Allergen Immunotherapy: Frequently Asked Questions

* How much does Allergen Immunotherapy(AI) cost?

* Do I have to get my first injection at the allergist’s office? 
 - It is preferable that patients receive their first injection from our office, particularly when first starting AI, so that instructions and procedures can be reviewed. This is less crucial for patients receiving a maintenance dose. Some facilities do require that the first shot from new sets be received in our office, so review of their particular policy is advisable.

* Is there a waiting time after receiving injections?
 - Patients are required to wait in the doctor’s office for 30 minutes after receiving AI. This is because the majority of shot reactions occur within this time frame, and if treatment is necessary, it will be quickly and effectively provided. Neither length of time on shots nor lack of past reactions is an adequate predictor of safety, and all patients are expected to abide by this rule. If you cannot wait 30 minutes you should not come for AI.

* What is considered a shot reaction?
 - Reactions to AI can vary from mild to severe (anaphylaxis), and can include symptoms such as increase in coughing, sneezing, runny nose, red and/or itchy eyes, feeling of tightness in the chest or throat, hives, and local or generalized itching. If you experience any symptoms not present prior to your shot you should report to the nurse immediately for treatment, even if you are unsure as to their relation to your injection. Occasionally reactions can occur after leaving the office. If they are severe you should return to the office or go to the nearest urgent care/ED. Symptoms experienced after receiving AI should be reported to the nurse at the next injection so that necessary adjustments can be made. Patients will commonly experience local reactions, which are considered an acceptable part of receiving AI. These can include redness, swelling and itching at the injection site. These should also be reported to the nurse, in addition to the size of the area involved and the length of time symptoms lasted.

* How are reactions treated?
 - Shot reactions are treated based on severity. Medications can include antihistamies, prednisone, and epinephrine. If a reaction occurs you will be asked to wait in the office until you are cleared to leave. Local reactions can be limited with the use of ice applied before and/or after injections, as well as us of topical anti-itch cream, and Tylenol for pain, all as needed.

* Do I need to check with the nurse before leaving after my injection(s)?
 - There is no need to check with a nurse after waiting the 30 minutes unless you have a concern. This policy may vary, however, depending on the office where injections are received.

* What happens if I am late or miss an injection?
 - Consistency is very important with AI, especially while building. However, if you miss a dose or are late your dose may be repeated or reduced depending on the length of time since your last injection.

* May I receive AI at other facilities? 

 -  Patients may take their extract to other facilities as long as there is a health care provider present who is willing and able to treat a reaction should one occur. Receiving AI at home is not permissible.

**Whenever transporting extract it is vital that it be kept cool, as heat will affect potency. When not in use, extract must be kept refrigerated.

* How long does a “starter set” last?
 - The initial extract set should last approximately 34 weeks when building weekly. The lower strengths will expire during this time if not used as intended. “Maintenance vials,” or those following completion of the “starter set,” will have a variable life based on compliance, time between injections, and maintenance dose. For example, a patient receiving a 1 cc maintenance dose every two weeks will have their maintenance vial(s) last 20 weeks. If the maintenance dose is less, or the interval is longer, then vials will naturally last longer.

* How and when do I order new extract?
 - Patients receiving AI in our office will automatically have their extract reordered once the vial(s) is/are empty. If AI is received at another facility, they may either give you your shot schedule (which serves as the reorder form), which you may mail, fax or bring in to our office. Alternately, the facility may be willing to fax the shot schedule to us for you. We do not accept orders by phone, as the previous shot schedule is required for new orders. Please allow two weeks for extract to be available.

* What is a “shot schedule”?
 - A shot schedule is the sheet on which a patient’s extract dilution, dose, and date at each injection are recorded. It also provides instructions on dosing, the interval allowed between injections, and how to proceed if a patient is late or missed an injection. It also serves as the order form for new extract.

* How do I receive my extract order?
 - If you are receiving AI outside our office, extract is sent by mail to your home unless we are advised in writing to send it elsewhere. Alternately, extract can be picked up at our office. Please be sure to advise our office as well as the office where injections are received of any address changes, as delays in mailing can affect the potency of the extract. If extract is returned to us as a result of incorrect address information, you will be responsible for payment of new extract if it needs to be made.

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