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Dilution Tables Here are some common dilution strategies used when making treatment vials. 5 – Fold Dilution – 5 mL Vials – 1:20 w/v Glycerinated Extract: 1:2 Dilution – 10mL and 5mL Vials: Used for example, when you want to convert a 1:10 w/v into a 1:20 w/v or if you want to convert 10,000… read more

Use of Allergen Extracts  >  Mixing Allergens  >  Mixing Concerns: Cross-Reactivity & Proteolytic Enzymes Mixing Concerns: Cross-Reactivity & Proteolytic Enzymes Some patients who present as polyallergic may require treatment with a mixture of different clinically relevant allergens. In the United States, it is standard practice to mix multiple allergens into a single treatment vial. This is… read more

Analytical Method – ID50EAL (“IDEAL 50”)

Standardized

potency values were established by a skin test titration study (ID50EAL) using a limited number of patients. “ID50EAL” is an acronym for “Intradermal Dilution for 50 mm sum of Erythema determines the bioequivalent ALlergy units.” This study measured the size of the erythema in allergic patients receiving a… read more

Anaphylaxis Crash Cart In addition to the recommended routine supplies, every practice that intends to perform allergen immunotherapy must be supplied and trained for possible severe systemic reactions, such as anaphylaxis. Below is a list of recommended emergency supplies that should be stocked separately from the routine supplies. Modifications may be necessary depending on the… read more

How to Perform Dilutions Once you have prepared the patient’s treatment vial (e.g., Red Vial), you will need to perform a series of dilutions before you begin treatment. Subcutaneous allergen immunotherapy begins with a small dose of a highly dilute allergen solution and, over time, increases in volume and concentration until the maintenance dose has… read more

Dosing One of the primary objectives when mixing allergenic extracts is to prepare a patient’s treatment set in a way that ensures an optimal therapeutic dose of each allergen in the patient’s allergen extract vial. Therefore, the limiting step when mixing is deciding what volume of each allergen to add to a patient’s maintenance vial.… read more

Effect of Storage Conditions on Stability Allergenic extracts should be stored in a refrigerator when not in use. The proper storage temperature is 2-8°C (36-46°F). It is recommended to include a recording device in a refrigerator in order to monitor temperature and to note any deviations if they occur. In the event of a power… read more

Effect of Formulation on Stability Below is a figure that shows how expiration dating varies by formulation. For

Standardized

products, these dates were established through FDA-approved testing methods. For non-

Standardized

products, these dates were established by the FDA. For more information on extract formulation, please see the section on Extract Formulations Expiration dates for bulk… read more

Major Allergen Characterization The active ingredients of allergenic extracts are the proteins that the immune system responds to. Within an extract, there may be multiple allergenic proteins. Major allergens are those proteins to which at least 50% of a population are sensitized to. Some of these allergens, such as Fel d 1 in cat, are… read more