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Allergy Clinic Policy and Procedures

Allergy Immunotherapy – Administration of Extracts Under Protocols from Allergists Not Privileged at the Northwestern University Health Service

Purpose:

Allergy immunotherapy is used to alter the immunologic response in allergic patients. The extracts used are individually prepared solutions supplied by allergists not privileged at the Northwestern University Health Service (NUHS). It is the intent of NUHS to provide to patients the service of administrating these extracts under protocols written and provided by outside allergists.

Policy:

NUHS expects the referring Allergist to reevaluate the patient at least annually.

Procedures:

Allergy Clinic Visit

The patient is seen by an RN who is privileged to administer immunotherapy extract. The patient must have:

  1. Referral agreement signed by the referring Allergist.
  2. “Request and Consent for Administration of Allergy Immunotherapy ” signed by the patient.
  3. Protocols for dosing and dose adjustment form from the referring Allergist and approved by the NUHS consulting Allergist.
  4. Allergen extract from the referring Allergist.
Storage of Extract
Administration of Extract
Dosage and Dose Adjustment

Dose changes are indicated:

  1. during escalation and maintenance dosing,
  2. the use of new vials,
  3. during seasonal exposures,
  4. if the constituents of the allergen immunotherapy extract have changed,
  5. missed doses, and
  6. if reactions have occurred. Detailed dose and dose adjustment for the above mentioned scenarios are per the schedule provided by the referring Allergist.

Any questions or clarifications should be made to the referring Allergist.

Contraindications
Documentation

Every visit is to be charted in the NUHS EMR documenting the following information:

The treatment record provided by the referring Allergist is to be completed for each visit and kept in a separate Allergy Clinic chart. Any time the treatment record is sent to the referring Allergist, a note should be placed in the EMR and a copy of the treatment record sent should be scanned into the EMR.

Treatment of Local Reactions by the RN
Immediate Treatment of Systemic Reactions by the RN

8/11/09 – ja revision 4

7/12/2018 jkl

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