Table 5. Recommended Equipment and Medications to Treat Immunotherapy Systemic Reactions
Adequate equipment and medications should be immediately available to treat anaphylaxis, should it occur. The following are suggested equipment and medications for the management of immunotherapy systemic reactions. Modifications of this suggested list might be based on anticipated emergency medical services' response time and physician's airway management skills: > stethoscope and sphygmomanometer; > tourniquet, syringes, hypodermic needles, and intravenous catheters (eg, 14-18 gauge);
> aqueous epinephrine HCl 1:1,000 wt/vol; > equipment to administer oxygen by mask; > intravenous fluid set-up; > antihistamine for injection (second-line agents for anaphylaxis, but H1 and H2 antihistamines work better together than either one alone);
> corticosteroids for intramuscular or intravenous injection (second-line agents for anaphylaxis);
> equipment to maintain an airway appropriate for the supervising physician's expertise and skill; and
> glucagon kit available for patients receiving β-blockers.
For a detailed listing of recommended equipment and medication for treatment of anaphylaxis, see Lieberman P, Nicklas RA, Oppenheimer J, et al. The diagnosis and management of anaphylaxis practice parameter: 2010 update. J Allergy Clin Immunol 2010;126:477-80, e1-42.
Selecting a Treatment Regimen
ÎAllergen immunotherapy should be administered in a setting where procedures that can reduce the risk of anaphylaxis are in place and where the prompt recognition and treatment of anaphylaxis is ensured. (C)
ÎAn assessment of the patient's current health status should be made before administration of the allergy immunotherapy injection to determine whether there were any health changes that might require modifying or withholding that patient's immunotherapy treatment. Poorly controlled asthma has been identified as a risk factor for a severe immunotherapy-induced reaction. Before the administration of the allergy injection, the patient should be evaluated for the presence of asthma symptoms. One might also consider an objective measure of airway function (eg, peak flow) for the asthmatic patient before allergy injections. (B)
ÎThe starting dose for build-up is usually a 1,000-fold or 10,000-fold dilution of the maintenance concentrate, although a lower starting dose might be advisable for highly sensitive patients. (D)
9
