Allergy Administration Procedure
Manual: Patient Care
Review Date: March 2010
Because of convenience and logistic factors, allergy extracts are often prepared by specialists
for administration at InterCare facilities.

A physician will always be present and immediately available in case of allergic
reaction following the injection of protein extracts.

Aqueous epinephrine 1:1,000 must be available for instantaneous use. Provisions for
maintaining an open airway should be in place.

Maintain absolute requirement for at least 20 minutes office observation after each
injection.
I. Before Administering Allergy Injection:
A.
Verify proper vial or container of extract, including patient’s name, allergen content and
proportions, strengths (dilutions), and dates of expiration of each ingredient.
B.
Ask, “Did you have any problems with the previous injection such as swelling or hives”?
Any trouble breathing, or wheezing? — Do not give injection if patient is wheezing
Are you currently sick with a fever? — Do not give injection if patient has a fever
Are you on beta blocker medication? — Do not give injection if patient on beta blocker
1. DO NOT give injection if patient has asthma flare up
2. DO NOT give injection if peak flow is less than 80% of their best (asthmatic
patients).
II. Assess Patient if on ‘MAINTENANCE’ and Missed a Scheduled Injection:
A.
By 1-2 weeks: Increase according to schedule.
B.
By 3-4 weeks: Repeat last dose.
C.
By 5-7 weeks: Decrease dose by 25% for each week over 4 weeks .
D.
Over 7 weeks: Call the allergy specialist’s office for instructions before administering
injection.
III. Assess Patient if on ‘BUILD UP’ Protocol and Missed a Scheduled Injection:
A.
Less than 10 days: Increase to next scheduled dose
B.
11 - 14 days: Repeat last dose given...THEN increase dose weekly until schedule is
completed.
C.
15 - 41 days: Decrease one dose for each week late...THEN increase dose weekly until
schedule is completed.
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Allergy Administration Procedure
Manual: Patient Care
D.
Review Date: March 2010
Over 6 weeks: Call the allergy specialist’s office for instructions before administering
injection.
IV. Technique of Administration of Allergy Injections:
A.
Record date, site and any adverse reactions* from previous injections.
B.
Discuss any adverse reactions* with physician PRIOR TO giving injection.
C.
If no adverse reaction* from previous injection: Proceed to draw up correct dosage.
D.
Dosage prescription, patient, and prepared syringe of extract to be double checked!
The person drawing up the dose and administering it, plus one other nurse:
1.
2.
3.
4.
check for correct vial or bottle of extract
check for correct dosage
check patient identification
both sign off on allergy record sheet
E.
Use 26 or 27 gauge 3/8 or ½ inch needle.
F.
Identify patient using 2 identifiers, i.e. name, D.O.B., SSN.
G.
Inject in the posterior aspect of the middle third of the upper arm.
H.
Aspirate plunger prior to injecting to determine if the needle is in a blood vessel.*
* IF ANY BLOOD appears, withdraw needle, dispose of syringe, and start over by
drawing up a new extract (See “D” above).
I.
Compress injection site for 60 seconds with cotton ball. Do not rub.
1. Patient should not exercise for two hours after allergy injection.
2. If swelling occurs, applying an ice pack may help to reduce local reaction.
3. Take antihistamine if haven’t already done so. Apply hydrocortisone cream if
needed.
4. A local reaction after 20-30 minutes is not unexpected: See “Reactions” below:
V. Local Reactions
A. A lump or swelling with erythema is not as significant as a lump with a WHEAL
1. WHEAL = hive-like appearance
2. The WHEAL is the most significant part of the local reaction.
3. If WHEAL has pseudopods or is surrounded by hives, consult allergy specialist!
a. “Negative” = swelling to 15mm (dime size): ... progress according to
schedule.
b. Swelling 15-20mm (dime to nickel size) ... repeat same dose*
c. Swelling 20-25 mm (nickel to quarter size) ... return to last dose which
caused no reaction.
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Allergy Administration Procedure
Manual: Patient Care
*
Review Date: March 2010
d. Swelling persisting more than 12 hours or over 25mm (quarter size) ...
decrease dosage by 50%.
If reduced dose is tolerated, increase dose by 0.05 weekly and resume schedule. If local reaction
occurs again, patient should be seen by the allergy specialist and bring dosing sheet!
VI. Systemic Reactions
A. NOTIFY PHYSICIAN IMMEDIATELY FOR ORDERS
B. Adults: Give 0.3CC of Epinephrine (1:1000) subcutaneously
Children:
Give 0.01 MG/KG up to 0.3 CC.
C. MONITOR BP / pulse, respirations (if in respiratory distress)
D. MONITOR patient for ½ to 1 hour after resolution of symptoms
E. FOR SEVERE REACTIONS, prescribe Epi-Pen or Ani-Kit to use in case of recurrent delayed
reaction.
F. MAINTAIN PATIENT ON ANTIHISTAMINES FOR 24 HOURS. Have patient bring extract to
allergy specialist’s office for the next injection. Send documentation of reaction with patient.
IF SYSTEMIC REACTION:
Hives, wheezing, itching, hypotension, tightness of chest, etc., after patient leaves the office,
(even up to six hours later), patient must return to the physician’s office or go to the nearest
emergency room.
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