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Allergy Injection Treatment Procedures and Precautions

Allergy Injection Treatment Procedures and Precautions

Method of Administration

Allergy injections are given subcutaneously, half-way between the elbow and the shoulder along the outer aspect of the back of the upper arm, or the outside of the mid-thigh. They should not be given too shallowly in the skin, nor should they ever be given without first aspirating (drawing back on the syringe plunger after the needle is in the tissue). If blood is seen when aspirating, the needle should be withdrawn before injecting and another area should be used for the injection. If there are 2 vials (such as “LEFT” and “RIGHT”), there should be 2 injections each time shots are given unless the doctor instructs otherwise. Some injections will be given from individual numbered unit dose vials while other will be dispensed from a larger multi-dose vial according to instructions specific for an individual patient.

A disposable 1 cc allergy treatment syringe with the ½ or 5/8 inch, 25, 26 or 27 gauge, regular bevel needle should be used to give the injections.

Important Precautions

  • The injections should never be administered unless injectable epinephrine 1:1000 is immediately available and there is a reliable person other than the patient to inject it.
  • OAAC requires that allergy injections be administered by a medically competent person in a medical facility equipped to treat (possible severe) allergic reactions. This advice encompasses all patients – even doctors, nurses, and other health professionals who are allergy patients.
  • Administration of allergy shots outside of an OAAC shot treatment room (for example your physician’s office) must be cleared by your OAAC physician (not just from your primary care physician or other health care provider); please do not proceed without it.

Injection Reactions

Allergy injection treatment is intended to decrease a patient’s sensitivities so that in time he/she will feel better. Injections should not cause allergy symptoms. Whenever problems occur, please discuss it with your OAAC doctor or staff.

A local reaction to an allergy injection consists of redness, soreness, itching, and/or swelling at the injection site. Most allergic individuals can be expected to have some local reaction at times. Some will have moderate local reactions regularly, at least until they have been on treatment for many months.

Should there be an excessive (greater than a quarter or 25 cent piece in diameter and lasting more than 24 hours) local reaction after an injection, an antihistamine (like Benadryl, Claritin, Allegra, Zyrtec or Xyzal), cold compress, and topical steroid cream may be used for symptom relief. Your OAAC physician and staff must be notified of the dose number and of the name of the specific vial before more injections are given. A dosage reduction may be indicated.

Systemic (generalized) anaphylaxis reactions to allergy injections are rare (0.015 to 0.02% of injections administered at OAAC Clinics). However, if they occur, prompt treatment with Epinephrine and not just an antihistamine like Benadryl is vitally important. It could save your life. In the event of a systemic (generalized) reaction after an allergy injection, there may or may not be marked swelling at the injection site, plus a vague feeling of apprehension and itching of the palms followed by generalized hives, flushing, sneezing, nasal congestion, increased mucus production or throat clearing, difficulty breathing, coughing, or wheezing.

PATIENTS MUST WAIT 20-30 MINUTES AFTER AN INJECTION SO THAT THEY MAY BE OBSERVED FOR SIGNS OF A GENERALIZED REACTION.

This type of reaction requires treatment with Epinephrine and not just an antihistamine like Benadryl. Prompt medical attention is always needed. If the shot was given at a location other than an OAAC treatment room your clinic physician must be notified before further allergy injections are given because dosage reduction is mandatory. Your OAAC physician is always notified by staff of systemic reactions which occur at an OAAC treatment room.

Beta blocker drugs may make systemic reactions more difficult to treat and you must notify your OAAC physician if you are taking one.

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Stinging Insect Allergy Can Ruin Outdoor Activities

When most people get stung by an insect, the sting site gets red, swells and itches. However, for those who are allergic to insect stings, their immune system overreacts to the venom in the sting. For some, a sting might be life-threatening. The reaction – anaphylaxis – is a medical emergency and could be fatal. Symptoms might include two or more of the following – itching and hives, swelling in the throat or tongue, difficulty breathing, dizziness, stomach cramps, nausea or diarrhea. Severe cases could bring a rapid blood pressure fall resulting in shock and loss of consciousness.

“If you’ve ever had a reaction to a sting, you may be allergic,” said OAAC’s Board-Certified Allergist Dr. Dean Atkinson. “If you’ve had an anaphylactic reaction, you should ask for a referral to an allergist to learn how to stay safe in the future.”

Indentifying Stinging Insects

“If you do get stung and have a reaction, pay attention to what the insect was so you can tell your allergist,” Dr. Atkinson said.

Honeybees and bumblebees only sting when provoked. Africanized honeybees also known as killer bees have been found in the Southwestern U.S. are more aggressive and may sting in swarms.  Domesticated honeybees live in man-made hives. Wild honeybees live in colonies or honeycombs in hollow trees or building cavities.

Paper wasps have nests made of a paper-like material that forms a circular comb of cells which open downward. Nests are often located under eaves, behind shutters, or in shrubs or woodpiles.

Yellow jackets have nests made of a paper-mache type material and are usually underground but can also be found in frame building walls, masonry cracks or woodpiles.

Hornets are usually larger in size than yellow jackets. Their nests are gray or brown, football-shaped and made of a paper material similar to yellow jacket nests. Hornets’ nests are usually found up in trees and shrubs, on gables or in tree hollows.

Fire ants build nests of dirt in the ground – sometimes the nests can be 18 inches tall in the right kinds of soil.

“Preventing stings is of upmost importance,” said Dr. Atkinson. “If you find a nest around your home, you should call an exterminator to have it removed.”

Insects usually sting when their homes are disturbed. If you encounter stinging insects flying around you, remain calm and move away. Avoid wearing brightly colored clothing and perfume outdoors.  The smell of food attracts insects. Be extra careful when cooking, eating or drinking sweet drinks like soda or juice. Insects can crawl inside straws or canned drinks. Keep food covered until eaten. Wear closed-toe shoes outdoors and avoid going barefoot.

Treating Stings

If the insect stinger is in your skin, remove the stinger within 30 seconds to avoid receiving more venom. A quick scrape of your fingernail will remove the stinger and venom sac. Avoid squeezing the sac – this will force more venom through the stinger and into your skin.

“Raise the limb and apply a cold compress to reduce swelling and pain,” Dr. Atkinson said. “Gently clean the area with soap and water to prevent secondary infections. Don’t break any blisters. You can use topical steroid ointments or oral antihistamines to relieve the itching.”

Dr.  Atkinson adds that if swelling progresses or the sting site seems infected, contact your physician.

“If you are severely insect-allergy allergic, carry auto-injectable epinephrine,” Dr. Atkinson said.  “Learn how to use it and keep it with you at all times. Also, some patients especially with frequent exposure to the outdoors start venom immunotherapy (allergy shots). It reduces the risk of a future severe reaction to less than 5 percent.”

Epinephrine is a rescue medication and someone will need to take you to the emergency room. Dr. Atkinson also suggests wearing a bracelet or necklace that identifies the wearer as having severe allergies.

“For those who have had a serious reaction to an insect sting, make an appointment with an allergist,” he said. “With proper testing, your allergist can diagnose your allergy and determine the best form of treatment.”

The post Stinging Insect Allergy Can Ruin Outdoor Activities appeared first on Oklahoma Allergy and Asthma Clinic.

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