Allergy Immunotherapy In-Home Patient Booklet: Treatment, Safety, and Dosage Instructions

Frequently Asked Questions Answered in this PDF

• How often should allergy injections be administered?

Answered at: Section – General Dosing Instructions
Allergy injections should be given twice per week, with at least 72 hours between doses.

• What pre-shot health screening questions must I ask before administering an injection?

Answered at: Section – Pre-Shot Health Screen
You must confirm:
Any wheezing or asthma symptoms in the last 48 hours?
Any increased allergy symptoms today?
Any illness, fever, or flu-like symptoms today?
Any delayed allergy reaction up to 24 hours after the last injection?
Is the patient pregnant or possibly pregnant?
Any new medical conditions or medications?
If “yes” to any, do not proceed and call the office.

• How do I record doses properly?

Answered at: Section – Dose Recording Log
Document each injection with: week/date, pass/fail health screen, dosage amount, injection location, initials, and any comments.

• What should I do if a patient misses a scheduled dose?

Answered at: Section – Missed Treatment Dose Adjustment
Up to 7 days: continue with the schedule.
8–14 days: repeat the last tolerated dose.
14 days: consult the allergy provider before proceeding.

• What should I do after a mild local reaction at the injection site?

Answered at: Section – Adverse Reactions Dose Adjustment
If mild (<2 cm and resolves quickly), repeat the last tolerated dose at the next visit.

• How should I adjust for a larger local reaction?

Answered at: Section – Adverse Reactions Dose Adjustment
For reactions 2–10 cm that resolve with medication, consult the allergy provider before proceeding.

• What should I do if a patient experiences a systemic reaction or uses an Epi-Pen?

Answered at: Section – Adverse Reactions Dose Adjustment
Stop all further injections and schedule an appointment with the provider.

• How do I manage a mild allergic reaction after an injection?

Answered at: Section – Mild Allergic Reaction Instructions
Apply an ice pack, administer oral Benadryl (per age/weight instructions), and apply 1% hydrocortisone cream to the site.

• What steps should I take for a moderate allergic reaction?

Answered at: Section – Moderate Allergic Reaction Instructions
Stop immunotherapy and schedule a provider appointment. Dosage schedule may need adjusting.

• What are the emergency steps for a major or systemic allergic reaction?

 Answered at: Section – Major/Systemic Allergic Reaction Instructions
Use an Epi-Pen immediately.
Call 911 and notify them it was due to a severe allergic reaction.
After calling 911, administer oral Benadryl per instructions.
Continue monitoring — relief may only be temporary.

• What side effects should I monitor for within 30 minutes of an injection?

Answered at: Section – Major/Systemic Allergic Reaction Instructions
Monitor for sneezing, itchy/watery eyes, runny nose, itchy throat, shortness of breath, or wheezing.

• What documentation should I complete at each appointment?

Answered at: Section – Dosage Log & Patient Information
Fill out health screening results, dosage given, location of injection, initials, and any relevant comments.

• When should patients administer injections during the day?

Answered at: Section – General Dosing Instructions
It is preferable to give doses during the day so the office can be contacted if guidance is needed.

• What do I do if a patient reports delayed allergic symptoms?

Answered at: Section – Pre-Shot Health Screen
Do not proceed with the injection and contact the office for provider instructions.

• How are dose adjustments made after adverse reactions?

Answered at: Section – Adverse Reactions Dose Adjustment
Mild local reaction: repeat last tolerated dose.
Large local reaction: consult provider.
Systemic reaction or Epi-Pen use: stop injections and schedule a provider appointment.

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Resource Asset

 

Video Transcript

0:00 – Trainer
Today, we're going to go over what it means to get an allergy test and what the immunotherapy process looks like. Before starting, make sure you have all of your supplies on hand.

0:15 – Trainer
Supplies include rubbing alcohol, a skin marker, multi-testers or scratchers, three test trays, a 15-minute timer, a ruler, and Benadryl for post-test care.

0:40 – Trainer
Now let’s talk about the paperwork. First is the allergy intake form, which patients fill out upon arrival. If they indicate allergies, they’re a candidate for testing. On the back are diagnosis codes for the provider to complete.

1:10 – Trainer
Next is the eligibility information sheet, where deductible, copay, and prior authorization details are tracked. Using this, you can fill out the financial agreement to confirm out-of-pocket costs with the patient.

1:40 – Trainer
The patient must also sign the consent form before testing. Without it, you cannot proceed. During the test, use the skin test recording form to document reaction sizes. At the end, have the patient sign it to confirm results.

2:10 – Trainer
For billing, complete the superbill with CPT and diagnosis codes. For ordering immunotherapy serums, use the RX form, selecting up to 16 pollen antigens and 16 environmental antigens based on sensitivity.

2:40 – Trainer
Before testing, ensure the patient hasn’t taken antihistamines within two days or corticosteroids within the past week, as these can interfere with results.

3:00 – Trainer
Prepare the patient’s arms (or back if needed) by cleaning with alcohol. Mark guides A–I with two-inch lines for placement of the multi-testers.

3:30 – Trainer
Start with tray A–C, then move to trays D–F and G–I. Place each multi-tester on its corresponding mark. Dispose of testers properly. Start your 15-minute timer after the first tray.

4:20 – Trainer
After 15 minutes, measure reactions with the paper ruler. Record the largest diameter of each hive or redness. Histamine should always react as the positive control.

5:00 – Trainer
Once all reactions are recorded, clean the skin with rubbing alcohol and apply topical Benadryl to reduce itching and inflammation.

5:20 – Trainer
If results show strong sensitivities, the patient is a good candidate for immunotherapy. Explain that immunotherapy is a custom serum tailored to their sensitivities, gradually improving their immune response.

5:50 – Trainer & Patient
Patient: “Sounds interesting. I’d like to try this immunotherapy.”
Trainer: “Sounds great. Please sign here.”
Patient: “Yes, sir.”
Trainer: “Your prescription should be ready in about a week, and you’ll receive a phone call. Thank you.”