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Dose Calculations for the Maintenance Vial Theformulabelowoffersasimplifiedmethodforcalculatingthevolumeofan extract to add based on the target dose selected. Importantly, thiscalculationcanbeusedforanypotencyunit(

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, B

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, PNU, w/v, or µg). V = 10T/E V: Volume to be drawn up from the manufacturer’s bulk concentrate and added to the patient’s vial T: Target maintenance dose in 0.5cc injection (e.g., 2000B

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, 1000PNU, 7.5µg Der… 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

Aseptic Procedures & Sterility Even though it is an FDA requirement that allergen extracts contain a preservative agent (e.g. phenol), it is essential to utilize aseptic techniques when preparing patient treament vials. When working with allergen extracts it is important to use a dedicated workspace that is clean and free of clutter. It is also… 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

Safety Concern – Latex in Rubber Stoppers ALK rubber stoppers are made of gray butyl synthetic rubber, but contain a small percentage of natural rubber, which may theoretically contain latex allergens that could interfere with proper diagnosis in latex- sensitive patients. n research that evaluated the potential effect of latex in rubber stoppers on allergenic… read more

Quality Concern – Coring Coring occurs when pieces of the vial’s rubber stopper break off and fall into the extract due to repeated syringe insertion. These pieces appear as small grey or dark particles that float around the vial. These are not to be confused with protein precipitates, which typically appear as light-colored particles. Regarding… 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

Positive & Negative Controls Postive Control – Histamine Since a major physiological component of the allergic response is histamine, it is important to use a histamine reagent to confirm that the patient’s skin has sufficient reactivity to properly interpret the skin test results. In line with this rationale, the histamine positive control can help determine… read more

Ancillary Supplies Along with your supply of allergen extracts, you will need to stock your clinic with additional supplies to support the practice of immunotherapy. The following is a basic list of products that will be useful for the handling and preparation of your extracts: Sterile empty vials with color-coded vial caps and patient vial… read more

Skin Testing Supplies Once you have reviewed the appropriate procedures, established your diagnostic panel, and ordered your supplies, you are ready to begin testing patients. Most practices will diagnose their patients by skin testing using glycerinated extracts and a sterile, disposable skin test device. Depending on the patient’s clinical history and the allergist’s training and… read more