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Allergy Program Overview
C O N F I D E N T I A L
C O N T E N T3 : WELCOME LETTER
4 : ALLERGY
5 : SKIN TEST
6 : PREPARING FOR THE TEST
7 : WHO SHOULD GET TESTED
8 : SIDE EFFECTS
9 : CRASH CART
10 : TESTING PANEL
17 : READING RESULTS
18 : THERAPY
19 : ALLERGY IMMUNOTHERAPY
20 : WHO SHOULD & SHOULDN'T GET THERAPY
21 : TREATMENT VIALS
22 : PRESCRIPTIONS
23 : ALLERGY INJECTIONS
24 : MISSED PROTOCOL
25 : TREATMENT TRACKING
27 : HOME THERAPY
29 : ANAPHYLAXIS
30 : MANAGEMENT OF ANAPHYLAXIS
32 : OFFICE-BASED ANAPHYLAXIS ACTION PLAN
34 : FOOD ALLERGY TESTING
35 : IgE TEST
36 : IgG TEST
37 : ALCAT TEST
39 : FORMS
48 : RESOURCES
C O N T E N T
©Jortay 2018. All Rights Reserved. 3
On behalf of the entire Jor tay team, I 'd l ike to welcome your
pract ice to our valued family of c l ients . We know how impor tant
the decis ion of healthcare par tner is , and we great ly appreciate
you entrust ing our team. We wi l l work hard to always aff i rm your
decis ion to work with Jor tay.
This manual is to provide you with an over view of Jor tay 's al lergy
test ing and immunotherapy program. You, as the provide, are
responsible for making the best and most appropriate medical
decis ions for your pat ient . We wi l l modify our program to meet
the needs of your pract ice and patients .
Again, thank you for select ing Jor tay. We look for ward to
working with you and your pat ients .
WELCOME TO
JORTAY ALLERGY TESTING AND
IMMUNOTHERAPY PROGRAM
©Jortay 2018. All Rights Reserved. 4
An al lergy occurs when a pat ient reacts to things l ike
pol len or cats that don't affect most people. I f the pat ient
comes into contact with something the pat ient is a l lergic to
(cal led an al lergen) , pat ient 's may have symptoms such as i tching
or sneezing. This is cal led am al lergic react ion.
WHAT IS AN ALLERGY?
©Jortay 2018. All Rights Reserved. 5
SKIN TEST
A skin pr ick test checks for immediate al lergic react ions to many substances at once. A
skin pr ick test uses lancet 's that barely penetrate the skin's sur face and is not painful .
These tests are not ver y invasive, and, for most al lergens, they tend to produce quick
results . A di luted al lergen is appl ied using a smal l , disposable plast ic device to pr ick the
sur face of your skin. The medical ass istant wi l l draw smal l marks on the skin of the pat ient
and apply a drop of al lergen extract next to each mark . The lancet is then used to pr ick the
extracts into the skin's sur face.
Once the extracts have been administered the medical ass istant must then wait 15 to 20
minutes to look for symptoms. The medical ass istant wi l l begin to look for raised, red,
i tchy bump that may look l ike a mosquito bite . The larger the wheal (bump), the more
sensit ive the pat ient may be to the al lergen. I f the pat ient is a l lergic , the results wi l l be
recorded then the skin wi l l be whipped off and cleaned.
©Jortay 2018. All Rights Reserved. 6
HOW SHOULD THE
PATIENT PREPARE FOR THE TEST?
Patient shouldn't take antihistamines for 3 to 7 days
beforethe test . ( I t 's okay to use nose [nasal] steroid sprays
and asthma medicines) . They wi l l not inter fere with skin
tests .
è H1 Antihistamines – Hold for 1 week before vis i t
- Zyr tec (Cetir iz ine) , Dimetapp, Patanase nasal spray
- Xyzal , Chlor-Tr imeton, Patanol eye drops
- Al legra (Fexofenadine) , Tavist , Tylenol Al lergy Sinus
- Clarat in (Loratadine) , Atarax (Hydroxyzine) , Optivar eye
drops
- Clar inex, Vistar i l , E lestat eye drops
- Benadr yl , Hismanal (Aztemizole) , Tylenol F lu Nightime
- Diphenylhydramine, Astel in nasal spray, Tylenol Cold and
Flu
- Act i fed, Astepro nasal spray, Dramamine/Mecl iz ine
è H2 blocking medications (for reducing stomach acid)
- Hold dose star t ing the evening before vis i t
- Pepcid (Famotidine) - Zantac (Ranit idine)
- Tagament (Cimetidine)
è Leukotriene blocking medications - Hold dose the
morning of visit
- Singulair (Monteleukast)
- Zyfo (Zi leuon)
- Accolate (Zafr lukast)
©Jortay 2018. All Rights Reserved. 7
è Must be at least age 5
è Not currently taking al lergy medicine
è No histor y of anaphylactic shock
è Has not been tested for same allergens within the
last year
Skin tests are general ly accepted
for al l age groups. In cer tain
c ircumstances, though skin tests
are not to be administered.
Provider 's consent is required
before administer ing any test .
Some patients who have been
advised not to take the skin test
are pat ients who have had a
severe al lergic react ion, are on
medicat ions that can inter fere
with test results , have cer tain skin
condit ions, as wel l as any other
reasons that provider might have.
Here at Jor tay we have a few
guidel ines we fol low.
WHO SHOULD
AND SHOULDN'T
GET TESTED
Jortay Testing Requirements
©Jortay 2018. All Rights Reserved. 8
Any medical test involves some r isk . The r isk
with al lergy skin tests is that al lergy symptoms
might occur during the test . The most common
symptoms are i tching and swel l ing of the skin
where the test was administered. In rare cases, a
more ser ious react ion can occur. That is why skin
tests should be done under provider 's
POTENTIAL SIDE EFFECTS
FROM ALLERGY SKIN TESTING
©Jortay 2018. All Rights Reserved. 9
è Stethoscope
è Sphygmomanometer
è Injectable Epinephrine 1:1,000 or Epi Pens
è Oxygen
è Intravenous 0.9 normal (NL) sal ine
è 1-way valve facemask
è Orophar yngeal and nasal phar yngeal airways
è Disposable face masks
è Oxygen saturation monitor
è Albuterol inhalational solution (0.05%), glucagon
è Written emergency protocol and char t for tracking patient treatment
CRASH CART
While preparing for al lergy test ing one
can never know how a pat ient can react
to an al lergen. Therefore, to be safe,
we recommend the provider provide
a crash car t in the off ice.
We recommend the fol lowing items
to be included in the crash car t :
Here at Jor tay, we have several di f ferent test ing panels . We can test for common al lergies
such as dog, and cat al lergies , as wel l as test ing for several di f ferent types of molds.
TESTING PANEL
©Jortay 2018. All Rights Reserved. 10
CAT FELIDAE A
DOG CANIDAE A
FEATHER MIX ANATIDAE A
HORSE EQUIDAE A
DUST MITE MIX DEMODICIDAE A
JOHNSON GRASS POACEAE A
IMAGE COMMON NAME FAMILY PANEL
POSITIVE CONTROL HISTAMINE
©Jortay 2018. All Rights Reserved. 11
BERMUDA GRASS POACEAE A
SEVEN GRASS MIX POACEAE A
CLADOSPOR SPEAR
MOLD DAVIDIELLACEAE B
ALTERNARIA MOLD PLEOSPORACEAE B
A
TRICHOCOMACEAE BASPERGIL MIX MOLD
CLADOSPOR HERB MOLD DAVIDIELLACEAE B
BIPOLARIS MOLD PLEOSPORACEAE B
FUSARIUM MOLD MIX NECTRIACEAE B
NEGATIVE CONTROL
IMAGE COMMON NAME FAMILY PANEL
©Jortay 2018. All Rights Reserved. 12
IMAGE COMMON NAME FAMILY PANEL
MUCOR LUS MOLD MUCORACEAE B
STERMPHYLL MOLD STACHYBOTRYS B
COCK ROACH MIX BLATTIDAE B
JUNIPER TREE MIX CUPRESSACEAE C
PENICILLMIX MOLD TRICHOCOMACEAE B
MELALEUCA TREE MYRTACEAE C
MESQUITE TREE FABACEAE C
OLIVE TREE OLEACEAE C
QUEEN PALM TREE ARECACEAE C
©Jortay 2018. All Rights Reserved. 13
IMAGE COMMON NAME FAMILY PANEL
ASH TREE MIX OLEACEAE C
PEPPER TREE ANACARDIACEAE C
BIRCH TREE MIX BETULACEAE C
SWEET GUM TREE ALTINGIACEAE C
CEDAR RED TREE CUPRESSACEAE D
COTTON WOOD
EAST TREE SALICACEAE D
CYPRESS BALD TREE CUPRESSACEAE D
ELM AMER TREE ULMACEAE D
OAK EASTERN TREE MIX FAGACEAE D
©Jortay 2018. All Rights Reserved. 14
IMAGE COMMON NAME FAMILY PANEL
HICKORY PECAN TREE MIX JUGLANDACEAE D
SYCAMORE AMER TREE PLATANACEAE D
WALNUT BLACK TREE JUGLANDACEAE D
WILLOW BLACK TREE SALICACEAE D
CEDAR RED TREE CUPRESSACEAE D
COCKLEBUR WEED ASTERACEAE E
FIREBUSH KOCHIA WEED AMARANTHACEAE E
DOCK SORREL WEED MIX POLYGONACEAE E
LAMIACEAE ESAGE WEED MIX
©Jortay 2018. All Rights Reserved. 15
IMAGE COMMON NAME FAMILY PANEL
SCALE ATRIPLEX WEED AMARANTHACEAE E
RUSSIAN THISTLE WEED AMARANTHACEAE E
PIGWEED ROUGH AMARANTHACEAE E
RAGWEED MIX ASTERACEAE E
LAMBS QUARTER WEED AMARANTHACEAE E
CATTLE EPITHELIA BOVIDAE F
ACREMONIUM MOLD HYPOCREACEAE F
AUREBOSIDUM MOLD AUREOBASIDIACEAE F
©Jortay 2018. All Rights Reserved. 16
IMAGE COMMON NAME FAMILY PANEL
CHATEOMIUM MOLD CHAETOMIACEAE F
BOTRYIS MOLD SCLEROTINIACEAE F
PLANTAIN ENGLISH WEED PLANTAGINACEAE E
HAMSTER EPITHELIA CRICETIDAE F
RABBIT EPITHELIA LEPORIDAE F
RAT EPITHELIA MURIDAE F
GUINEA PIG EPITHELIA CAVIIDAE F
©Jortay 2018. All Rights Reserved. 17
Results of the al lergy test ing wi l l be presented to the providerby the medical ass istant
within 15 to 20 minutes af ter the test has been administered. A posit ive test result means
that a pat ient is a l lergic to a substance. A posit ive result wi l l be ref lected by a raised, red,
i tchy wheal that may look l ike a mosquito bite . Posit ive response is def ined as a wheal
greater than 99% of wheals generated by the administrat ion of sal ine to the subject 's back
or forearm by the same operator.
Quintest (HS)
b puncture
Smal lpox needle
(HS) pr ick
DuoTip (L incoln) pr ick
Lancet (HS) puncture
Lancet (ALK) Puncture
DermaPICK I I (Biomedixs) Pr ick
0 mm
0 mm
1.5 mm
2 mm
3 mm
0 mm
DuoTip (L incoln)
twist
Bifurcated needle
(ALO) pr ick
Mult iTest(L incoln)
Puncture
Bifurcated needle
(ALO) puncture
Quick Test
(Pantrex)
Greer Track
(Greer)
3.5 mm
4 mm
4 mm
4.5 mm
4 mm
3.5 mm
Devices for which a 3-mm wheal would be significantDevices for which a wheal >3 mm should be used
as significant
Device99th Percentile of reactions at
the negative control sitesDevice
99th Percenti le of reactions
at the negative control sites
READING RESULTS
a) Oppenheimer J, Nelson HS. Skin Test ing. Ann Al l Asthma Immunol . 2006;96:S6-12.
b) HS = Hol l ister Steir, Greer = Greer laboratories , L incoln = Lincoln Diagnost ics , ALK = ALK America, ALO = Al lergy
Labs of Ohio"
©Jortay 2018. All Rights Reserved. 18
The shots contain a smal l , but
increasing amount of the al lergen the
pat ient is sensit ive to. Whether given
in shot form or under the tongue,
immunotherapy involves giv ing
gradual ly increasing doses of the
substance to which the pat ient is
a l lergic (a lso known as the pat ient 's
a l lergen) .
That reduces the pat ient 's a l lergy
symptoms when the pat ient comes
across the al lergen in the future.
Immunotherapy also reduces the
inf lammation that comes with hay
fever and asthma.
THERAPY
©Jortay 2018. All Rights Reserved. 19
Allergen immunotherapy, a lso known as al lergy shots , is a form of long-term treatment that
decreases symptoms for many people with al lergic rhinit is , a l lergic asthma, conjunct iv i t is (eye
al lergy) or st inging insect al lergy.
An al lergy shot decreases the sensit iv i ty to
al lergens, and of ten leads to last ing rel ief of
a l lergy symptoms even af ter treatment is
stopped. This makes i t a cost effect ive, benef ic ia l
treatment approach for many people.
IMMUNOTHERAPY PHASES
Immunotherapy treatment is structured to work
l ike a vaccine. Over t ime your body responds to
the injected amounts of an al lergen whi le
gradual ly increasing doses, by developing
immunity or tolerance to the al lergen.
Immunotherapy treatment decreases the
sensit iv i ty to al lergens and of ten leads to last ing
rel ief of a l lergy symptoms. Immunotherapy
treatment is broken down in 2 phases: bui ld-up and maintenance phase. Through these two phases
a pat ient can lower the chances of having an al lergic react ion.
BUILD-UP PHASE
During the bui ldup phase patients init ia l ly receive ver y low doses of al lergens by subcutaneous ( i .e .
into the t issue just under the skin) inject ion. With each shot , the dose is s lowly increased to bui ld
immune system tolerance. Af ter each shot , the pat ient is monitored for 30 minutes for any react ion.
The length of this phase depends upon how of ten the inject ions are received, but general ly ranges
from six to twelve months.
With a frequency of inject ions ranging from one to three t imes a week , that 's a Rx Dose of 52 – 156
for the f i rst year.
MAINTENANCE PHASE
The maintenance phase begins once the effect ive dose is reached. The effect ive maintenance dose
depends on the pat ient 's level of al lergen sensit iv i ty and the pat ient 's response to the bui ld-up
phase. During the maintenance phase, shots are spaced out to ever y 2-4 weeks or longer, as
prescr ibed by the provider. During this t ime the dose of al lergen remains constant . Typical ly, a
pat ient wi l lbe on Classic SCIT (subcutaneous immunotherapy) for 3-5 years .
ALLERGY IMMUNOTHERAPY
©Jortay 2018. All Rights Reserved. 20
Immunotherapy treatment, a lthough effect ive is not for ever yone. There are cer tain restr ict ions to who
can and who cannot par t ic ipate in immunotherapy treatment. These pat ient 's i f they par t ic ipate in
immunotherapy are putt ing themselves at r isk for fur ther medical problems. In order to keep the pat ient
safe, we advise ever y pat ient check with their doctor f i rst before they par t ic ipate in immunotherapy.
PATIENTS ON BETA-BLOCKERS
For pat ients on beta blockers , combining epinephrine and beta-blocker medicat ion can be l i fe-
threatening to a pat ient . In the absence of a beta-blocker, a systemic dose of epinephrine does not have
much effect on the mean blood pressure because i t has both alphaadrenergic effects (producing
vasoconstr ict ion) and beta-adrenergic effects (producing vasodi lat ion) . I f a pat ient on a nonselect ive
beta-blocker receives a systemic dose of epinephrine the beta-blocker prevents the vasodi lat ion,
leaving unopposed alpha vasoconstr ict ion. The result ing hyper tensive react ion can be large enough to
possibly lead to a stroke in some patient 's shouldn't have an apostrophes. Your Jor tay provided medical
ass istant wi l l not administer al lergy immunotherapy treatment (al lergy shots) to a pat ient taking beta
blocker medicat ion
WHO SHOULD AND SHOULDN'T GET THERAPY
©Jortay 2018. All Rights Reserved. 21
A color-coding system is used to identi fy the strength of pat ient treatment vials .
S i lver is the f i rst color, which is the weakest . The color-coding system then goes,
green, blue, yel low and red. Red is the highest concentrat ion possible . The red dose is
achieved in the maintenance phase of immunotherapy and is where the effect ive dose
is reached to treat the al lergen.
TREATMENT VIALS
COLOR CODE
SILVER
GREEN
BLUE
YELLOW
RED
STRENGTH
WEAKEST CONCENTRATION
1:10,000 vol/vol
1:1,000 vol/vol
1:100 vol/vol
1:10 vol/vol
1:1 vol/vol
DILUTION
STRONGESTCONCENTRATION
Bu
ild
-Up
Main
ten
an
ce
©Jortay 2018. All Rights Reserved. 22
There are two reasons why a pat ient would need mult iple prescr ipt ions:
è Cer tain al lergens are recommended to not be mixed together ; therefore, i f a pat ient is to be treated
for al lergens that wi l l counteract each other, that could warrant mult iple prescr ipt ions.
è I t is recommended that no more than ten (10) al lergens be mixed together. I f the pat ient is to be
treated for more than 10 al lergens, this would also warrant mult iple prescr ipt ions." there are two
dif ferent reasons why the pat ient would need mult iple prescr ipt ions.
The f i rst reason why a pat ient would need mult iple perscrpt ions is because one is i f the pat ient is
a l lergic to mold, pol len, dust , and dandruff.
Mold cannot be mixed with other al lergens therefore the pat ient would have to be on mult iple
prescr ipt ions. Also, i f a pat ient is a l lergic to more than 10 al lergens then wi l l have mult iple
prescr ipt ions.
PRESCRIPTIONS
©Jortay 2018. All Rights Reserved. 23
Allergy inject ions (shots) are most commonly used and the most effect ive
form of al lergy immunotherapy. Each inject ion contains a smal l amount of an
al lergen that tr iggers the pat ient 's specif ic a l lergic react ion. Each inject ion
contains enough al lergens to st imulate the pat ient 's immune system. As the
pat ients progresses through treatment protocol the doses of the inject ion
increases, which helps the pat ient 'sbody get use to the al lergens
(desensit izat ion) . Desensit izat ion is the el imination or reduction of natural or
acquired react iv i ty or sensit iv i ty to an external st imulus (al lergen) . Whi le
taking al lergy inject ions one wi l l become desensit ized to the al lergen and be
able to l ive l i fe symptom free.
Introduction
Allergy inject ions are NOT administered the same way that vaccines l ike f lu
shots or pediatr ic shot ser ies are given. Al lergy shots are given into the sub-
cutaneous t issues and NOT the muscle l ike most vaccines. The subcutaneous
t issue is the layer where the fat is…or the layer between the skin and muscle .
This document attempts to instruct how one administers al lergy shots
correct ly into the subcutaneous t issues. As with al l information provided by
Jor tay and the Taylor Al lergy program, al l pat ient treatment plans, dosage
and administrat ion is decided by the pat ient ’s physic ian.
THE WRONG WAY TO GIVE AN ALLERGY SHOT!
Note that the syringe was inserted incorrectly. The skin was not
pinched prior to insertion. Most likely, the needle is in the muscle
and there is an increased risk of anaphylaxis if given improperly
like this.
Please be mindful of word spacing and line breaks. As some of the
words are running together and there's an unnecessary line break.
How to Give Allergy
Shots
ALLERGY INJECTIONS
After drawing up the appropriate amount of allergy serum, hold the syringe
comfortably in your dominant hand. Visually confirm correct volume of serum drawn
up and that there are no air bubbles present.
Step 1:
The allergy shot is administered into the tricep region of the arm (back part of the
upper arm). Pinch only the skin (excluding the muscle) between your thumb and index
finger using your non-dominant hand. Pinching helps lift and isolate the
subcutaneous tissues up and away from the muscle.
Step 2:
Insert needle into the skin ONLY HALF THE LENGTH OF THE NEEDLE!!! Do NOT push
the needle all the way in. Inject the serum.
Step 3:
©Jortay 2018. All Rights Reserved. 24
Missed treatment protocol happens when a pat ient is not taking their a l lergy inject ions on the
prescr ibed t ime frame. To get the pat ient back on track we have a missed inject ion protocol
system. When, a pat ient has not had their a l lergy inject ion in under 10 days they are f ine to
continue taking the same dose that they are currently prescr ibed. Once a pat ient has been
without al lergy shots over 10 days they stand the r isk of backtracking and fur ther their actual
treatment t ime.
By 10 – 14 days: Repeat the last dose
By 14 – 21 days: Decrease by one dose
By > 21 days: Decrease by 2 doses
By > 40 days: Restar t at f irst dose for that vial with vial testing
By > 60 days: Retest and create new vials
MISSED TREATMENT PROTOCOL
©Jortay 2018. All Rights Reserved. 25
TREATMENT TRACKING
©Jortay 2018. All Rights Reserved. 26
TREATMENT TRACKING
©Jortay 2018. All Rights Reserved. 27
TO PATIENTS RECEIVING DESENSITIZATION INJECTIONS IN OUR OFFICE
The fol lowing guidel ines are ver y impor tant for the safe and effect ive administrat ion of al lergy
desensit izat ion treatment and should be fol lowed careful ly :
1 . Any inject ion can cause a react ion of ( increased) wheezing, hives , nasal congest ion, runny nose,
vomit ing or s ignif icantly increased shor tness of breath. I f this occurs as a result of an al lergy inject ion, i t
wi l l general ly occur within two hours of the inject ion. I f one of these react ions occurs , or i f you feel that
you have become i l l as a result of an al lergy inject ion, you must contact one of our doctors immediately.
This can be done by cal l ing any one of our off ices or our home. In addit ion, i f this occurs , you must see
one of the doctors before your next inject ion.
2. Any inject ion can cause a react ion of redness or swel l ing or pain on your arm where you receive the
inject ion. I f this occurs the day of the inject ion, i t is a normal react ion. I f i t lasts unti l the day af ter the
inject ion, this should be repor ted to one of the nurses pr ior to your next inject ion.
3. TO PATIENTS WITH HIGH BLOOD PRESSURE, GLAUCOMA OR HEADACHE: Please noti fy our off ice i f your
pr imar y care physic ian gives you a drug cal led a beta blocker for control of your high blood pressure,
glaucoma or headache.
4. IF YOU HAVE BEEN STARTED ON ANY NEW MEDICINE/DRUG SINCE YOUR LAST VISIT, PLEASE INFORM
THE NURSE OR DOCTOR BEFORE YOUR INJECTION.
5. I f you are feel ing wel l , you may receive your inject ions without wait ing to see the doctor. However, we
would l ike to have you see a doctor each t ime you star t new vials .
6 . I f you are having any symptoms or are s ick , please schedule an appointment to see your doctor before
receiving an inject ion.
7. To expedite your v is i t , please schedule with the receptionist the day you wish to come in for inject ion or
to see the doctor.
8 . You should wait in our off ice for 20 – 30 minutes af ter each inject ion in case there is a react ion to an
inject ion.
9. Optimum therapeutic results usual ly require three to f ive years of desensit izat ion therapy.
Discontinuation of therapy ear l ier than this may result in a higher increase of recurrence.
10. TO ALL OF OUR FEMALE PATIENTS: Not al l drugs used in treatment of al lergic diseases have been
cleared for use during pregnancy. I f you are planning on becoming pregnant , or are pregnant , please
discuss drug use with one of our physic ians.
11. Desensit izat ion therapy general ly takes at least 6-12 months before any benefit is noted.
Improvement thereaf ter may be gradual .
12. I f you have any quest ions regarding your inject ions, these instruct ions, or your al lergy symptoms,
please cal l our off ice at any t ime and speak with one of the doctors . There are 24 hour answering ser vices
on al l off ice and home telephones, and a physic ian is avai lable 24 hours a day for consultat ion.
13. Please inform your pr imar y physic ian of al lergy medicat ion you are taking, so proper prescr ibing can
occur
HOME THERAPY
©Jortay 2018. All Rights Reserved. 28
GENERAL RELEASE
Patient ’s Name: __________________________________________________________ I have requested that al lergy
inject ions prescr ibed and/or provided by ________________________ be administered by someone other than
employees of the off ice. I acknowledge that I have been advised by the off ice that the inject ion of the al lergy
extract should be per formed by a qual i f ied person and not by the pat ient , or the parent of the pat ient . I
understand that because of the above, the off ice, i ts agents , successors and assigns, and al l other persons, f i rms
and corporat ions involved in the manufacture and prescr ipt ion of the extract , cannot assume responsibi l i ty for
the administrat ion of the extract , and any result ing consequences.Therefore, on behalf of myself, my heirs ,
executors , administrators and assigns, as wel l as any minor chi ldren for which I am act ing as parent and/or
guardian, I hereby demise, release and forever discharge ________________________________ and Jor tay and their
agents , successors and assigns of whatsoever kind of nature, ar is ing from and by reason of any and al l known and
unknown, foreseen and unforeseen bodi ly and personal injur ies , and the consequences thereof, result ing and
to result f rom the administrat ion of said al lergy extracts . I acknowledge that the person who wi l l be requested to
administer and inject the extract wi l l be advised of this release. I understand that the __________________________
advised against this and I have decided to waive that warning and continue home administrat ion. I understand
that the posit ion statement of the AAAAI strongly recommends against home administrat ion of al lergen
immunotherapy and I understand there have been deaths repor ted in associat ion with a l lergen
immunotherapy.
_______________________ _______ __________ _______________________________ _______ __________
Pat ient Signature Date Parent Signature ( for minor) Date
Address ___________________________________________________________________________________________________
___________________________________________________________________________________________________________
City, State, & Zip ___________________________________________________________________________________________
©Jortay 2018. All Rights Reserved. 29
Anaphylaxis is a severe, potential ly
l i fe-threatening al lergic react ion. I t
can occur within seconds or
minutes of exposure to something
a pat ient is such as peanuts or bee
st ings.
Anaphylaxis causes a person's
release a f lood of chemicals that
can cause them to go into shock —
their blood pressure drops
suddenly, and your air ways narrow,
blocking breathing. Signs and
symptoms include a rapid, weak
pulse; a skin rash; and nausea and
vomit ing. Common tr iggers include
cer tain foods, some medicat ions,
insect venom and latex.
Anaphylaxis requires an inject ion
of epinephrine and a fol low-up tr ip
to an emergency room. I f there is
no epinephrine in the off ice, the
pat ient needs to go to an
emergency room immediately. I f
anaphylaxis isn't treated r ight
away, i t can be fatal .
ANAPHYLAXIS
Key Equipment and supplies to treat a patient when they have an anaphylactic episode.
Stethoscope Sphygmomanometer Injectable Epinephrine 1:1 ,000 or Epi Pensè � è � è
Oxygen Intravenous 0.9 normal (NL) sal ine 1-way valve facemaskè � è � è
Orophar yngeal and nasal phar yngeal a ir ways Disposable face masksè � è
Oxygen saturat ion monitor Albuterol inhalat ional solut ion (0 .05%), glucagonè � è
Written emergency protocol and char t for tracking patient treatmentè
©Jortay 2018. All Rights Reserved. 30
Administer epinephrine intra-muscular ly in the mid-outer thigh. There is no absolute
contraindicat ion to the administrat ion of epinephrine as c lear ly stated in the Food and
Drug Administrat ion package inser t for AIE . This includes pat ients with acute coronar y
syndrome, and although the r isk-to-benefit rat io needs to be assessed with care in such
patient 's , i t usual ly favors the administrat ion of epinephrine.
Rapid administrat ion of a s ingle dose of epinephrine for mild symptoms of anaphylaxis
result ing from al lergy immunotherapy almost always stops the progression of symptoms,
with no addit ional epinephrine inject ions being required.
è Immediately assess air ways, breathing, c irculat ion, mentat ion and summon appropriate
assistance from staff members .
è I f needed, star t CPR and cal l 911 for EMS.
è In some patient 's , a second inject ion of epinephrine may be necessar y.
è Place pat ient in a supine posit ion, unless respirator y compromise contraindicates to
prevent or counteract potential c i rculator y col lapse.
è Pregnant pat ients should be on their lef t s ide. I f di f f iculty breathing, have patient s i t
up.
To maintain hemodynamic stabi l i ty, intravenous access is essential . Hypotension should be
treated with rapid f luid replacement using 1 to 2 L of 0 .9% normal sal ine, infused rapidly
(e .g. 5-10 mL/kg within the f i rst 5 minutes for an adult and up to 30 mL/kg in the f i rst hour
for chi ldren) .
Administrat ion of oxygen is the second most impor tant therapeutic inter vention, second
only to epinephrine administrat ion, and should be considered for al l pat ient 's regardless
of their respirator y status. Oxygen should be administered to pat ients with any respirator y
dif f iculty.
Oxygen up to 100% should be administered at a f low rate of 6 to 10 L/min through a
facemask . Ideal ly oxygen saturat ion should be monitored and kept at 94% to 96% by
oximetr y.
In most off ice sett ings, bag-valve-mask venti lat ion wi l l be the method of choice to suppor t
venti lat ion in the event of respirator y fai lure or arrest . When provider can adequately
venti late the pat ient using the bag-valve-mask , there is no evidence that the use of
MANAGEMENT OF ANAPHYLAXIS AT THE ONSET
©Jortay 2018. All Rights Reserved. 31
MANAGEMENT OF ANAPHYLAXIS AT THE ONSET
For s igns and symptoms of
bronchospasm (e.g. wheezing,
coughing and shor tness of
breath) that has not responded
to intramuscluar epinephrine,
administer albuterol (adult dose
2.5 – 5.0 mg/3mL of sal ine;
pediatr ic dose 2.5 mg/3mL of
sal ine) through a nebul izer and
facemask .
I t is recommended that al l
Advanced Cardiovascular L i fe
Suppor t providers be trained
and experienced in the inser t ion
of 1 advanced air way because
there wi l l be t imes when the
bag-mask is inadequate.
Rapid administrat ion of a s ingle
dose of epinephrine for mild
symptoms of anaphylaxis
result ing from al lergy
immunotherapy (AIT) a lmost
always stops the progression of
symptoms, with no addit ional
epinephrine inject ions being
required.
In contrast , delayed
administrat ion of epinephrine is
of ten bel ieved to be the major
contr ibuting factor to fatal i t ies .
©Jortay 2018. All Rights Reserved. 32
A treatment and act ion plan that is easy to read and fol low during an emergency.
I t should be posted in al l pat ient care areas of the off ice and with the emergency suppl ies
for ready access .
Maintain c l inical prof ic iency with anaphylaxis management involves cer t i f icat ion in basic
cardiopulmonar y resuscitat ion and, ideal ly, advanced l i fe suppor t to insure the proper
ski l lset for treatment of refractor y anaphylaxis , including air way management, cardiac
compressions, venous and intraosseous access , and parental medicat ion calculat ion and
del iver y.
Immediate Measures:
è Air way: Assess air way, breathing, c irculat ion, and orientat ion; i f needed, suppor t the
air way using the least invasive but effect ive method (e .g. bag-valve-mask) .
è CPR: Star t chest compressions (100/min) i f cardiovascular arrest occurs at any t ime.
è Epinephrine intramuscular : Inject epinephrine 0.3-0.5mg (0.01 mg/kg for chi ldren)
intramuscular ly in the vastus lateral is ( lateral thigh) .
è Get Help: Summon appropriate assistance in off ice.
è Posit ion: Place adults and adolescents in recumbent posit ion; place young chi ldren in
posit ion of comfor t ; place pregnant pat ient on lef t s ide.
è Oxygen: Give 8-10 L/min through facemask or up to 100% oxygen as needed; monitor
by pulse oximetr y i f avai lable.
è Epinephrine intramuscular : Repeat epinephrine ever y :15 minutes for up to 3 inject ions
i f the pat ient is not responding.
è EMS: Cal l 911 i f no immediate response to f i rst dose of intamuscular epinephrine or i f
anaphylaxis is moderate to severe.
è Intravenous f luids : Establ ish intravenous l ine for venous access and f luid replacement;
keep open with 0.9 NL sal ine, push f luids for hypotension or fai lure to respond to
epinephrine using 5-10mg/kg as quickly as possible and up to 30 mL/kg in f i rst hour for
chi ldren and 1-2L for adults .
OFFICE-BASED ANAPHYLAXIS ACTION PLAN
©Jortay 2018. All Rights Reserved. 33
Additional treatment measures
Albuterol : Consider administrat ion of 2 .5 – 5mg of nebul ized albuterol in 3 mL of sal ine
for lower air way obstruct ion; repeat necessar y ever y 15 min.
Glucagon: Pat ient 's on beta blockers who are not responding to epinephrine should be
given 1 – 5 mg of glucagon intravenously s lowly over 5 min because rapid administrat ion
of glucagon can induce vomit ing.
Advanced air way management: Use supraglott ic air way, endotracheal intubation, or
cr icothyroidotomy for marked str idor, severe lar yngeal edema, or when venti lat ions using
the bag-valve-mask is inadequate and EMS has not arr ived.
Optional treatment (eff icacy has not establ ished)
H1 antihistamine: Consider giv ing 25– 50mg of diphenhydramine intravenously for adults
and 1 mg/kg (maximum of 50 mg) for chi ldren; use to 10mg of cet ir iz ine i f an oral
ant ihistamine is administered.
Cor t icoster iods: Administer 1 -2 mg/kg up to 125 mg per does, intravenously or oral ly, of
methyplprednisolne or an equivalent formulat ion.
Obser vation and monitoring
Obser vat ion in the off ice: Obser ve in off ice unti l ful l recover y for an addit ional 30-60
minutes for al l pat ients who are not candidates for EMS transpor t to hospital .
Discharge Management
Education: Educate pat ient and family on how to recognize and how to treat anaphylaxis
Auto-injectable epinephrine: Prescr ibe two (2) doses of auto-injectable epinephrine for
pat ients who have experienced an anaphylact ic react ion and for those at r isk for severe
anaphylaxis ; train pat ient , pat ient provider, and on family on how to use auto-injector.
Anaphylaxis act ion plan: Provide patients with an act ion plan instruct ing them on how and
when to administer epinephrine.
OFFICE-BASED ANAPHYLAXIS ACTION PLAN
©Jortay 2018. All Rights Reserved. 34
Food al lergies is an immune system react ion that occurs soon af ter eat ing a cer tain food. Even a
t iny amount of the al lergy-causing food can tr igger s igns and symptoms such as digest ive
problems, hives , or swol len air ways. In some people, a food al lergy can cause severe symptoms
or even a l i fe-threatening react ion known as anaphylaxis .
For some people, an al lergic react ion to a food may be uncomfor table but not severe. For other
people, an al lergic food react ion can be fr ightening and even l i fe-threatening. Food al lergy
symptoms usual ly develop within a few minutes to two hours af ter eat ing the offending food.
The most common food allergy signs and symptoms include:
è Tingl ing or i tching in the mouth
è Hives, i tching or eczema
è Swel l ing of the l ips , face, tongue and throat or other par ts of the body
è Wheezing, nasal congest ion or trouble breathing
è Abdominal pain, diarrhea, nausea or vomit ing
è Dizziness , l ightheadedness or fa int ing
When it comes to food al lergy test ing there are three methods that are used most frequently to
test the accuracy of a pat ient 's a l lergies to food. Those tests consist of the IgE test , the IgG test
and the Alcat test .
FOOD ALLERGY TESTING
©Jortay 2018. All Rights Reserved. 35
Allergies are a common and chronic condit ion that involves the body 's immune system.
Normal ly, a person's f ight off v iruses, bacter ia , and other infect ious agents . When a person has
an al lergy, their system treats a harmless substance, l ike dust or pol len, as a threat . To f ight
this perceived threat , their immune system makes antibodies cal led immunoglobul in E ( IgE) .
These antibodies travel to cel ls that release chemicals , causing an al lergic react ion. This
react ion usual ly causes symptoms in the nose, lungs, throat , or on the skin.
IgE Testing
©Jortay 2018. All Rights Reserved. 36
IgG Testing
Immunoglobul in G ( IgG) , the most abundant types
of ant ibodies , is found in al l body f luids and
protects against bacter ia l and viral infect ions.
Immunogobul in G ( IgG) tests measure delayed
immune react ions of foreign objects or undigested
proteins that leak across the gut l in ing and into
the blood stream causing a delayed immune
response.
In IgG test ing, the blood is tested for IgG antibodies instead of being tested for IgE antibodies
( i .e . , the antibodies typical ly associated with food al lergies) . The existence of serum IgG
antibodies towards foods is c la imed by many pract i t ioners as a tool to diagnose food al lergy
or intolerance.
©Jortay 2018. All Rights Reserved. 37
The Alcat test measures food and immune react ions through st imulat ion of leukocytes .
The leukocytes , which comprise f ive c lasses of white blood cel ls , including monocytes,
lymphocytes, eosinophi ls , basophi ls and neutrophi ls (~ 70 - 80% of WBC's) can be
chal lenged with individual food or chemical extracts . Immunologic defense react ions, of
neutrophi ls , in it iate an instrumental pr imar y role in inf lammation. Whi le this is a ver y
effect ive f i rst- l ine defense strategy against acute infect ions, chronic act ivat ion of the
immune system may lead to health disorders .
The Alcat Test does not identi fy type 1 c lassical IgE mediated (anaphylaxis) a l lergies .
The dif ference between the Alcat Test and IgG antibody test ing: Food and Chemical
sensit iv i t ies are mediated by mult iple pathogenic mechanisms. By using the cel lular
approach, instead of a s ingle antibody such as IgG, the Alcat Test can identi fy food and
chemical sensit iv i t ies regardless of the pathway ( immunologic , toxic , pharmacologic) . The
cel ls release free radicals and inf lammator y mediators without antibody involvement.
Most studies suggest that food specif ic IgG antibodies are protect ive and thereby not
pathogenic .
ALCAT
©Jortay 2018. All Rights Reserved. 38
The Alcat Test gives healthcare professionals a tool for managing condit ions l inked to
inf lammation and chronic act ivat ion of the immune system. The Alcat Test measures
individual responses to foods and other substances on the cel lular level and may
reveal the underly ing tr igger of cer tain symptoms.
Food and chemical sensitivit ies have been l inked to migraines, aching joints,
fatigue, gastrointestinal disorders, and other symptoms related to chronic
activation of the immune system.
Clinical assessments of the Alcat Test used to guide dietar y modif icat ion have shown
signif icant improvement in many common symptoms. The eff icacy of the Alcat Test has
been documented in numerous studies implementing r igorous double-bl ind and of ten
placebo-control led study designs.
©Jortay 2018. All Rights Reserved. 39
FORMS
_____________________
Medical Assistant
Patient Name: __________________________________________________________________________________
Date: _____________________
D.O.B.: ___________________
S
ER
VIC
E F
OR
M
95004 Allergy Testing ___________________
95115 Single Injection
95117
Multiple Injections
95165
Immunotherapy ______________ Doses X
___________#of Prescription
DX Code (s):
Primary Insurance: __________________________________________________________________________
Secondary Insurance: _______________________________________________________________________
Tertiary Insurance: __________________________________________________________________________
The above insurance policy is current and I attest I have no other insurance for th is
date of service.
NOTE: While allergy testing and treatment (immunotherapy) are usually a
covered expense by insurance companies, copays and deductibles may still apply.
___________________________________
Patient’s Signature
Date
______________________________
Internal Use:
________________________
________________________
Practice Name/Ordering Physician: Telephone: ( ) -
Street Address: Fax: ( ) -
City: State Zip Email:
Controls: Epicutaneous: NEGATIVE: POSITIVE: Intradermal: POSITIVE:
Epicutaneous: Testing Date(s): / / Testing Time: AM PM
Intradermal: Testing Date(s): / / Testing Time: AM PM
Practitioner Signature Date
PANEL B Epicutaneous
W (mm) F
Intradermal
W (mm) FSite Allergen
1
2
3
4
5
PANEL A Epicutaneous
W (mm) F
Intradermal
W (mm) FSite Allergen
1
2
3
4
5
PANEL A Epicutaneous
W (mm) F
Intradermal
W (mm) F
Site Allergen
PANEL B Epicutaneous
W (mm) F
Intradermal
W (mm) F
Site Allergen
6
7
8
9
10
PANEL C Epicutaneous
W (mm) F
Intradermal
W (mm) FSite Allergen
1
2
3
4
5
PANEL C Epicutaneous
W (mm) F
Intradermal
W (mm) F Site Allergen
6
7
8
9
10
PANEL D Epicutaneous
W (mm) F
Intradermal
W (mm) FSite Allergen
1
2
3
4
5
PANEL D Epicutaneous
W (mm) F
Intradermal
W (mm) F
Site Allergen
6
7
8
9
10
PANEL E Epicutaneous
W (mm) F
Intradermal
W (mm) FSite Allergen
1
2
3
4
5
PANEL E Epicutaneous
W (mm) F
Intradermal
W (mm) F
Site Allergen
6
7
8
9
10
PANEL F Epicutaneous
W (mm) F
Intradermal
W (mm) FSite Allergen
1
2
3
4
5
PANEL F Epicutaneous
W (mm) F
Intradermal
W (mm) F
Site Allergen
6
7
8
9
10
6
7
8
9
10
Patient Name: Patient ID:
Date of Birth: / /
Days: Medication:
Days: Medication:
Location: Back: q
Arm: q
Testing Technician:
NEGATIVE:
Last use of antihistamin e(o r othe rmedicatio naectin g respon se to histamine
©Jortay 2018. All Rights Reserved. 40
PA
NE
L T
ES
TIN
G S
HE
ET
ALLERGEN IMMUNOTHERAPY PATIENT CONSENT FORM
Immunotherapy, hyposensit izat ion, or al lergy inject ions should be administered at a medical
faci l i ty with a medical physic ian present s ince occasional react ions may require immediate therapy.
These react ions may consist of any or a l l the fol lowing symptoms: i tchy eyes, nose, or throat ; nasal
congest ion; runny nose; t ightness in the throat or chest ; coughing; increased wheezing;
l ightheadedness; fa intness ; nausea and vomit ing; hives ; general ized i tching; and shock , the last
under extreme condit ions. React ions, even though unusual , can be ser ious and
rarely, fatal . You are required to wait in the medical faci l i ty in which you receive the inject ions for 30
minutes af ter each inject ion. I f the pat ient is 17 years of age or younger, a parent or legal guardian
must be present during the wait ing period. I ver i fy that I (or pat ient) am not taking betablocker
medicat ions or that i f I am, I have discussed the r isks/benefits of doing so with my physic ian (see
information sheet) .
I have read ( i f new patient) or re-read ( i f establ ished patient) the pat ient information sheet on
immunotherapy and understand it . The oppor tunity has been provided for me to ask quest ions
regarding the potential s ide effects of immunotherapy and these quest ions have been answered to
my sat isfact ion. I understand that ever y precaution consistent with the best medical pract ice wi l l
be carr ied out to protect me against such react ions. I a lso agree that i f I have an al lergic react ion to the
inject ions that the physic ian-in-charge has permission to treat said react ion.
I acknowledge the fact with my s ignature that I am authoriz ing the off ice to bi l l for al lergen vaccines,
even i f, for any reason, I decide not to init iate the al lergen immunotherapy program af ter the vaccine
has been made. Vaccines may be prepared up to 12 weeks pr ior to my appointment. I agree to obtain
pr ior authorizat ion, i f needed, from my insurance plan.Pat ient is ult imately responsible for any
charges incurred in this off ice.
I t is your legal responsibi l i ty to pay any deductible amount, co-payments , co-insurance, and or any
other balances not paid by your insurance carr ier or supplemental insurance. Your s ignature on this
document indicates that you agree to pay for any outstanding charges incurred in this off ice.
Pat ient Name: __________________________________________________________________________
Patient Signature:__________________________________________ DATE ______________________
PARENT or LEGAL GUARDIAN_____________________________ DATE ________________________
As parent or legal guardian, I understand that I must accompany my chi ld throughout
the entire 30-minute wait .
WITNESS__________________________________________________ DATE________________________
©Jortay 2018. All Rights Reserved. 41
©Jortay 2018. All Rights Reserved. 42
BL
AN
K P
ER
SC
RP
TIO
N
Maintenance Concentrate
Prescription Form
Patient Name:
Patient Number:
Birthdate:
Telephone:
Prescribing Physician:
Address:
Telephone:
Fax:
Allergen Extract Content:
*Components of mixes listed on a separate
sheet Specific Instructions:
Prepared by: Date prepared:
Volume to add =Maintenance Concentration
Conc. of Manufacturer’s Extractx Total Volume
Bottle Name AbbreviationsTree: T Mold:MGrass: G Cat: CWeed: W Dog: DRagweed: R Cockroach: CrMixture: Mx Dust Mite: Dm
AntigenNumber
Extract Name Allergen or Di-luent (Common
Phrase orGenus
species)*
Concentration and Type of
Manufacturer’s Extract (AU, BAU, W/V,
PNU)/(50% G, Aq, Ly, AP, AL)
Volume of Manufacturer’s Extract to Add
Extract Manu-facturer
Lot Number Expiration Date
1
2
3
4
5
6
7
8
9
10
Diluent
TotalVolume
BAU = Bioequivalent Allergy Unit, AU = Allergy UnitPNU = Protein Nitrogen UnitW/V = Weight per Volume RationG = 50% GlycerinatedAq = Aqueous, Ly = LyophilizedA::= Alum precipitated, AP = Acetone precipitated
Maintenance concentration and subsequent dilutions reported as volume/volume (v/v) dilutions with mainte-
/
concentration=1:1 v/vnance
/
AL
LE
RG
Y &
IM
MU
NO
TH
ER
AP
Y N
OT
ES
D.O.S .: ___________________
Patient Name: ____________________________
D.O.B.: ________________________
Plan
Allergen Test
Allergen Skin
Test Results & Recommendations
Procedure Codes:
95004: ____________________________
# Extracts/Allergens Tested
95165: ______________________________
#D oses Prescribed
Provider Name: ______________________________________________________
Provider Signature: __________________________________________________
©Jortay 2018. All Rights Reserved. 43
©Jortay 2018. All Rights Reserved. 44
ALLERGY IMMUNOTHERAPY PRESCRIPTION
Physic ian’s Name: _______________________________________________ DEA# ____________________________
Tax ID #: _________________________________________ NPI#:____________________________________________
Patient ’s Ful l Name: _______________________________________________________ D.O.B. : _________________
Insurance Carr ier : _________________________________________ Phone No: _____________________________
Preferred Pharmacy: _______________________________________________________________________________
CHECK NEEDED PRESCRIPTION:
OTC/LIQUID 12.5 MG/5ML Chi ldren’s Benadr yl (Diphenhydramine) Use as directed by provider for
any mild al lergic react ions.
CHECK ONE ONLY:
ADULT EPI-PEN 1 Pak Epinephrine Auto-Injectors .3MG
For a weight of 66 pounds or more. Keep with you when administer ing Immunotherapy as directed
by provider. Should only be used in the event of a severe al lergic react ion. (No Ref i l ls ) .
EPI-PEN Jr. 1-Pak Epinephrine Auto-Injectors .15MG
For Chi ldren weighing between 33 – 65 pounds. Keep with you when administer ing immunotherapy
as directed by provider. Should only be used in the event of a severe al lergic react ion. (No Ref i l ls ) .
Physic ian’s Signature: ______________________________________ Date: _____________________
©Jortay 2018. All Rights Reserved. 45
Skin Test: Skin tests are methods of test ing for al lergic ant ibodies . A test consists of
introducing smal l amounts of the suspected substance, or al lergen, into the skin and noting
the development of a posit ive react ion (which consists of a wheal , swel l ing, or f lare in the
surrounding area of redness) . The results are read at 15 to 20 minutes af ter the appl icat ion
of the al lergen. The skin test methods are:
Prick Method: The skin is pr icked with a needle where a drop of al lergen has already been
placed.
Intradermal Method: This method consists of inject ing smal l amounts of an al lergen into
the super f ic ia l layers of the skin.
Interpret ing the cl inical s ignif icance of skin tests requires ski l l ful correlat ion of the test
results with the pat ient ’s c l inical histor y. Posit ive tests indicate the presence of al lergic
ant ibodies and are not necessar i ly correlated with c l inical symptoms.
You wi l l be tested to impor tant ( locat ion) airborne al lergens and possibly some foods.These
include, trees, grasses, weeds, molds, dust mites , and animal danders and, possibly some
foods. The skin test ing general ly takes 45 minutes. Pr ick (also known as percutaneous) tests
are usual ly per formed on your back but may also be per formed on your arms. Intradermal
skin tests may be per formed i f the pr ick skin tests are negative and are per formed on your
arms. I f you have a specif ic a l lergic sensit iv i ty to one of the al lergens, a red, raised, i tchy
bump (caused by histamine release into the skin) wi l l appear on your skin within 15 to 20
minutes. These posit ive react ions wi l l gradual ly disappear over a period of 30 to 60
minutes, and, typical ly, no treatment is necessar y for this i tchiness . Occasional ly local
swel l ing at a test s i te wi l l begin 4 to 8 hours af ter the skin tests are appl ied, par t icular ly at
s i tes of intradermal test ing. These react ions are not ser ious and wi l l disappear over the
next week or so. They should be measured and repor ted to your physic ian at your next v is i t .
You may be scheduled for skin test ing to antibiot ics , caines, venoms, or other biological
agents . The same guidel ines apply.
DO NOT
1. No prescr ipt ion or over the counter oral ant ihistamines should be used 4 to 5 days pr ior
to scheduled skin test ing. These include cold tablets , s inus tablets , hay fever medicat ions,
or oral treatments for i tchy skin, over the counter al lergy medicat ions, such as Clar i t in ,
Zyr tec, Al legra, Act i fed, Dimetapp, Benedr yl , and many others .Prescr ipt ion antihistamines
such as Clar inex and Xyzol should also be stopped at least 5 days pr ior to test ing. I f you
have any quest ions whether or not you are using an antihistamine, lease please asks the
nurse or the doctor. In some instances a longer period of t ime off these medicat ions may be
necessar y.
PATIENT INSTRUCTION/CONSENT FORM FOR ALLERGY SKIN TESTING
©Jortay 2018. All Rights Reserved. 46
2. You should discontinue your nasal and eye antihistamine medicat ions, such as Patanase,
Pataday, Astepro, Optivar, or Astel in at least 2 days before the test ing. In some instances a
longer period of t ime off these medicat ions may be necessar y. I f you have any quest ions
whether or not you are using an antihistamine, lease please asks the nurse or the doctor. In
some instances a longer period of t ime off these medicat ions may be necessar y.
3 . Medicat ions such as over the counter s leeping medicat ions (e .g. Tylenol PM) and other
prescr ibed drugs, such as amytr iptyl ine hydrochlor ide (Elavi l ) , hydroxyzine (Atarax) ,
doxepin (Sinequan) , and imipramine (Tofrani l ) have antihistaminic act iv i ty and should be
discontinued at least 2 weeks pr ior to receiving skin test af ter consultat ion with your
physic ian. Please make the doctor or nurse aware of the fact that you are taking these
medicat ions so that you may be advised as to how long prior to test ing you should stop
taking them.
YOU MAY
1. You may continue to use your intranasal a l lergy sprays such as Flonase Rhinocor t ,
Nasonex, Nasacor t . Omnaris , Veramyst and Nasarel .
2 . Asthma inhalers ( inhaled steroids and bronchodi lators) , leukotr iene antagonist s (e .g.
Singulair, Accolate) and oral theophyl l ine (Theo-Dur,T-Phyl , Uniphyl , Theo-24, etc . ) do
not inter fere with skin test ing and should be used as prescr ibed.
3. Most drugs do not inter fere with skin test ing but make cer tain that your physic ian and
nurse know about ever y drug you are taking (br ing a l ist i f necessar y) . .
Skin test ing wi l l be administered at this medical faci l i ty with a medical physic ian or other
health care professional present s ince occasional react ions may require immediate therapy.
These react ions may consist of any or al l of the fol lowing symptoms: i tchy eyes, nose, or
throat ; nasal congest ion; runny nose; t ightness in the throat or chest ; increased wheezing;
l ightheadedness; fa intness ; nausea and vomit ing; hives ; general ized i tching; and shock , the
latter under extreme circumstances. Please let the physic ian and nurse know i f you are
pregnant or taking beta blockers . Al lergy skin test ing may be postponed unti l af ter the
pregnancy in the unl ikely event of a react ions to the al lergy test ing and beta-blockers are
medicat ions they may make the treatment of the react ion to skin test ing more dif f icult .
Please note that these reactions rarely occur but in the event a reaction would occur,
the staff is ful ly trained and emergency equipment is available.
After skin test ing, you wi l l consult with your physic ian or other health care professional who
wi l l make fur ther recommendations regarding your treatment.
We request that you do not br ing smal l chi ldren with you when you are scheduled for skin
test ing unless they are accompanied by another adult who can s it with them in the
reception room.
©Jortay 2018. All Rights Reserved. 47
___________________________________________________________________________________________
I have read the pat ient information sheet on al lergy skin test ing and understand it . The
oppor tunity has been provided for me to ask quest ions regarding the potential s ide effects
of al lergy skin test ing and these quest ions have been answered to my sat isfact ion. I
understand that ever y precaution consistent with the best medical pract ice wi l l be carr ied
out to protect me against such react ions.
Pat ient is ult imately responsible for any charges incurred in this off ice. I t is your legal
responsibi l i ty to pay any deductible amount, co-payments , co-insurance, and or any other
balances not paid by your insurance carr ier or supplemental insurance. Your s ignature on
this document indicates that you agree to pay for any outstanding charges incurred in this
off ice.
Pat ient Name: ______________________________________________________________________________
Patient Signature___________________________________________ Date s igned___________________
Parent or legal guardian*__________________________________ Date s igned____________________
*as parent or legal guardian, I understand that I must accompany my chi ld throughout the
entire procedure and vis i t .
Witness ____________________________________________________ Date s igned___________________
©Jortay 2018. All Rights Reserved. 48
ALLERGY
Allergies are inappropriate or exaggerated react ions of the immune system to substances that , in the
majority of people, cause no symptoms. Symptoms of the al lergic diseases may be caused by
exposure of the skin to a chemical , of the respirator y system to par t ic les of dust or pol len (or other
substances) , or of the stomach and intest ines to a par t icular food.
ANAPHYLAXIS
Anaphylaxis , or anaphylact ic shock , is a severe, f r ightening and l i fe-threatening al lergic react ion. The
react ion, a lthough rare, can occur af ter an insect st ing or as a react ion to an injected drug - for
example, penici l l in or ant itetanus (horse) serum. Less commonly, the react ion occurs af ter a
par t icular food or drug has been taken by mouth.
ANTIBODY
An antibody is a protein (also cal led an immunoglobul in) that is manufactured by lymphocytes (a type
of white blood cel l ) to neutral ize an antigen or foreign protein. Bacter ia , v i ruses and other
microorganisms commonly contain many antigens, as do pol lens, dust mites , molds, foods, and other
substances. Although many types of ant ibodies are protect ive, inappropriate or excessive formation
of ant ibodies may lead to i l lness . When the body forms a type of ant ibody cal led IgE ( immunoglobul in
E) , a l lergic rhinit is , asthma or eczema may result when the pat ient is again exposed to the substance
which caused IgE antibody formation (al lergen) .
ANTIGEN
An antigen is a substance that can tr igger an immune response, result ing in production of an
antibody as par t of the body 's defense against infect ion and disease. Many antigens are foreign
proteins (those not found natural ly in the body) . An al lergen is a special type of ant igen which causes
an IgE antibody response.
ANTIHISTAMINE DRUGS
Antihistamines are a group of drugs that block the effects of histamine, a chemical released in body
f luids during an al lergic react ion. In rhinit is , ant ihistamines reduce i tching, sneezing, and runny nose.
ANTI-INFLAMMATORY DRUGS
Anti- inf lammator y drugs reduce the symptoms and s igns of inf lammation. Although not a drug,
immunotherapy ("al lergy shots") reduces inf lammation in both al lergic rhinit is and al lergic asthma.
ASTHMA
Asthma is a chronic , inf lammator y lung disease character ized by recurrent breathing problems.
People with asthma have acute episodes or when the air passages in their lungs get narrower, and
breathing becomes more dif f icult . Sometimes episodes of asthma are tr iggered by al lergens,
a lthough infect ion, exercise, cold air and other factors are also impor tant tr iggers .
RESOURCES
©Jortay 2018. All Rights Reserved. 49
BRONCHITIS
Bronchit is is an inf lammation of the bronchi ( lung air ways) , result ing in persistent cough that
produces considerat ion quantit ies of sputum (phlegm). Bronchit is is more common in smokers and in
areas with high atmospheric pol lut ion.
BRONCHODILATOR DRUGS
Bronchodi lators are a group of drugs that widen the air ways in the lungs.
BRONCHUS
Any of the larger air passages that connect the trachea (windpipe) to the lungs. The plural form of
"bronchus" as "bronchi ."
CONTACT DERMATITIS
Contact dermatit is is an inf lammation of the skin or a rash caused by contact with var ious substances
of a chemical , animal or vegetable nature. The react ion may be an immunologic response or a direct
toxic effect of the substance. Among the more common causes of a contact dermatit is react ion are
detergents lef t on washed clothes, nickel ( in watch straps, bracelets and necklaces, and the
fastenings on underclothes) , chemicals in rubber gloves and condoms, cer tain cosmetics , plants such
as poison ivy, and topical medicat ions.
CORTICOSTEROID DRUGS
Cor t icosteroids are a group of ant i- inf lammator y drugs s imi lar to the natural cor t icosteroid
hormones produced by the cor tex of the adrenal glands. Among the disorders that of ten improve
with cor t icosteroid treatment include asthma, al lergic rhinit is , eczema and rheumatoid ar thr it is .
DIGESTIVE SYSTEM
The digest ive system is the group of organs that breaks down food into chemical components that
the body can absorb and use for energy and for bui lding and repair ing cel ls and t issues.
ECZEMA
An inf lammation of the skin, usual ly causing i tching and sometimes accompanied by crust ing, scal ing
or bl isters . A type of eczema of ten made worse by al lergen exposure is termed "atopic dermatit is" .
EPINEPHRINE
Epinephrine is a natural ly occurr ing hormone, also cal led adrenal ine. I t is one of two chemicals ( the
other is norepinephrine) released by the adrenal gland. Epinephrine increases the speed and force of
hear t beats and thereby the work that can be done by the hear t . I t di lates the air ways to improve
breathing and narrows blood vessels in the skin and intest ine so that an increased f low of blood
reaches the muscles and al lows them to cope with the demands of exercise. Epinephrine has been
produced synthetical ly as a drug s ince 1900. I t remains the drug of choice for treatment of
anaphylaxis .
EXTRINSIC ASTHMA
Extr insic asthma is asthma that is tr iggered by an al lergic react ion, usual ly something that is inhaled.
©Jortay 2018. All Rights Reserved. 50
HAY FEVER
See Rhinit is .
HISTAMINE
Histamine is a chemical present in cel ls throughout the body that is released during an al lergic
react ion. Histamine is one of the substances responsible for the symptoms on inf lammation and is
the major reason for running of the nose, sneezing, and itching in al lergic rhinit is . I t a lso st imulates
production of acid by the stomach and narrows the bronchi or air ways in the lungs.
HIVES
See Ur t icar ia .
IMMUNE SYSTEM
The immune system is a col lect ion of cel ls and proteins that works to protect the body from
potential ly harmful , infect ious microorganisms (microscopic l i fe-forms) , such as bacter ia , v i ruses
and fungi . The immune system plays a role in the control of cancer and other diseases, but also is the
culpr it in the phenomena of al lergies , hypersensit iv i ty and the reject ion of transplanted organs,
t issues and medical implants .
IMMUNOGLOBULINS
Immunoglobul ins , a lso known as antibodies , are proteins found in blood and in t issue f luids .
Immunoglobul ins are produced by cel ls of the immune system cal led B-lymphocytes. Their funct ion
is to bind to substances in the body that are recognized as foreign antigens (of ten proteins on the
sur face of bacter ia and viruses) . This binding is a crucial event in the destruct ion of the
microorganisms that bear the antigens. Immunoglobul ins also play a central role in al lergies when
they bind to antigens that are not necessar i ly a threat to health and provoke an inf lammator y
react ion.
IMMUNOTHERAPY
Immunotherapy ("al lergy shots") is a form of preventive and anti- inf lammator y treatment of al lergy
to substances such as pol lens, house dust mites , fungi , and st inging insect venom. Immunotherapy
involves giv ing gradual ly increasing doses of the substance, or al lergen, to which the person is
a l lergic . The incremental increases of the al lergen cause the immune system to become less sensit ive
to the substance, perhaps by causing production of a par t icular "blocking" antibody, which reduces
the symptoms of al lergy when the substances is encountered in the future.
INFLAMMATION
Inf lammation is the redness, swel l ing, heat and pain in a t issue due to chemical or physical injur y, or
to infect ion. I t is a character ist ic of al lergic react ions in the nose, lungs, and skin.
INTRINSIC ASTHMA
Intr insic asthma is asthma that has no apparent external cause.
LYMPHOCYTE
A lymphocyte is any of a group of white blood cel ls of crucial impor tance to the adaptive par t of the
©Jortay 2018. All Rights Reserved. 51
body's immune system. The adaptive por t ion of the immune system mounts a tai lor-made defense
when dangerous invading organisms penetrate the body 's general defenses.
MAST CELL
Mast cel ls play an impor tant role in the body 's al lergic response. Mast cel ls are present in most body
t issues, but are par t icular ly numerous in connective t issue, such as the dermis ( innermost layer) of
skin. In an al lergic response, an al lergen st imulates the release of ant ibodies , which attach
themselves to mast cel ls . Fol lowing subsequent al lergen exposure, the mast cel ls release substances
such as histamine (a chemical responsible for al lergic symptoms) into the t issue.
RAST
RAST is an abbreviat ion for RadioAl lergoSorbent Test , a trademark of Pharmacia Diagnost ics , which
or iginated the test . RAST is a laborator y test used to detect IgE antibodies to specif ic a l lergens.
RESPIRATORY SYSTEM
The respirator y system is the group of organs responsible for carr ying oxygen from the air to the
bloodstream and for expel l ing the waste product carbon dioxide.
RHINITIS
Rhinit is is an inf lammation of the mucous membrane that l ines the nose, of ten due to an al lergy to
pol len, dust or other airborne substances. Seasonal al lergic rhinit is a lso is known as "hay fever," a
disorder which causes sneezing, i tching, a runny nose and nasal congest ion.
SINUS
The s inuses (paranasal s inuses) are air cavit ies within the facial bones. They are l ined by mucous
membranes s imi lar to those in other par ts of the air ways.
SINUSITIS
Sinusit is is inf lammation of the membrane l ining the facial s inuses, of ten caused by bacter ia l or v iral
infect ion.
THEOPHYLLINE
Theophyl l ine is a bronchodi lator drug, given by mouth, that widens the air ways to the lung. I t a lso is
used to prevent attacks of apnea (cessat ion of breathing) in premature infants and to treat hear t
fa i lure because i t st imulates hear t rate and increases ur ine excret ion.
URTICARIA
Urticar ia is a skin condit ion, common known as hives , character ized by the development of i tchy,
raised white lumps surrounded by an area of red inf lammation.
The Role of Immunotherapy in the Treatment of Asthma
AHRQ Comparat ive Effect iveness Reviews, No. 196
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w w w . j o r t a y a l l e r g y . c o m
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