inches in diameter or lasts until the following day.

  B. GENERALIZED REACTIONS:
   Generalized reactions occur rarely, but are the most important because of the potential danger of progression to
   collapse and death if not treated. These reactions may include:

  (1) Urticarial reactions (hives} include varying degrees of rash, swelling, and/or itching of more than one part of the
        body. There may be mild to moderate discomfort, primarily from the itching. This uncommon reaction may
        occur within minutes to hours after an injection.

  (2) Angioedema is rare and is characterized by swelling of any part of the body, inside or out, such as the ears,
        tongue, lips, throat, intestine, hands, or feet, alone or in any combination. This may occasionally be
        accompanied by asthma and may progress to the most  severe reaction, anaphylactic shock. In the absence of
        shock, the principle danger lies in suffocation due to swelling of the airway. Angioedema may occur within
        minutes after the injection and requires immediate medical attention.

  (3) Anaphylactic shock is the rarest complication, but is a serious event characterized by acute asthma, vascular
        collapse flow blood pressure), unconsciousness, and potentially death. This reaction usually occurs within
        minutes of the injection and is extremely rare.

  The above reactions are unpredictable and may occur with the first injection or after a long series of injections,
   with no previous warning. All generalized reactions require immediate evaluation and medical intervention. If a
   localized or generalized reaction occurs, the vaccine dosage will be adjusted for subsequent injections.
   Appropriate advice and treatment will always be available from our office staff at the time of any adverse reaction.

  OBSERVATION PERIOD FOLLOWING INJECTIONS
  All patients receiving immunotherapy injections should wait in the clinic area for 30 minutes following each
  injection. If you have a reaction, you may be advised to remain in the clinic longer for medical observation and
  treatment. If a generalized reaction occurs after you have left the clinic area, you should immediately return to the
  clinic or go to the nearest emergency medical facility. If you cannot wait the 30 minutes after your injection, you
  should not receive an immunotherapy injection. There are several allergy vaccine-related deaths each year in the
  United States. While most systemic reactions are not life-threatening if treated promptly, this fact does stress the
  importance of remaining in the clinic for the suggested observation time. If you do not remain in the clinic area for
  the designated time, the Allergist may recommend discontinuation of immunotherapy. Under no circumstances will
  injections be permitted without the immediate availability of emergency medical treatment. If the prescribed
  injections are to be given elsewhere, this clinic must be provided with the name and address of the physician who
  will assume the responsibility for your injections. You will be asked to complete the "Request for Administration of
  Immunotherapy at an Outside Medical Facility." Our office will then contact the designated facility and confirm their
  availability for administration of your immunotherapy injections.

  INITIAL EXTRACT PRESCRIPTION
  Your initial prescription includes all vaccine vials that are required to reach a "maintenance" dose. In order to
  utilize these vials prior to their expiration date (6 months from date of preparation), you will need to receive
  injections at least once or twice per week on a regular basis. Taking injections twice per week will allow you to
  reach maintenance earlier, well before expiration. If you take injections once per week regularly, you will reach
  maintenance level at about the same time as the expiration date. When you receive regular maintenance
  injections, the renewal vials generally last 2 to 3 months, but still carry a 6-month expiration period.

  PREGNANCY
  Females of child-bearing potential: If you become pregnant while on immunotherapy, notify the office staff
  immediately, so your allergist can determine an appropriate dosage schedule for the injections during pregnancy.
  Immunotherapy doses will not be advanced during pregnancy, but may be maintained at a constant level.

  NEW MEDICATIONS
  Please notify the office staff if you start any new prescription medication, particularly medication for high blood
  pressure, migraine headaches, and glaucoma. "Beta blocker" medications are contraindicated while on
  immunotherapy, and your injections will need to be discontinued while you are taking a beta blocker.

  ALLERGY INJECTION SCHEDULE
  Allergy injections are offered in our clinic on a "walk-in" basis during the following hours. No appointment is
  necessary; simply sign in at the front desk during the designated hours. A minimum 48 hour interval is necessary
  between injection visits. A parent or legal guardian must be present before an injection will be given to a minor.
  Please be prepared to wait in the clinic area for 30 minutes following each injection.

Monday:

7:30am to 12:00pm

 

and

 

1:30pm to 4:00pm

 

Tuesday:

7:30am to 12:00pm

 

and

 

1:30pm to 6:00pm

 

Wednesday:

7:30am to 12:00pm

 

Closed

 

 

 

Thursday:

7:30am to 12:00pm

 

and

 

1:30pm to 6:00pm

 

Friday:

7:30am to 12:00pm

 

and

 

1:30pm to 4:00pm

 

(Any temporary exceptions to these hours will be posted in the clinic, and available as a handout for our patients, at the beginning of the month. Please check at the front desk each month for this handout. Thanks!)

 

 

 


 

Allergy Associates Medical Group and Research Center has been serving the San Diego community since 1986
6386 Alvarado Court, Suite 210, San Diego, California 92120
619.286.6687 voice     -     619.286.6695 fax
 Dedicated to Excellence in Respiratory and Allergy Related Disorders.

Copyright © 2008-2011 Allergy Associates Medical Group, Inc., Allergy Associates Research Center