IMMUNOTHERAPY CARD

ALLERGY SERVICE

Versión 1. Junio 2020

SIP:

DIAGNOSIS:

VACCINE:

COMPOSITION:

DR:

THIS CARD BELONGS TO:

TEL. – ALLERGY CLINIC, TORREVIEJA HOSPITAL:

965721313 Extension 5071

NAME AND SURNAME/S:

CONTENTS

Page 04PRESENTACIÓN

Page 05INTRODUCCIÓN

Pages 06-09PRACTICAL IMMUNOTHERAPY MANAGEMENT

Page 10

Page 11-18

Appendix

RECORD OF REACTIONS TO VACCINES

CALENDAR OF SYMPTOMS

ADMINISTRATION GUIDELINES

010203

0506

04

3.1 ADMINISTRATION OF IMMUNOTHERAPY3.2.ACTION IN THE EVENT OF A DELAY IN THE ADMINISTRATION OF THE IMMUNOTHERAPY DOSE3.3 TREATMENT OF REACTIONS

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1. PresentationThe Allergy Service has created this Immunotherapy Card to serve as a useful tool both for patients with allergies who need immunotherapy as part of their allergy treatment, and for the healthcare professionals responsible for administering this treatment.

The patient should always carry this card along with his/her immunotherapy box so the healthcare staff can make a note of the details of the treatment and any reactions it may have caused.

At the end of the card there is a calendar for monitoring symptoms which the patient should complete to keep a proper record of their symptoms, and this should be brought along to every visit to their allergy specialist.

ALLERGY SERVICE. UNIVERSITY HOSPITAL OF TORREVIEJAPhysician: Dr. María Dolores Martos Calahorro

Nurse: Idoya Alfonso González

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2. IntroductionBefore starting the administration of immunotherapy against allergens you should read the following instructions:• The vaccine or immunotherapy is the only specific treatment that is able to modify the

natural course of your allergic disorder, control your symptoms and avoid the appearance of more serious conditions. In addition, it forms part of the overall treatment of your allergic disease along with the measures to avoid allergens and additional treatment with other medicines, which you should not stop taking unless otherwise instructed by your doctor.

• The administration of allergen extracts is not completely free of risks, just as with other medicines. It may cause local reactions around the injection site and, more rarely, general reactions. If you experience itching or inflammation, we recommend applying something cold to the area where the immunotherapy was administered. You should notify the nurse responsible for giving you the next dose if the inflammation exceeded an area of 8-10 cm in diameter.

• The vaccine must be administered in a healthcare facility: outpatient clinic, health centre, hospital, specialist consulting room, etc. It should never be administered at the patient’s home.

• This treatment is controlled and therefore should not be administered in the A&E department.

• It is important to adhere to the intervals between each injection, which are given on the follow-up card. If, for any reason, there is a delay in administering the next dose, you should notify the medical staff in case the dose needs to be altered.

• The vaccine must be kept in the fridge (preferably in the door section). Do not put it in the freezer. If you suspect the cold chain of your vaccine may have been compromised, be sure to notify your specialist.

• You should delay the dose and notify your specialist if you suffer from, or have recently suffered from:

- An asthmatic crisis or respiratory tract infection (cold).- A fever or a severe skin condition.- Hepatitis, active tuberculosis or any other similar infectious process.- If you have been given a vaccine with live viruses (MMR) in the last 10 days.

• If you have been prescribed any other medication for another illness, you must inform the healthcare personnel as there are some drugs that are contraindicated for the vaccine, especially medicines for blood pressure, heart conditions, thyroid disorders and glaucoma.

• After the extract has been administered, you should remain in the centre for at least 30 minutes without doing any strenuous physical exercise. You should also avoid hot baths or saunas within three hours of the treatment (it is fine to have a shower).

• If you have any queries about your immunotherapy, or if there were any incidents associated with the previous dose, or you need to make an appointment as you will shortly be running out of the vaccine, please contact your allergy specialist (Dr María Dolores Martos) between Monday and Friday on 965 72 12 00 / 965 721 400 - Ext. 5017.

3.Practical immunotherapy management

BEFORE ADMINISTERING THE IMMUNOTHERAPY DOSE:

ADMINISTRATION OF THE IMMUNOTHERAPY:

3.1. ADMINISTRATION OF THE IMMUNOTHERAPY

The nursing staff should check the patient’s physical state of health. The patient should not be experiencing any kind of asthmatic crisis, febrile infectious disease or have been given any live virus vaccines in the previous ten days.

If the patient thinks she may be pregnant, you should contact the allergy specialist.

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Check that the vaccine and its expiration date are both correct. Check that the vial is at room temperature.Check the tolerance of the dose administered previously, and the time that has elapsed since the last dose was given.Load the dose immediately before its administration, always purging within the vial so as not to waste any of the vaccine.Administer the dose, alternating the arms at each session.You should not reduce the dose when starting a new box or in spring unless specifically instructed to do so by the allergy specialist.

If there is not enough volume in a single vial:If the vials are from the same box, you can mix them until you get the required volume.If the vials are from different boxes, first administer what is left in the older vial in one arm, and 30 minutes later complete the dose with the vial from the new box in the other arm. If there is no second vial, administer what is left in the old vial and then administer the regular dose 15 days later.

Immunotherapy should be administered by deep subcutaneous injection, pinching the skin and the subcutaneous tissue. Insert the needle with the bevel facing upwards at an angle of 45º-60º, on the outer side of the arm about four fingers above the elbow. Aspirate slowly before injecting the liquid to ensure you have not pierced a blood vessel. After the injection, press down on the application point; do not under any circumstances massage the injection site.

In some cases, due to a prior local reaction, the allergy specialist will recommend that you administer the immunotherapy as described above, but in the deltoid area and at an angle of 90º.

Make a note of the date, the arm into which the immunotherapy was administered, and add the signature of the person responsible for administering the dose, and indicate whether there was any immediate reaction.Ask the patient to rest for 30 minutes in the waiting room and to notify the nursing staff before they leave so they can check for any possible side effects and treat them accordingly. The patient will be held responsible if they do not comply with this regulation.

AFTER IMMUNOTHERAPY ADMINISTRATION:IM

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3.2. ACTION IN THE EVENT OF A DELAY IN THE DATE OF THE ADMINISTRATION OF THE IMMUNOTHERAPY DOSE

The days of delay will be counted from the theoretical date of the next dose and not from the last dose administered:

3.3. TREATMENT OF REACTIONS

LOCAL REACTION: this consists of the appearance of redness, itching and swelling in the area where the immunotherapy was administered, which can appear immediately (within the first 30 minutes of administration) or later on (after an hour or more).

SYSTEMIC REACTION: this is characterized by signs and/or symptoms that appear away from the immunotherapy administration area. These reactions tend to appear within a few minutes of the injection.

These may include:

Mild systemic reactions: minor rhinitis and/or cough.Moderate systemic reactions: hives (aka urticaria), angioedema, asthma.Severe systemic reactions or anaphylactic shock: severe and rapid reaction, which presents with itching, erythema, hypotension, dizziness and bronchial obstruction, and requires immediate treatment.

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DURING THE INITIATION PERIOD

DURING THE MAINTENANCE PERIOD

DELAY DOSE

≤ 4 weeks

> 4 weeks

≤ 6 weeks

6 – 8 weeks

>8 weeks

Repeat the last dose administered and continue increasing the doses according to the guidelines

Contact the Allergy Service

Repeat the last dose administered

Reduce the last dose administered by 0.2 ml and administer the regular dose at one month

Contact the Allergy Service

Action in the event of a local reaction:

Oxygen flow at 4-8 l/min with a Ventimask at 40%.

Nebulizer aerosol mask (salbutamol or terbutaline).

The patient must be seen by an allergy specialist to assess their reaction and adjust the immunotherapy dose.

Apply a tourniquet in the area close to the injection site, loosening it for 30 seconds every five minutes.

Administer adrenalin 1/1000 subcutaneously or intramuscularly.

If bronchospasm occurs, add:

Action in the event of a systemic reaction:

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IMMEDIATE REACTION

LATE REACTION

DIAMETER OF OEDEMA ACTION

≤ 5 cm in adults or ≤ 3 cm in children

> 5 cm in adults or> 3 cm in children

≤ 5 cm in adults or ≤ 3 cm in children

> 5 cm in adults or> 3 cm in children

NormalNo treatment required

Apply cold compress locallyOral antihistamineContact the Allergy Service to modify guidelines

NormalNo treatment required

Apply cold compress locallyOral antihistamineContact the Allergy Service to modify guidelines

Adults: 0.5 ml in the contralateral arm to the administration of the immunotherapy Children: 0.01 mg/kg (0.1 ml per 10 kg of weight), without exceeding 0.5 mlThese doses can be repeated up to three times, if necessary, at intervals of 15 minutes.

4.Record of reactions to vaccines

VIAL NO. DOSE DATE TYPE OF REACTION

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5. Calendar of symptoms4.Record of reactions to vaccines

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5. Calendar of symptoms

12

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13

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6. Administration guideline

Torrevieja Department of Health Crta. Torrevieja a San Miguel de Salinas, CV-95 03186

Torrevieja - AlicanteTeléfono: +0034 965 721 200

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