Environmental Subcutaneous Immunotherapy (SCIT)

107 NEWTOWN ROAD, SUITE 2A, DANBURY, CT 06810

131 KENT ROAD, SECOND FLOOR, NEW MILFORD, CT 06776

901 ETHAN ALLEN HIGHWAY, RIDGEFIELD, CT 06877

488 MAIN AVENUE, NORWALK, CT 06851

BEFORE PROCEEDING

Please read through this important information:

(NOTE: this link will also be emailed to you for later reference)

🔗 Environmental Allergies at Advanced Specialty Care

WHAT YOU SHOULD KNOW BEFORE YOU BEGIN ALLERGEN IMMUNOTHERAPY

What is immunotherapy (allergy shots)?

Immunotherapy (allergy shots) is a proven method to treat asthma and allergic rhinoconjunctivitis (eye/nose allergies). This is accomplished by injecting increasing doses of the things to which one is allergic, such as dust mites, cat/dog, pollen and mold. Over time, this consistent allergen exposure presented to the immune system in a different way than normal exposure, decreases the person’s sensitivity to their allergen, allowing increased exposure without triggering allergy or asthma symptoms. As one becomes less allergic, the need for medication generally decreases. Allergy shots make one less allergic over time, which is fundamentally different from medication, which may control symptoms but does not alter the underlying degree of allergy. Many people consider allergy shots a more natural way to treat the underlying allergies, then the long-term use of medication.

What is the usual treatment schedule?

There are two phases to allergy shots: build-up and maintenance.

Build-up phase:
During the build-up phase, each time that the allergy shots are administered, the dose is increased slightly, as long as the previous injection was well tolerated. The traditional buildup injection schedule is to receive the allergy injections once a week until the top dose is achieved, which usually takes approximately 6-7 months. Top dose is achieved more quickly if injections are initially administered twice a week. Alternatively, there is an accelerated buildup injection schedule known as “cluster immunotherapy “which reduces the total number of allergy injections administered during the buildup phase and the length of time required to achieve the top dose. This is accomplished by “clustering” several allergy injection visits into extended visits during the beginning of the immunotherapy build-up phase.

Maintenance phase:
Once the top dose is achieved (often even prior to achieving top dose) one’s allergy and/or asthma symptoms usually have improved. However, if immunotherapy was stopped once the top dose was achieved, the benefit would be short-term, and our goal is long-term benefit. In order to achieve long-term benefit, we continue to administer the top dose of the allergy shots, increasing the time interval between injections. The injection interval is generally increased to a four-week interval. The top dose is administered once every three or four weeks until immunotherapy is stopped. To maximize the likelihood of continued benefit even after the allergy shots are stopped, the injections are continued for an average of 3-5 years once the top dose has been achieved. Typically, at either 6- or 12-month intervals, a new set of immunotherapy (allergy shot) vials will be made. For your safety, the dose you receive from the new vial will be lowered, and you will need to build back to the top dose over a few visits.

What happens if I miss an allergy shot visit?

People often miss an allergy shot visit due to travel, vacation or illness. This does not cause a problem since the dose of the next allergy injection can be modified to accommodate the missed visit.

How well does the treatment work?

Most patients are very pleased with their decrease of symptoms. Allergy shots diminish the degree of sensitivity to one’s allergic triggers. Some patients completely lose their sensitivity, while others experience a significant decrease of their sensitivity, but in some circumstances may still develop some allergy symptoms if sufficient exposure to their allergens occurs. The current extracts utilized for the injections are vastly superior to what was available in the past.

What are the risks of allergy shots?

Allergy shots have been administered for more than 100 years. Therefore, we are confident that there are no long-term side effects. However, each time that one receives an allergy injection there is a small risk of a reaction. Some patients experience some redness, itching or swelling at the injection site, especially as higher doses are reached. These reactions are undesirable, but not dangerous. The likelihood of these symptoms can be minimized by administering an anti-histamine prior to coming to the office for the allergy injection. A small minority of patients may experience a generalized allergic reaction, which could include hives/swelling, sneezing/wheezing or abdominal symptoms. In very rare situations patients have developed faintness due to a drop of blood pressure or generalized life-threatening anaphylaxis. In consideration of this risk, all patients must remain in the physician’s office for 30 minutes after administration of the allergy injections.

When should I not receive my allergy injection?

Certain conditions increase the risk of adverse reactions, such as if you are experiencing an exacerbation of asthma or significant allergy symptoms. Respiratory infections other than a minor cold may also increase the likelihood of a reaction. The concurrent use of a “beta blocker” medication, commonly prescribed for blood pressure or glaucoma is a relative contraindication to receiving allergy injections. If a beta blocker medication is prescribed during your course of allergy shots, schedule an office visit with your allergist to discuss this issue prior to receiving your next allergy injection.

Your part of treatment:

By proceeding, I understand and agree to the following:

1. I will notify the nurse of any significant reaction prior to receiving my next allergy injection.

2. If I become pregnant while on allergy injections, prior to your next injection, please schedule an office visit with your allergist to discuss whether immunotherapy should be continued during pregnancy. In general, immunotherapy is safe to continue while pregnant. YOU MUST NOTIFY THE OFFICE PRIOR TO ANY FURTHER INJECTIONS ONCE YOU ARE PREGNANT.

3. I will notify the office if a beta blocker/ace inhibitor medication is prescribed, since that type of medication makes immunotherapy less safe.

4. I am aware I must wait in the office for 30 minutes after every allergy injection.

5. Prior to receiving your next injection, I will let the nurse know if there have been changes in my health, especially problems such as uncontrolled high blood pressure, recent heart attacks/chest discomfort or heart rhythm abnormality.

ADVERSE REACTIONS TO ALLERGY INJECTIONS

Allergy injection treatment (immunotherapy) involves the injection of gradually increasing doses of the substances to which the patient is allergic, thereby increasing the patient’s tolerance to those substances. Most patients do not experience significant adverse reactions to immunotherapy. However, there are two types of adverse reactions that can occur following an allergy injection.

How to recognize a reaction:

The first type of reaction is a localized reaction. It involves swelling, redness and itching limited to the injection site. As long as this is mild and does not last for more than a few hours, no treatment is needed. If the area is uncomfortable, you may apply cold, and—if you have not already done so—take an antihistamine by mouth. If the swelling is larger than two inches in diameter, or such that it is uncomfortable to move the arm, or if it is still present the day after the injection, this constitutes a large localized reaction. A large localized reaction is not dangerous, but it may be a signal that your body is not ready to receive a higher dose. It is therefore important that you tell the nurse about any large localized reactions at the time of your next visit, before you receive the next dose. Advise the nurse of the location and duration of the swelling. This will allow the nurse to adjust the dose appropriately. 

The second type of reaction is a generalized reaction. During this type of reaction the patient feels allergic at one or more places in the body separate from the location of the injections. Generalized reactions are much less common than localized reactions, and are therefore not experienced by the majority of patients. However, when they do occur they can be dangerous, and it is therefore essential for you to recognize whether such a reaction is occurring.

Symptoms of such a reaction can include:

• Hives or itching of any part of the body other than the site of the injections (palms, soles, nose, throat, eyes, chest, entire body, etc.)
• Flushing (redness) of the skin, with or without hives
• Swelling of the throat
• Cough, wheeze, or chest tightness or discomfort
• Tearing, sneezing or nasal congestion
• Faintness, or generalized feelings of “not being well”
• Metallic taste
• Cramping of the uterus, stomach, or intestine

Generalized reactions are usually mild or moderate in severity, but on occasion they can be severe or even life threatening. In its worst, full blown form, a severe anaphylactic reaction can result in death! 

FOR PATIENT SAFETY, IT IS THEREFORE MANDATORY THAT THE PATIENT (AND PARENT, IF THE PATIENT IS A CHILD) WAIT IN THE WAITING ROOM FOR 30 MINUTES FOLLOWING EACH AND EVERY ALLERGY INJECTION.

This 30 minute waiting period is necessary even for a patient who has received allergy injections for many years without having any adverse reactions.

What to do if a reaction occurs: 

If any of these symptoms occur during the waiting period, you must notify the receptionist, nurse or doctor immediately. Even if the symptoms are mild, or if you are not certain that they represent a reaction to the injection, you should still bring them to our attention and let the doctor decide whether a reaction is occurring. Treatment of reactions works best if started promptly. 

Occasionally, reactions of this type can be delayed, starting after the end of the 30 minute waiting period, or rarely, as late as two hours following the injection(s). If any generalized allergy symptoms occur on the way home, immediately return to the office. If such symptoms occur after returning home, take an antihistamine (if it is not already in your system) and--if wheezing or chest tightness is present--take two puffs of your fast-acting inhaler, and call the office. If it is after office hours, the answering service will contact the doctor.

If the reaction is severe, phone 911 for transport to the emergency room. 

How to make reactions less likely to occur:

Reactions to allergy injections are more likely to occur if allergy symptoms are active prior to receiving the injections. Remember that allergy injections are not medication to make one feel better immediately. Rather, they are injections of allergy-causing materials given in an effort to build-up a tolerance over time. They should be given when the situation is stable. If the patient has had an increase in allergen exposure and has symptoms which are out of control, an allergy injection at that time would be more likely to cause a reaction, and therefore should not be given. Do not come for an allergy injection if wheezing is present or if allergy symptoms are out of control. Do not come for an allergy injection if you have a respiratory infection such as sinusitis, bronchitis, cold or flu. Always inform the nurse if there has been a change in your status, or if you are on new medications prescribed by other doctors.

If you are contemplating pregnancy during your course of immunotherapy, please discuss this with your allergist.

 

(OPTIONAL)
ALLERGY TREATMENT CONSENT—MINORS OVER 16 YEARS OLD

If you do not give permission for the minor to receive treatment without an adult, you may proceed without ticking the above box.

ALLERGY TREATMENT FOR CHILDREN

Although most patients do not have adverse reactions to allergy injections, oral immunotherapy or other treatment, severe reactions do occur occasionally.

To insure the proper monitoring of your child, an allergy injection, oral immunotherapy or other treatment will be administered to a patient under the age of 18 only if a parent or responsible adult over the age 18 years of age is present (unless the minors over 16 years of age consent form is signed). If someone other than the parent will be accompanying the child, we must have a signed consent from the parent giving us permission to administer treatment in the absence of a parent.

***THE PARENT OR RESPONSIBLE ADULT MUST REMAIN IN THE OFFICE WITH THE CHILD DURING THE REQUIRED WAIT PERIOD (30 MINUTES AFTER ALLERGY INJECTIONS, VARIED TIME REQUIREMENTS FOR OTHER TREATMENTS).
***

Please complete this portion if your child under eighteen will be receiving treatment accompanied by someone other than a parent:

I give permission to the physicians and nurses of Advanced Specialty Care, Allergy & Asthma to administer allergy treatments, injections, testing, and medical treatment to and to discuss medical diagnosis and treatment for my child under the age of 18 years in my absence, when accompanied by one of the following adults over the age of 18 years...

AUTHORIZATION TO PREPARE ALLERGY-INJECTION EXTRACT

Following a discussion of the technique of Allergy Injection Treatment (immunotherapy, “allergy shots”), I request such therapy for myself / my child.

I therefore hereby authorize Advanced Allergy & Asthma, to prepare individualized allergen extract for my / my child’s treatment. I understand that this is being prepared for this specific case, and once made cannot be used for other individuals. I understand that a bill for this material will be submitted at the time the extract is prepared. If Allergy & Asthma Associates is a participating provider with my insurer, or is billing my insurer through a PPO arrangement, I agree to be responsible for any applicable co-payment or co-insurance. I also agree to obtain and maintain any required referrals. If my financial dealings with Advanced Allergy & Asthma are direct and not through an insurer, I agree to be personally responsible for the cost of this extract once it is prepared.

I further understand that once prepared, the dilutions of this treatment extract have specific expiration dates, and that it is my responsibility to inform Allergy & Asthma Associates PC prior to coming for an injection treatment if I am more than 3 weeks overdue for an allergy injection. I understand that additional fees may apply if new dilutions of this extract must be prepared because of my failure to adhere to the treatment schedule, or because reactions to treatment necessitate repeating or decreasing of dosage.

This authorization shall remain valid until revoked in writing.