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Immunotherapy (Primary Care Clinical Sites) (102.080)

Immunotherapy (Primary Care Clinical Sites) (102.080) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, Medications, Drug-Specific

102.080

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UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE

TITLE: IMMUNOTHERAPY: (Primary Care Clinical Sites)

Effective Date: May, 2006 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education

Reviewed April, 2008 August, 2011 June, 2012


PURPOSE: To provide guidelines for the effective and safe administration of
immunotherapy (allergy injections) by authorized personnel at UWMF Family Practice
and Internal Medicine Clinics.

DEFINITION: Immunotherapy is the current term used to describe the administration of
gradually increasing quantities of an allergenic antigen to a person with allergic disease.
The patient requires increasing doses of the allergen to help the body’s immune system
make a protective response versus an allergic response. The goal is to decrease the
patient’s sensitivity to the allergens and to reach maintenance dose level of the antigen.
Once a maintenance dosage is reached, the injections are usually administered every two
to four weeks to build and/or maintain tolerance.
Authorized personnel are clinical staff (ie RN/LPN/CMA) trained in giving
immunotherapy who have the ability to recognize early signs of anaphylaxis, who
possess the ability to initiate appropriate emergency procedures and who can administer
emergency medications (under protocol) in the event of an anaphylactic reaction.
Minors are defined as persons less than 18 years of age.

POLICY:
 Patients receiving allergy injections must be under the care of a UWMF Allergist.
*New patients to the UWMF system must see a UWMF Allergist before
continuing their allergy injections if they have been initiated at another
allergy clinic.
 There must be a UWMF provider (MD/NP/PA) at the clinic they are receiving
their allergy injections who is willing to take responsibility for their care, who has
access to their medical record, and who is competent in identifying and treating
anaphylaxis.
 All allergy antigens will be delivered from the UWMF Allergy clinic.
o After review by a UWMF Allergist, provisions may be made for patients
transferring into the UWMF System to complete an open antigen vial from
the patient’s former clinic.
 Changes in dosages/protocols will be established by the patient’s UWMF
Allergist.
 All ‘new’ staff giving allergy injections will be provided training through one of
the following: Allergy Injection Presentation provided through the UWMF
Clinical Staff Education Department, onsite training by allergy staff, or training at

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the UWMF Allergy clinic. Any new clinics giving allergy shots will be provided
with an ‘onsite’ Allergy Injection in-service by the UWMF Allergy Department.
New staff cannot give allergy injections without receiving the required training.
 Minors or adults, who are not their own POA, must have a parent, legal guardian,
or agent in the clinic during the allergy injection and for the 30 minute post
injection waiting period.


PROCEDURE:

1. Check provider’s order and clarify any questions with the provider.

2. A UWMF provider (MD/NP/PA) must be on the premises during antigen
administration. The provider should be able to manage anaphylaxis (adequately
trained and skilled), including administration of epinephrine.

Note: Allergy injections should not be given if there is not a UWMF provider
(MD/NP/PA) present in the clinic because of the potential for an allergic reaction
to the allergy injection!

3. Review:
 The clinic’s Code Blue Policy
 Location of emergency equipment (crash cart, oxygen, suction)
 The Anaphylactic Protocol.
 If a systemic reaction is suspected the INITIAL TREATMENT is IM
Epinephrine, NOT Benedryl!
 Location of Epinephrine (1:1,000) or Epi-Pen
4. Wash hands and gather equipment.

5. Use triple check system for drawing up allergy injections – read label before, during
and after drawing up antigen, checking the patient’s name on both the antigen and
cover page of patient’s antigen schedule, antigen, and vial # with corresponding
schedule. Read the Allergy ‘protocol’ page provided with each patient’s antigen
schedule for specific information.

6. Introduce yourself and identify the patient, while you provide privacy.

7. Explain procedure to the patient and answer patient questions.
Questions to ask a patient prior to administering any immunotherapy:
 Do you have your Epi Pen with you today?
o Patients must bring their Epi Pen to all allergy clinic visits. Epi
Pens are required because of the risk of a delayed systemic allergic
reaction which starts several hours after the injection. Although
rare, delayed reactions do occur. If the patient does not have their

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Epi Pen, the allergy injection should not be given. Any questions
should be directed to the Allergy Clinic Injection room at 608-287-
2600.
 Are you healthy today?
o If patient has fever, consult a physician. Patients should be on
antibiotics 4-5 days and feeling better before receiving an allergy
injection.
 How is your asthma today?
o If patient is having any asthmatic symptoms, please consult
Allergy Clinic Injection room at 608-287-2600.
 How are your allergies today?
o If patient is having any allergy symptoms, , please consult Allergy
Clinic Injection room at 608-287-2600.
 How did you do after your last allergy injection?
o If more than a location reaction, please consult Allergy Clinic
Injection room at 608-287-2600.
 Are you pregnant, on beta blockers, and/or have you had a bee sting in the
last week?
o Please consult Allergy Clinic Injection room at 608-287-2600.

If you are unsure if you should administer the antigen – Check with the Allergy
Clinic Injection room at 608-287-2600 before giving injection.

8. Administer the allergy antigen via a subcutaneous injection.

 Prep site with alcohol.
 Be sure to aspirate as severe reactions may occur following an IV injection.
 Use an allergy tray syringe - 1mL, 27g x 3/8 inch.
 Do not apply a Band-Aid to the injection site after the injection.
 Have patient (guardian/agent) remain in clinic for 30 minutes post injection.
Do not give the allergy injection if the patient is unable/unwilling to wait
30 minutes. The majority of allergy injection reactions occur within 30
minutes of the injection. If there are any questions or problems with the wait
time, contact the Allergy Clinic injection room or advise the patient to make
an appointment with his/her allergist to discuss any questions or concerns
about the wait time.
 Instruct patient/guardian to notify the staff if signs of a reaction occur.
 Observe patient every 10 minutes while in clinic.
 If patient is receiving his/her first allergy injection, provide patient education
materials regarding allergy injections.
 Instruct/remind patient to have their arm(s) checked before leaving the clinic.

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9. Document on the patient’s “injection schedule” form/patient’s allergy record:
Note: If antigen paperwork is from a non UWMF facility, documentation should
be done on that form and the UWMF Standard Allergy form.

 The date, dose, vial#, site of injection, and the time the injection was given.
 Any questions from the patient/guardian.
 Any patient teaching provided.
 How the patient tolerated the injection.
 Complications (if any).
 Refusal to remain for the 30 minutes post injection.

10. Charge for injections given, using appropriate billing sheet or in HealthLink.
 95115- one injection
 95117- 2 or more injections
 Diagnosis code: 477.0

REVISED/REVIEWED BY: Dr. Thomas Puchner, Allergy Clinic
Dr. Healy, Christopher, Allergy Clinic
Dr. Robert Kriz, Allergy Clinic
Dr. Michael Ritter, Allergy Clinic

WRITTEN BY: Ronnie Peterson, RN, MS, Manager of Clinical Support

REFERENCES: Immunotherapy: A Practical Review and Guide; Volume 20,
Number 1 August 2000.

AUTHORIZATION:



Medical Director Date