Venom Allergies

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BEFORE PROCEEDING

Please read through this important information:

(NOTE: these links will also be emailed to you for later reference)

🔗 Venom Allergies at Advanced Specialty Care

Venom Immunotherapy

What is venom immunotherapy?

Venom immunotherapy is a method of decreasing a person’s sensitivity to stinging insect venom.  This is accomplished by injecting gradually increasing doses of purified insect venom over a period of time.  When a very small quantity of a weak solution of the purified venom is administered by injection, the individual is able to tolerate it without experiencing an allergic reaction.  The quantity administered is gradually increased at a regular interval, resulting in the ability to tolerate a larger quantity of venom without the occurrence of an allergic reaction.  Similarly, when/if the individual is stung by a venomous insect, a generalized allergic reaction becomes very unlikely to occur, or, if a reaction does occur, it is likely to be mild compared to the previous venomous insect sting reaction.

What is the usual treatment schedule?

Injections are administered at weekly intervals while the dose is being raised.  Some individuals come two or three times a week to achieve the protective dose more quickly, particularly if the stinging season is close at hand.  It generally requires 14 doses to achieve the top dose, although this time period may vary depending upon the individual’s degree of sensitivity and whether or not reactions to the injections occur.  Once the top dose has been achieved, the injection interval is increased to two weeks, then three weeks, then four weeks for the rest of the first year.  During the second year of venom immunotherapy, the injection schedule is increased to a five-week interval once and then to a six-week interval.  Most individuals continue to receive allergy injections every six weeks until a decision is made to stop the venom immunotherapy.  Most patients receive their top doses of venom immunotherapy for about five years.  Some patients may be able to stop venom immunotherapy sooner than five years, while others may need to continue venom immunotherapy for more than five years. 

How well does venom immunotherapy work?

Venom immunotherapy is a very effective treatment with regard to preventing generalized allergic reactions to venomous insect stings.  Approximately 95% of individuals who receive protective doses of venom immunotherapy will not experience a generalized allergic reaction to a venomous insect sting.  Those individuals who do experience a generalized allergic reaction to a venomous insect sting while receiving venom immunotherapy generally have very mild reactions, usually limited to a few hives.

What are the alternatives to venom immunotherapy?

The alternative to venom immunotherapy is to keep injectable Epinephrine (such as an EpiPen) and a quick-acting oral antihistamine such as diphenhydramine (Benadryl) available for emergency use with the intent of immediately administering the Epinephrine and antihistamine if a venomous insect sting occurs.  If the EpiPen is administered, one should then phone 911 for transport to the emergency room.

What are the risks of venom immunotherapy?

The potential adverse reaction to venom immunotherapy is an allergic reaction to the material being injected.  Most patients experience some amount of redness, itching or swelling at the site of the injection, especially as higher doses are reached.  A minority of patients will experience a generalized allergic reaction following the injection.  For this reason, one must wait 30 minutes in the office after receiving venom immunotherapy.  Severe or life-threatening allergic reactions have occurred after injections in rare instances.  A physician is always available in the office to treat an adverse reaction to the venom injection, in the event that one occurs.

When should I not receive my venom 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 venom injection.

2.  If I become pregnant while on venom 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 venom 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.

ALLERGY INJECTIONS FOR CHILDREN

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

To ensure the proper monitoring of your child, an allergy injection, oral immunotherapy or other treatment will be administered to a patient under the age of 16 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 30-MINUTE WAIT PERIOD FOLLOWING THE INJECTION.
***

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.