Determine When Skin Testing, Test Doses and Desensitization are Appropriate
|
|
- Verity Matthews
- 7 years ago
- Views:
Transcription
1 Determine When Skin Testing, Test Doses and Desensitization are Appropriate David A. Khan, MD Professor of Medicine Allergy & Immunology Program Director Division of Allergy & Immunology 1
2 Disclosures Research Grants NIH, Vanberg Family Fund Speaker Honoraria Merck, Genentech, Viropharma, Baxter Organizations: Joint Task Force on Practice Parameters
3 Objectives Be able to identify patients appropriate for drug skin testing Be able to identify patients appropriate for drug challenges Be able to identify patients appropriate for drug desensitization
4 Case 1 The Role of Drug Skin Testing
5 Drug Skin Testing Penicillin is only drug with well-validated outcomes Skin testing with platinum-based chemotherapeutics of value Skin testing for drug-induced anaphylaxis may be helpful Skin testing for most other drugs and other reaction types of unclear benefit 5
6 Penicillin Skin Testing Penicillin skin testing using PRE-PEN and PCN-G has good negative predictive value (96-99%) in excluding penicillin allergy Some of these studies may have excluded penicillin anaphylaxis Macy E et al. JACI In Practice 2013;1: Solensky R, Khan DA et al. Ann Allergy Asthma Immunol 2010;105:273e1-e78. delreal GA, et al. Ann Allergy Asthma Immunol 2007;98: Green GR, et al. J Allergy Clin Immunol1977;60: Brown BC, et al. JAMA1964;189:
7 PRE-PEN & PCN-G 500 patients with history of PCN allergy Rash (40%), hives/ae (34%), unknown (14%), other (8%), anaphylaxis (2.8%) Mean time since reaction 20 years 496 negative skin tests underwent amoxicillin challenge 15/496 had subjective symptoms (e.g. itching) with amoxicillin challenge 4/496 had urticaria within 1 hr with amoxicillin challenge NPV= % Macy E et al. JACI In Practice 2013;1:
8 Drug-Induced Anaphylaxis Case 40 year old woman with history of recurrent urinary tract infection developed confusion, nausea, dyspnea, chest pain, sensation of throat closure, facial swelling, generalized erythema, pruritus, and collapse within 20 minutes after the first dose of cotrimoxazole and an energy drink. Treated with epinephrine 0.3mg IM x 2 at pediatric ED and transferred to a nearby adult emergency department where BP was 87/46 mmhg Resolution of hypotension after 3 rd dose of epinephrine and IV fluids
9 Drug-Induced Anaphylaxis Case Patient remains unconvinced that sulfonamide antibiotic was the cause of her anaphylaxis Skin testing to TMP/SMX performed using a nonirritating dose
10 Skin testing for Antibiotics There are no validated diagnostic tests for evaluation of IgE-mediated allergy to nonpenicillin antibiotics Skin testing with non-irritating concentrations of non-penicillin antibiotics established for 15 commonly used antibiotics A negative skin test result does not rule out the possibility of an immediate-type allergy Positive skin test results to a drug concentration known to be nonirritating suggests the presence of drug-specific IgE Empedrad R et al. J Allergy Clin Immunology 2003;112:629.
11 Antimicrobial drug Nonirritating concentration Full-strength concentration Dilution from full strength azithromycin 10 µg/ml 100 mg/ml 1:10,000 cefotaxime 10 mg/ml 100 mg/ml 1:10 cefuroxime 10 mg/ml 100 mg/ml 1:10 cefazolin 33 mg/ml 330 mg/ml 1:10 ceftazidime 10 mg/ml 100 mg/ml 1:10 ceftriaxone 10 mg/ml 100 mg/ml 1:10 clindamycin 15 mg/ml 150 mg/ml 1:10 cotrimoxazole 800 µg/ml 80 mg/ml 1:100 erythromycin 50 µg/ml 50 mg/ml 1:1000 gentamicin 4 mg/ml 40 mg/ml 1:10 levofloxacin 25 µg/ml 25 mg/ml 1:1000 imipenem/cilastin 0.5 mg/ml 500 mg/100 ml 1:10 meropenem 1 mg/ml 50 mg/ml 1: 50 nafcillin 25 µg/ml 250 mg/ml 1:10,000 ticarcillin 20 mg/ml 200 mg/ml 1:10 tobramycin 4 mg/ml 80 mg/2 ml 1:10 vancomycin 5 µg/ml 50 mg/ml 1:10,000 Khan DA. Drug Allergy. In Manual of Allergy & Immunology 5 th Ed. 2012
12 Positive Trimethoprim-Sulfamethoxazole Skin Test
13 Case 2 The Role of Drug Challenge
14 Terminology Drug Challenge Test dosing Drug provocation test Graded dose challenge Incremental challenge
15 Definition of Drug Challenge The intention of a drug challenge is to verify that a patient will not experience an adverse reaction to a given drug Intended for patients who are unlikely to be allergic to the given drug Graded challenge or test dosing describes administration of progressively increasing doses of a medication until a full dose is reached Some test doses may be full therapeutic doses Solensky R, Khan DA et al. Ann Allergy Asthma Immunol 2010;105:273e1-e78.
16 Multiple Drug Allergy Case 38 yo woman with multiple drug-induced anaphylaxis Listed Drug Allergies RhoGAM Ciprofloxacin Ceftriaxone Amoxicillin Also reports episodes of crawling skin, nasal congestion, few non-pruritic skin lesions, throat tightness Treated with prednisone (up to 400 mg/d) for months at a time
17 RhoGAM Symptoms with Drug Reactions After 15 minutes, urticaria, throat tightness, BP 90/50 mm Hg, dyspnea, sense of impending doom Subsequent drug reactions: Usually within minutes of 1 st dose Itching, tingling lips, throat tightness, dysphonia, cough Other triggers Certain toothpastes, perfumes
18 Multiple Drug Allergy Case Skin testing with non-irritating concentration of ceftriaxone negative Penicillin skin tests negative What would you recommend now? A. Continued avoidance of all listed drugs due to anaphylactic history B. Drug desensitization if listed antibiotic required C. Graded challenge D. Full therapeutic dose challenge
19 Drug Anaphylaxis Case Due to doubtful reaction history patient given full therapeutic dose of ciprofloxacin 12 minutes later had itching of palms, lip numbness, and mild throat tightness BP 133/83, P 132 Over next 5 minutes symptoms more severe, with worsening throat tightness BP 142/96, P 142 Laryngoscopy performed and revealed VCD with arytenoids completely adducting with inspiration Symptoms resolved with reassurance and relaxation
20 Drug-Induced Vocal Cord Dysfunction (VCD) Often mistaken for anaphylaxis Primary and most severe symptom is isolated throat tightness Often have histories of multiple drug anaphylaxis from structurallyunrelated drugs Lack objective angioedema elsewhere Khan DA. Ann Allergy Asthma Immunol 110 (2013) 2-6.
21 Role of Drug Challenges Drug challenges are an important tool in diagnosis and management of drug allergic patients With careful assessment of patients and appropriately designed protocols, drug challenges can be safely performed in your office Patients with > 10 listed allergies and subjective symptoms at higher risk for subjective symptoms with drug challenge Kao L et al. Ann Allergy Asthma Immunol 110 (2013) 86e91.
22 Benefit of Drug Challenges The real benefit of drug challenges is that it answers the question (Is the patient allergic to the drug?) Avoids unnecessary repeated empiric desensitizations Great service the practicing allergist can provide to patients and referring physicians
23 New Code for Oral Challenge Ingestion Challenge Higher RVUs Minimum of 61 minutes required Likely requires a graded challenge Stay tuned on this No E&M should be billed in conjunction with this code
24 Case 3 Drug Desensitization
25 Case of Macrolide Allergy A 68-year-old woman developed urticaria and shortness of breath six days into a course of clarithromycin for Mycobacterium avium intracellulare infection Her pulmonologist advised her to take a test dose of azithromycin 250 mg. Within an hour she developed urticaria, shortness of breath, and throat tightness resulting in an emergency department visit. Swamy N et al. Ann Allergy Asthma Immunol 2010;105:
26 Macrolide Allergy Case: Confirmed with Skin Tests Swamy N et al. Ann Allergy Asthma Immunol 2010;105:
27 Role of Drug Desensitization Penicillin and chemotherapy desensitization protocols have been studied the most Similar desensitization principles can be used for other drugs Most drug desensitizations associated with ~ 1/3 risk of reactions during desensitizations severe anaphylactic reactions are rare Choice of location depends on treatment facilities, experience, drug, and patient factors
28 Drug Challenge vs Drug Desensitization Likelihood of drug allergy Challenge low Desensitization high # steps 1-3 > 12 Dosing increments 10-fold 2-fold Diagnostic test yes no Induces drug tolerance Must be repeated prior to drug readministration Reactions with procedure no no yes yes < 10% ~ 30% 28
29 Drug Desensitizations Indicated for patients with: High likelihood or confirmed drug allergy e.g. + skin test In need of culprit drug where no therapeutic alternative exists
30 Basic Template of Drug Desensitization Protocols Typical starting dose is 1/10,000 th of target therapeutic dose Can also use calculated dose from skin test as starting point Further dosage increases are typically double the previous dose Administered at minute intervals until therapeutic dosage achieved
31 Oral Penicillin Desensitization Wendel GD et al. New Engl J Med 1985;312:
32 Intravenous Desensitization Protocol Castells MC. Curr Opin Allergy Clin Immunol 2006;6:
33 Oral Clarithromycin Desensitization Protocol Swamy N et al. Ann Allergy Asthma Immunol 2010;105:
34 Back to the Case Clarithromycin desensitization performed in the office No adverse reactions developed during the desensitization After the desensitization she began routine administration of clarithromycin 500 mg twice a day and received this dose over the following three months She tolerated the treatment course without any adverse effects, and had resolution of her respiratory symptoms
35 Conclusions Other than penicillin skin testing, drug skin testing has a limited utility when negative, but when positive can be helpful Drug challenges are an underutilized tool and with careful selection of patients, can be done safely in the office Drug desensitizations are effective when used appropriately but are often over utilized instead of performing a drug challenge
Emergency Anaphylaxis Management: Opportunities for Improvement. Ronna Campbell, MD, PhD August 31, 2015
Emergency Anaphylaxis Management: Opportunities for Improvement Ronna Campbell, MD, PhD August 31, 2015 disclosures Anaphylaxis Roundtable discussion held at the 2014 American College of Allergy, Asthma
More informationAnaphylaxis before and after the emergency
Anaphylaxis before and after the emergency Mike Levin Paediatric Asthma and Allergy Division University of Cape Town Red Cross Hospital michael.levin@uct.ac.za http://www.scah.uct.ac.za/scah/clinicalservices/medical/allergy
More informationEpinephrine Auto-Injectors & Trends in Oral Immunotherapy
Epinephrine Auto-Injectors & Trends in Oral Immunotherapy Erika Gonzalez-Reyes, MD Chief of Allergy, Immunology & Rheumatology Associate Professor of Clinical Pediatrics Baylor College of Medicine Children
More informationPRIMARY CARE PRACTICE GUIDELINES
1 of 6 1. OUTCOME To identify anaphylaxis in the primary care setting and provide an evidence informed emergency response utilizing the most current provincial and federal practice guidelines. 2. DEFINITIONS
More informationAllergy Action Plan For the 2015-2016 School Year
Allergy Action Plan Student s Name: DOB Grade ALLERGY TO: Asthmatic: Yes*[ ] No [ ] *Higher risk for severe reaction! STEP 1 TREATMENT Symptoms: Give checked medication To be determined by physician authorizing
More informationHow to Submit a School Epinephrine Report
1. INTRODUCTION AND INSTRUCTIONS Dear School Nurse, The revised Regulations Governing the Administration of Prescription Medications in Public and Private Schools (105 CMR 210.000) require schools to submit
More informationAnaphylaxis: Treatment in the Community
: Treatment in the Community is likely if a patient who, within minutes of exposure to a trigger (allergen), develops a sudden illness with rapidly progressing skin changes and life-threatening airway
More informationAllergies: ENT and Allergy Center of Missouri YOUR GUIDE TO TESTING AND TREATMENT. University of Missouri Health Care
Allergies: YOUR GUIDE TO TESTING AND TREATMENT ENT and Allergy Center of Missouri University of Missouri Health Care 812 N. Keene St., Columbia, MO 65201 (573) 817-3000 www.muhealth.org WHAT CAUSES ALLERGIES
More informationAnaphylaxis and other adverse events
Anaphylaxis and other adverse events Aim: To be able to manage anaphylaxis and other adverse events correctly Learning outcomes Define local and systemic adverse events Distinguish between anaphylaxis
More informationSMO: Anaphylaxis and Allergic Reactions
REGION I EMERGENCY MEDICAL SERVICES STANDING MEDICAL ORDERS EMT Basic SMO: Anaphylaxis and Allergic Reactions Overview: Allergic reactions can vary in severity from a mild reaction consisting of hives
More informationProtocol for Management of Suspected Anaphylactic Shock
Protocol for Management of Suspected Anaphylactic Shock COMMUNICABLE DISEASE CONTROL Summary of First Steps for Suspected Anaphylaxis Signs and Symptoms: Within minutes signs/symptoms can develop and do
More informationAdrenaline autoinjector (EpiPen) for acute allergic anaphylaxis
for acute allergic anaphylaxis This review of adrenaline autoinjector was first published in December 2003. This update describes the change to the PBS listing to allow prescribing immediately after hospital
More informationImmunology, J Allergy Clinical Immunology 1998; Vol.102, No. 2, 173-175.
DATA HEALTH BRIEF: EPINEPHRINE ADMINISTRATION IN SCHOOLS Massachusetts Department of Public Health Bureau of Community Health Access and Promotion School Health Unit August 1, 21 July 31, 211 (School Year
More informationAnaphylaxis: A Life Threatening Allergic Reaction
Anaphylaxis: A Life Threatening Allergic Reaction What is Anaphylaxis? Anaphylaxis is a sudden, severe, and potentially fatal allergic reaction that can cause a wide range of symptoms, including breathing
More informationAppendix 7 Anaphylaxis Management
Appendix 7 Anaphylaxis Management Anaphylaxis: Initial Management in Non-Hospital Settings This section is intended for the initial management of patients in a public health clinic, medical office or similar
More informationEMT-B Epinephrine Training Module. Dr. Danielle Campagne Dr. Rawnie Ruegner UCSF-Fresno Department of Emergency Medicine January, 2008
EMT-B Epinephrine Training Module Dr. Danielle Campagne Dr. Rawnie Ruegner UCSF-Fresno Department of Emergency Medicine January, 2008 Objectives Review of Allergic Reactions Review Protocols and Procedure
More informationLIFE-THREATENING ALLERGIES POLICY
CODE: C.012 Program LIFE-THREATENING ALLERGIES POLICY CONTENTS 1.0 PRINCIPLES 2.0 POLICY FRAMEWORK 3.0 AUTHORIZATION 1.0 PRINCIPLES 1.1 Halifax Regional School Board will maximize the safety of students
More informationMARYLAND STATE SCHOOL HEALTH SERVICES GUIDELINES
Department of Health and Mental Hygiene Maryland State Department of Education Maryland State School Health Council MARYLAND STATE SCHOOL HEALTH SERVICES GUIDELINES Emergency Management Guidelines for
More informationManagement of an anaphylactic reaction to Omalizumab (Xolair) drug therapy
Management of an anaphylactic reaction to Omalizumab (Xolair) drug therapy Turnberg Building Respiratory Medicine 0161 206 3158 All Rights Reserved 2014. Document for issue as handout. What is an allergic
More informationPARENT/GUARDIAN REQUEST: ADMINISTRATION OF EMERGENCY EPINEPHRINE, ANAPHYLAXIS CARE PLAN/ IHP & IEHP
IEF Elementary School 105 Andrew Street, Green Brook, N.J. 08812 School Nurse: Mrs. Ostrander Office Phone: 732-9681052 ext. # 3 Fax: 732-968-0791 Green Brook Township Public Schools Green Brook Middle
More informationThis annual data report demonstrates findings consistent with previous reports:
DATA HEALTH BRIEF: EPINEPHRINE ADMINISTRATION IN SCHOOLS Massachusetts Department of Public Health Bureau of Community Health Access and Promotion School Health Unit August 1, 29 July 31, 21 (School Year
More informationTreatment of Fever and Infection in Children with Transfusion Dependent Thalassaemia
Treatment of Fever and Infection in Children with Transfusion Dependent Thalassaemia Document Information Version: 2 Date: June 2014 Authors (incl. job title): Professor David Rees, Sue Height (consultant
More informationAnaphylaxis Recognition and Out of Hospital Management
Western Canada Immunization Forum Anaphylaxis Recognition and Out of Hospital Management Joy Loewen, Manager Province-wide Immunization Program March 6, 2014 1 Presenter Disclosure Joy Loewen Relationships
More information1. Dosing Schedule: your customized schedule of your weekly injections as provided by the center.
Home Immunotherapy Raza Pasha, MD Congratulations. You are now on the path to better control of your allergies. The following is your instruction guide to allow you to become more familiar with proper
More informationInfluenza Vaccine Protocol Agreement (O.C.G.A. Section 43-34-26.1)
Influenza Vaccine Protocol Agreement (O.C.G.A. Section 43-34-26.1) This Influenza Vaccine Protocol Agreement (the "Protocol") authorizes the Georgia licensed pharmacists (the "Pharmacists") or nurses (
More informationMEDICATION MANUAL Policy & Procedure
MEDICATION MANUAL Policy & Procedure TITLE: Section: Initial Management of Anaphylaxis Following Immunization Medication Specific NUMBER: MM 20-005 Date Issued: October 2009 Source: Distribution: Capital
More informationAdverse Events Following Immunisation (AEFI) Noel McCarthy Thames Valley Public Health England Centre and Everybody
Adverse Events Following Immunisation (AEFI) Noel McCarthy Thames Valley Public Health England Centre and Everybody A fifteen year old with diabetes came for his MMR and was referred by the school nurse
More informationEmergency treatment of anaphylactic reactions
Emergency treatment of anaphylactic reactions Emergency treatment of anaphylactic reactions Objectives - to understand: What is anaphylaxis? Who gets anaphylaxis? What causes anaphylaxis? How to recognise
More informationEMERGENCY EPINEPHRINE AUTO-INJECTOR DEVICES Policy Code: 5024/6127/7266
EMERGENCY EPINEPHRINE AUTO-INJECTOR DEVICES Policy Code: 5024/6127/7266 Anaphylaxis is a severe systemic allergic reaction from exposure to allergens that is rapid in onset and can cause death. Many severe
More informationAnaphylaxis / Urticaria / Angioedema HSJ 29/02/12
Anaphylaxis / Urticaria / Angioedema HSJ 29/02/12 Case Study Female, 42,? Penicillin Allergy After 1 tab amoxyl, tongue/throat swelling, lips, ears Collapse, given adrenaline Had amoxycillin several times
More informationtrust clinical guideline
CG04 VERSION 1.0 1/5 Guideline ID CG04 Version 1.0 Title Approved by Allergic Reactions Clinical Effectiveness Group Date Issued 01/01/2013 Review Date 31/12/2016 Directorate Authorised Staff Clinical
More informationANTIBIOTICS IN SEPSIS
ANTIBIOTICS IN SEPSIS Jennifer Curello, PharmD, BCPS Clinical Pharmacist, Infectious Diseases Antimicrobial Stewardship Program Ronald Reagan UCLA Medical Center October 27, 2014 The power of antibiotics
More informationFood Allergies. Food Allergy statistics: True Prevalence of Food Allergy
Food Allergies Food Allergies Food Allergy statistics: 11 million Americans, including adults 6% of US children 2% of adults have shellfish allergy True Prevalence of Food Allergy Patient/Parent Self Report
More informationStudents 4000 OP 4.550. Anaphylaxis in Schools
Students 4000 OP 4.550 Anaphylaxis in Schools BACKGROUND The District recognizes it has a duty of care to students who are at risk from life-threatening allergic reactions while under school supervision
More informationYoon Nofsinger, M.D. Tampa ENT Associates, 3450 East Fletcher Avenue, Tampa, FL 33613 Phone (813) 972-3353, Fax (813) 978 3667
Yoon Nofsinger, M.D. Tampa ENT Associates, 3450 East Fletcher Avenue, Tampa, FL 33613 Phone (813) 972-3353, Fax (813) 978 3667 General Information: Allergies and Injection Therapy 1. General: You have
More informationSection 400: Code # 453.4R
Section 400: Code # 453.4R Administering Medication Conditions for Administering Prescription Drugs Except as otherwise specifically provided by law, a school bus driver, employee, or volunteer that has
More informationTable of Contents. Page
Table of Contents 1.0 Purpose 3 2.0 Scope 3 3.0 Definition of Anaphylaxis 3 4.0 Recognition of Anaphylaxis: General Principles 3 5.0 Recognition of Anaphylactic Reaction 5 6.0 Treatment of Anaphylactic
More informationALLERGIC REACTIONS. Mary Horvath RN, CSN. M.Ed. Certified School Nurse Bridge Valley Elementary Doyle Elementary
ALLERGIC REACTIONS Mary Horvath RN, CSN. M.Ed. Certified School Nurse Bridge Valley Elementary Doyle Elementary STATISTICS Allergic reactions affect up to 15 million people in the United States, including
More informationRise of the killer peanuts
Rise of the killer peanuts Epi Then, Epi Now Taher Vohra, MD Henry Ford Hospital Department of Emergency Medicine ObjecCves To define anaphylaxis To review the epidemiology of anaphylaxis To discuss treatments
More informationUpdate on Anaphylaxis: Recognition and Treatment in a College Health Service. Eleanor W Davidson MD Sara H Lee MD February 27 2014
Update on Anaphylaxis: Recognition and Treatment in a College Health Service Eleanor W Davidson MD Sara H Lee MD February 27 2014 Our backgrounds Sara Lee Pediatrics, Adolescent Medicine Faculty, Rainbow
More informationREAD THIS FOR SAFE AND EFFECTIVE USE OF YOUR MEDICINE PATIENT MEDICATION INFORMATION. [new-ka la]
READ THIS FOR SAFE AND EFFECTIVE USE OF YOUR MEDICINE PATIENT MEDICATION INFORMATION Pr NUCALA [new-ka la] mepolizumab lyophilized powder for subcutaneous injection Read this carefully before you start
More informationANAPHYLAXIS. Introduction. Differential Diagnosis. Starship Children s Health Clinical Guideline
Introduction Differential Diagnosis Management Treatment of Anaphylaxis (Flow Chart) Disposition from Emergency Department Adrenaline Autoinjectors Action Plan Adrenaline Autoinjector Information Sheet
More informationllergy Testing: When to test, when not to and what to do with the results
llergy Testing: When to test, when not to and what to do with the results Kelly Maples, MD, FAAAAI, FACAAI Assistant Professor of Pediatrics and Internal Medicine CHKD/EVMS Sensitization Allergy The results
More informationWyckoff Administration Policy on Epinephrine Nurse, Student and or Delegate
Wyckoff Administration Policy on Epinephrine Nurse, Student and or Delegate It is the policy of this school to apply New Jersey Law N.J.S.A. 18A: 40-12.3-12.6 in the following way: The school will provide
More informationPERRYSBURG EXEMPTED VILLAGE SCHOOL DISTRICT
PERRYSBURG EXEMPTED VILLAGE SCHOOL DISTRICT MEDICATION IN SCHOOL 5330 F1/page 1 of 5 Before the student will be permitted to take medication during school hours or to use a self-administer medication and
More informationAnaphylaxis. Exceptional healthcare, personally delivered
Anaphylaxis Exceptional healthcare, personally delivered 2 Introduction Anaphylaxis (also known as anaphylactic shock) is a severe, potentially fatal allergic reaction. Anaphylaxis is caused by your body
More informationWilliam E. Berger, M.D., M.B.A. Clinical Professor Department of Pediatrics Division of Allergy and Immunology University of California, Irvine
Allergic Reactions & Access to Emergency Response William E. Berger, M.D., M.B.A. Clinical Professor Department of Pediatrics Division of Allergy and Immunology University of California, Irvine Mechanistic
More informationAdapted from the Ministry of Education BCSTA website. Interior Health
Adapted from the Ministry of Education BCSTA website Interior Health July 2013 WHAT IS AN ALLERGY? Allergies occur when the immune system becomes unusually sensitive and overreacts to common substances
More informationAnaphylaxis Management. Pic 1 Severe allergic reaction which led to anaphylaxis
1 Anaphylaxis Management Pic 1 Severe allergic reaction which led to anaphylaxis What is an allergic reaction? 2 An allergy is when someone has a reaction to something (usually a protein) which is either
More informationProtocol and Procedures for the Emergency Administration of Epinephrine
M a r i n C o u n t y O f f i c e o f E d u c a t i o n 1111 Las Gallinas Avenue San Rafael California 94903 415-472-4110 Fax: 415-491-6625 www.marinschools.org School District: Protocol and Procedures
More informationAllergy Shots and Allergy Drops for Adults and Children. A Review of the Research
Allergy Shots and Allergy Drops for Adults and Children A Review of the Research Is This Information Right for Me? This information may be helpful to you if: Your doctor* has said that you or your child
More informationBROCKTON AREA MULTI-SERVICES, INC. MEDICAL PROCEDURE GUIDE. Date(s) Reviewed/Revised:
Page 1 of 5 PROCEDURE FOR: MAP-certified staff and RN/LPN MAP-certified staff are to be trained in the use of epinephrine administration via pre-filled autoinjector devices(s) annually. Certified staff
More informationCollege of Licensed Practical Nurses of Alberta. Anaphylaxis Learning Module FOR LICENSED PRACTICAL NURSES
College of Licensed Practical Nurses of Alberta Anaphylaxis Learning Module FOR LICENSED PRACTICAL NURSES February 2005 Adapted from: The College of Licensed Practical Nurses of Alberta Immunization Certificate
More informationA ragweed pollen as a treatment for a ragweed allergy? It s called immunotherapy.
A ragweed pollen as a treatment for a ragweed allergy? It s called immunotherapy. RAGWITEK is a prescription medicine used for sublingual (under the tongue) immunotherapy to treat ragweed pollen allergies
More informationNEW YORK STATE DEPARTMENT OF HEALTH BUREAU OF EMERGENCY MEDICAL SERVICES
NEW YORK STATE DEPARTMENT OF HEALTH BUREAU OF EMERGENCY MEDICAL SERVICES TRAINING PROGRAM OUTLINE FOR UNLICENSED OR UNCERTIFIED PERSONNEL TO ADMINISTER EPINEPHRINE BY AUTO-INJECTOR IN LIFE-THREATENING
More informationVaccine Protocol Agreement. Name of Pharmacy: Address: City, State, Zip:
Vaccine Protocol Agreement Name of Pharmacy: Address: City, State, Zip: This Vaccine Protocol Agreement (the "Protocol") authorizes the Georgia licensed pharmacists (the "Pharmacists") or nurses ( Nurses
More informationGlossary of Terms. Section Glossary. of Terms
Glossary of Terms Section Glossary of Terms GLOSSARY Acute: Symptoms which can occur suddenly with a short and severe course. Adrenaclick /Generic Adrenaclick : a single use epinephrine auto-injector that
More informationEpinephrine & Anaphylaxis To Stick or Not To Stick
Epinephrine & To Stick or Not To Stick William Hurley, MD FACEP Harborview Medical Center hurleyw@u.washington.edu Washington Poison Center hurley@wapc.org Epinephrine & Describe common initiators of anaphylaxis.
More informationHOMES AND SENIORS SERVICES
Page 1 of 9 PURPOSE: All vaccines have the potential to cause adverse reactions. In order to minimize adverse reactions, clients should be carefully screened for contraindications to a vaccine before it
More informationRULE 59 NEBRASKA DEPARTMENT OF EDUCATION REGULATIONS FOR SCHOOL HEALTH AND SAFETY TITLE 92, NEBRASKA ADMINISTRATIVE CODE, CHAPTER 59
NEBRASKA DEPARTMENT OF EDUCATION RULE 59 REGULATIONS FOR SCHOOL HEALTH AND SAFETY TITLE 92, NEBRASKA ADMINISTRATIVE CODE, EFFECTIVE DATE MAY 13, 2006 (REVISED) State of Nebraska Department of Education
More informationBSTA Anaphylaxis /Stock Epinephrine Policy
BSTA Anaphylaxis /Stock Epinephrine Policy (Severe Allergic Reaction) It is the policy of Beehive Science and Technology Academy to provide at least two (2) doses of auto- injectable epinephrine (hereinafter
More informationADMINISTRATION OF DRUG PRODUCTS/MEDICATIONS TO STUDENTS
ADMINISTRATION OF DRUG PRODUCTS/MEDICATIONS TO STUDENTS 453.4 Drug products/medications are given to students in the school setting to continue or maintain a medical therapy which promotes health, prevents
More informationAquarium of the Pacific Food Allergy and Anaphylaxis Protocol
Aquarium of the Pacific Food Allergy and Anaphylaxis Protocol Purpose Statement: The Aquarium of the Pacific recognizes the increasing prevalence of allergies in children, including many life threatening
More informationNew 7/1/2015 MCFRS 1
New 7/1/2015 MCFRS 1 The providers will summarize the need for this change from an epinephrine auto injector The provider will define the proper dosage of epinephrine for the adult and pediatric patient
More informationTaking the Bite out of Dog ma
Taking the Bite out of Dog ma Dr. Michael Woo MD, CCFP(EM), RDMS Director, Emergency Medicine Ultrasonography Associate Professor, Department of Emergency Medicine Ultrasound uottawa DEM 25 May 2013 ACKNOWLEDGEMENTS
More informationEMERGENCY TREATMENT OF ANAPHYLAXIS EPINEPHRINE AUTO-INJECTOR
I. GENERAL GUIDELINES EMERGENCY TREATMENT OF ANAPHYLAXIS EPINEPHRINE AUTO-INJECTOR A. PURPOSE To counteract a severe allergic reaction (anaphylaxis) to a foreign substance as prescribed by the licensed
More informationAnaphylaxis: a severe, life threatening allergic reaction usually involving swelling, trouble breathing, and can progress to shock
Allergy is a condition in which the immune system causes sneezing, itching, rashes, and wheezing, or sometimes even life-threatening allergic reactions. The more you know about allergies, the better prepared
More informationsymptoms due to anaphylaxis is difficult to ascertain.
Factors associated with repeated use of epinephrine for the treatment of anaphylaxis Veena Manivannan, MBBS*; Ronna L Campbell, MD, PhD*; M. Fernanda Bellolio, MD*; Latha G. Stead, MD*; James T. C. Li,
More informationSection 9: serious allergy during an anaesthetic (anaphylaxis)
Risks associated with your anaesthetic Section 9: serious allergy during an anaesthetic () When you have an anaesthetic you will receive a number of medicines, drugs or injections. During the anaesthetic
More informationGuideline Statement for Treatment of Anaphylactic Reaction in the Surgical Patient
Adopted BOD October 2005 Updated BOD January 2013 Guideline Statement for Treatment of Anaphylactic Reaction in the Surgical Patient Introduction Anaphylaxis, also referred to as an anaphylactic reaction,
More informationAppropriate Treatment for Children with Upper Respiratory Infection
BCBS ACO Measure Appropriate Treatment for Children with Upper Respiratory Infection HEDIS Measure CPT II coding required: YES Click here to go to Table of Contents BCBS Measure: Page 50 of 234 Dated:
More informationIf#Your#Child#Requires#Medication#While#at#Camp:#
If#Your#Child#Requires#Medication#While#at#Camp:# All prescription and nonprescription medication given in child care, camp or school settingsrequireawritten#authorizationfromyourhealthcareprovider,aswellasparent
More informationClinical Performance Director of Nursing Allison Bussey
PGD 0314 Patient Group Direction Administration of Adrenaline (Epinephrine) 1:1000 (1mg/ml) Injection By Registered Nurses employed by South Staffordshire & Shropshire Healthcare Foundation NHS Trust This
More informationGet Trained. A Program for School Nurses to Train School Staff in Epinephrine Administration
A Program for School Nurses to Train School Staff in Epinephrine Administration The Get Trained School Nursing Program was created through an unrestricted grant from Mylan Specialty. The Program is intended
More informationPOAC CLINICAL GUIDELINE
POAC CLINICAL GUIDELINE Acute Pylonephritis DIAGNOSIS COMPLICATED PYELONEPHRITIS EXCLUSION CRITERIA: Male Known or suspected renal impairment (egfr < 60) Abnormality of renal tract Known or suspected renal
More informationCHAPTER 21 QUIZ. Handout 21-1. Write the letter of the best answer in the space provided.
Handout 21-1 QUIZ Write the letter of the best answer in the space provided. 1. A severe form of allergic reaction is called A. an allergen. C. epinephrine. B. anaphylaxis. D. an immune reaction. 2. Harmless
More informationEmergency Treatment for Vaccine Reactions
Massachusetts Department of Public Health Division of Epidemiology and Immunization Model Standing Orders Emergency Treatment for Vaccine Reactions Note: These model standing orders are current as of December
More informationEpiPen Review For Teachers/Staff CONCORD PUBLIC SCHOOLS CONCORD-CARLISLE REGIONAL SCHOOL DISTRICT
EpiPen Review For Teachers/Staff CONCORD PUBLIC SCHOOLS CONCORD-CARLISLE REGIONAL SCHOOL DISTRICT Objectives: Recognize early signs of an allergic reaction State immediate and safe response Administer
More informationCLINICAL PRACTICE GUIDELINE: ANAPHYLAXIS REGISTERED NURSE INITIATED MANAGEMENT AUTHORIZATION: Effective Date: Integrated Professional Practice
CLINICAL PRACTICE GUIDELINE: ANAPHYLAXIS REGISTERED NURSE INITIATED MANAGEMENT AUTHORIZATION: Integrated Professional Practice Council Page 1 of 10 ADAPTED from BC Health Authorities Provincial Decision
More informationYORK REGION DISTRICT SCHOOL BOARD. Policy and Procedure #661.0, Anaphylactic Reactions
WORKING DOCUMENT YORK REGION DISTRICT SCHOOL BOARD Policy and Procedure #661.0, Anaphylactic Reactions The Anaphylactic Reactions policy and procedure address staff responsibilities with regard to providing
More informationBiologic Treatments for Rheumatoid Arthritis
Biologic Treatments Rheumatoid Arthritis (also known as cytokine inhibitors, TNF inhibitors, IL 1 inhibitor, or Biologic Response Modifiers) Description Biologics are new class of drugs that have been
More informationSection I New Policy with copy of updated Epipen Order, and protocol. Section II Anaphylaxis Management Algorithm
Anaphylaxis Policy Contents Section I New Policy with copy of updated Epipen Order, and protocol Section II Anaphylaxis Management Algorithm Section III Demonstration of Epipen use for all staff members
More informationThe reaction is termed anaphylaxis if there are life-threatening features such as respiratory difficulties and/or hypotension.
HYPERSENSITIVITY AND ANAPHYLACTIC REACTIONS DURING AND AFTER TREATMENT WITH CHEMOTHERAPY- CLINICAL GUIDELINE FOR RECOGNITION AND TREATMENT. 1. Aim/Purpose of this Guideline 1.1. The aim of this document
More informationPACKAGE LEAFLET: INFORMATION FOR THE USER. VITAMINE B12 STEROP 1mg/1ml Solution for injection / oral solution. Cyanocobalamin
PACKAGE LEAFLET: INFORMATION FOR THE USER VITAMINE B12 STEROP 1mg/1ml Solution for injection / oral solution Cyanocobalamin Read all of this leaflet carefully before you start using this medicine because
More informationAntibiotic Prophylaxis for the Prevention of Infective Endocarditis and Prosthetic Joint Infections for Dentists
PRACTICE ADVISORY SERVICE FAQ 6 Crescent Road, Toronto, ON Canada M4W 1T1 T: 416.961.6555 F: 416.961.5814 Toll Free: 1.800.565.4591 www.rcdso.org Antibiotic Prophylaxis for the Prevention of Infective
More informationMedicines Management
Medicines Management Patient Group Direction for the Supply/administration of Adrenaline (Epinephrine) for Treatment of Anaphylaxis by accredited community Pharmacists. Rationale To enable a pharmacist,
More informationPrimary Care Paramedic. Diphenhydramine (Benadryl) Certification Package
Primary Care Paramedic Diphenhydramine (Benadryl) Certification Package 1 Welcome to the Primary Care Paramedic Diphenhydramine Certification package! The addition of Benadryl to your list of medications
More informationAdult Chemotherapy Induced Anaphylaxis Policy
Adult Chemotherapy Induced Anaphylaxis Policy The Beatson West of Scotland Cancer Centre 1053 Great Western Road Glasgow G12 0YN Written by: Elaine Barr Authorised by: D.Dunlop, C. Forte Issue Number :
More informationGuidelines for anaphylaxis emergency medication (adrenaline [epinephrine] autoinjector) prescription
Guidelines for anaphylaxis emergency medication (adrenaline [epinephrine] autoinjector) prescription Introduction The aim of these guidelines is to outline the appropriate prescription of adrenaline (epinephrine)
More informationThe Diagnosis of Food Allergy
The Diagnosis of Food Allergy Robert A. Wood, MD Professor of Pediatrics and International Health Director, Pediatric Allergy and Immunology Johns Hopkins University School of Medicine Disclosures Research
More informationI m m u n o t h e r a p y General Information About Allergy Injections
General Information About Allergy Injections The following information is for patients who may be considering immunotherapy (allergy shots or injections) as part of their allergy treatment plan. The goal
More informationDate: November 30, 2010
Department of Health and Human Services Public Health Service Food and Drug Administration Center for Drug Evaluation and Research Date: November 30, 2010 To: Through: From: Subject: Drug Name(s): Application
More informationWhat Medical Emergencies Should a Dental Office be Prepared to Handle?
What Medical Emergencies Should a Dental Office be Prepared to Handle? Gary Cuttrell, DDS, JD, University of NM Division of Dental Services Santiago Macias, MD, First Choice Community Healthcare Dentists
More informationChildren s Allergy and Anaphylaxis Protocols for Schools and Child Care Organisations
Children s Allergy and Anaphylaxis Protocols for Schools and Child Care Organisations This protocol can be used by anyone caring for a child who may be at risk of allergic symptoms or Anaphylaxis. The
More informationtable of contents drug reference
table of contents drug reference ADULT DRUG REFERENCE...155 161 PEDIATRIC DRUG REFERENCE...162 164 PEDIATRIC WEIGHT-BASED DOSING CHARTS...165 180 Adenosine...165 Amiodarone...166 Atropine...167 Defibrillation...168
More informationFood Allergy Action Plan
Food Allergy Action Plan Name: D.O.B.: / / Allergy to: Weight: lbs. Asthma: Yes (higher risk for a severe reaction) No Place Student s Picture Here Extremely reactive to the following foods: THEREFORE:
More information9/16/2014. Anti-Immunoglobulin E (IgE) Omalizumab (Xolair ) Dosing Guidance
Disclosure Statement of Financial Interest New Therapies for Asthma Including Omalizumab and Anti-Cytokine Therapies Marsha Dangler, PharmD, BCACP Clinical Pharmacy Specialist James H. Quillen VA Medical
More informationAntibiotic-Associated Diarrhea, Clostridium difficile- Associated Diarrhea and Colitis
Antibiotic-Associated Diarrhea, Clostridium difficile- Associated Diarrhea and Colitis ANTIBIOTIC-ASSOCIATED DIARRHEA Disturbance of the normal colonic microflora Leading to alterations in bacterial degradation
More informationAllergies and Autoimmune Inner Ear Disease
Allergies and Autoimmune Inner Ear Disease Allergy is the term used to describe an over-reaction of the body to a substance that is normally harmless to most people. This substance is called an allergen,
More informationBCCA Protocol Summary for Advanced Therapy for Relapsed Testicular Germ Cell Cancer Using PACLitaxel, Ifosfamide and CISplatin (TIP)
BCCA Protocol Summary for Advanced Therapy for Relapsed Testicular Germ Cell Cancer Using PACLitaxel, Ifosfamide and CISplatin (TIP) Protocol Code Tumour Group Contact Physician UGUTIP Genitourinary Dr.
More information