As you begin this build-up phase there are several factors to keep in mind concerning your treatment:

Transcription

1 SLIT IMMUNOTHERAPY INSTRUCTIONS David R. Scott, M.D./William A. Scott, M.D. Congratulations on beginning your new sublingual immunotherapy (SLIT) prescription! The initial 30 doses are advancement doses. The purpose of this Build-Up Phase is to stimulate your immune system to develop immunity or tolerance to the allergens which are causing your symptoms. The build-up phase involves beginning at one drop of the lowest concentration (1:100 Blue Bottle) and advancing until you reach a target maintenance dose of five (5) drops in the highest concentration (1:1 Red Bottle) (called the maintenance dose ). The dosing regimen for the Build-Up Phase is outlined below: 1:100 Blue (Most Diluted) 1:10 Yellow 1:1 Red (Most Concentrated) Maintenance 1 1 drop 2 1 drop 3 2 drops 4 2 drops 5 3 drops 6 3 drops 7 4 drops 8 4 drops 9 5 drops 10 5 drops 11 1 drop 12 1 drop 13 2 drops 14 2 drops 15 3 drops 16 3 drops 17 4 drops 18 4 drops 19 5 drops 20 5 drops 21 1 drop 22 1 drop 23 2 drops 24 2 drops 25 3 drops 26 3 drops 27 4 drops 28 4 drops 29 5 drops 30 5 drops From this point forward, you will continue taking 5 drops per day from the red bottle. As you begin this build-up phase there are several factors to keep in mind concerning your treatment: 1) You must remain consistent with your dosing (ideally daily) in order to be able to reach maintenance levels in a reasonable amount of time (30 days). 2) Keep in mind that your extract vials carry a 6-month expiration. Refrigerate the bottles you are not using. Keep the bottle you are currently using out of the refrigerator in a convenient place to help you remember your daily dose. 3) If you miss a dose periodically, do not worry. Adjustment recommendations are found on the back side of your instruction packet, and, of course, you may always call our office for advice. 4) When your advancement has been completed and you have reached a maintenance dosage (5 days of the red bottle), you should schedule a follow-up visit with our office in order to review your progress and to discuss the Maintenance Phase of your immunotherapy. If changes in the concentration of your allergy extract are needed, this is the most appropriate time to make changes. If you live far from Grand Junction, we can discuss this over the telephone with you. 5) You should also have an Epi-pen 2-pak available and an antihistamine at the time of each dosing. This should be used for the initial treatment of any major systemic allergic reaction that might occur. If you have questions or concerns at any time, please call us at

2 ALLERGY & ASTHMA CENTER OF WESTERN COLORADO, P.C. Adult & Pediatric Allergy, Asthma & Immunology Name: DAVID R. SCOTT, M.D. (last) (first) (MI) WILLIAM A. SCOTT, M.D. CATHRYN E. SCHNELL, P.A.-C DOB: Bottles: 1120 Wellington Ave., Suite 204; Grand Junction, CO Telephone: (970) OR FAX (970) SLIT DOSING LOG FOR DAILY BUILD UP ***START WITH BLUE BOTTLE*** Days 1-10 Blue Bottle (Most Dilute 1:100) 1. 1 drop 2. 1 drops 3. 2 drops 4. 2 drops 5. 3 drops 6. 3 drops 7. 4 drops 8. 4 drops 9. 5 drops drops ***START YELLOW BOTTLE AFTER COMPLETION OF BLUE BOTTLE*** Days Yellow Bottle (Middle Strength 1:10) drop drops drops drops drops drops drops drops drops drops ***START MAINTENANCE BOTTLE AFTER COMPLETION OF YELLOW BOTTLE*** Days Red Bottle (Strongest 1:1) drop drops drops drops drops drops drops drops drops drops After completing above build up, then continue maintenance dose (Red Bottle) 5 drops per day. For maintenance doses, please use the maintenance dose log sheet.

3 ALLERGY & ASTHMA CENTER OF WESTERN COLORADO, P.C. Adult & Pediatric Allergy, Asthma & Immunology DAVID R. SCOTT, M.D. WILLIAM A. SCOTT, M.D. CATHRYN E. SCHNELL, P.A.-C 1120 Wellington Ave., Suite 204; Grand Junction, CO Telephone: (970) OR FAX (970) Sublingual Immunotherapy (SLIT) Instructions INSTRUCTIONS FOR ADMINISTRATION OF ALLERGY DROPS ADMINISTRATION OF SUBLINGUAL DROPS: 1. Record all doses including the date on the dosing log. 2. Drops should be placed under the tongue and held there for two minutes, then swallowed. For multiple bottles, drops from each bottle may be added together under the tongue all at once. If itching of the mouth occurs and is uncomfortable, then spit out the dose and do not swallow. 3. If mouth itching persists beyond 5 minutes after dosing, take an oral antihistamine. If mouth itching persists beyond 30 minutes after taking the antihistamine, reduce the next dose by ½ and call our office. 4. If any suspected systemic allergy symptoms occur, follow the instructions outlined below. 5. Any adverse events associated with the dosing should be recorded in the Remarks section. 6. If you are unsure of any dosing, please call our office for advice. 7. Always be certain that your oral antihistamines and your Epinephrine Auto-injector (Epi-Pen 2-pak) are available at the time of dosing. If you have asthma you also should have your rescue albuterol inhaler. 8. Extra bottles should be kept refrigerated until ready to use. However, your current bottle can be kept on a counter top. Avoid extreme heat or freezing of the extract bottles. 9. Always check the bottle label before dosing, to be certain that you have the correct bottle. Do not take drops if you are running a fever > 99.5, if you are having a major asthma attack, or if you have any open sores or wounds in the mouth. 10. Do not dose on days of dental procedures. 11. Dose adjustments based on missed days or adverse reactions are outlined on the next page. 12. Do not take allergy drops if you are also taking a prescription beta blocker medication. Please ask if you are uncertain whether you are taking this type of medication. 13. For women of child-bearing age, notify our office if you become pregnant. We generally recommend that you continue SLIT during pregnancy. 14. Order more allergy extract two weeks before you need it. Pre-payment is required before your new allergy extract can be mixed. Two 28 dose bottles, 1:1 (red), which will last 8 weeks, will then be mailed to you.

4 DOSE CHANGE BASED ON MISSED TREATMENTS/ADVERSE REACTIONS: MISSED DAYS DOSAGE ADJUSTMENT 1-7 Days Continue advancement or repeat if at the maintenance dose Days Decrease drop dosage by ½ the number of drops and then advance by one drop each day to former dose. More than 21 Days Call our office for instructions. REACTION TO SLIT No Reaction Minimal reaction (itching of mouth or under tongue is common) Mild reaction (swelling of lips/tongue) Severe Systemic reaction (major hives, major oral swelling, major throat tightness, major wheezing, major shortness of breath or fainting) RESPONSE Dose according to schedule or continue maintenance dosing. Take an oral antihistamine as needed. Continue routine dosing schedule. Take an oral antihistamine as needed. Reduce the dosage to last tolerated dose, repeat x 2, continue advancement. Take an oral antihistamine, use epinephrine injection on way to ER/911. Repeat dose in 10 minutes if you are not getting better. If you have asthma symptoms, use your albuterol inhaler every 30 seconds up to 10 times in a row. Call our office and arrange a follow-up visit before further dosing. SYSTEMIC ADVERSE REACTIONS TO ALLERGEN IMMUNOTHERAPY: There is always the possibility of a systemic allergic reaction (anaphylaxis) to one of the doses, even though the same dose may have been previously well tolerated. Anaphylactic symptoms may include progressive itching (nose, throat, eyes, skin, palms of hands, soles of feet, etc.), sneezing, coughing, nasal congestion/drainage, throat swelling or tightness, wheezing, asthma, shortness of breath, nausea, vomiting, abdominal cramping, diarrhea, generalized hives. Rarely, decreased blood pressure (hypotension) with fainting or collapse may occur. For a severe systemic reaction, an epinephrine injection on the way to the E.R./911 is mandatory. Do not try to wait and see what happens. Early and rapid treatment with epinephrine is critical. At the first signs of any major systemic reaction, give epinephrine in the leg and CALL 911 or have some drive you to the E.R. The most dangerous symptoms of a major systemic reaction are throat swelling, shortness of breath, major wheezing or raspy breathing, major hives or fainting. Depending on the nature and severity of the reaction, this dose of epinephrine may be repeated in 10 minutes. An antihistamine should also be given by mouth. PLEASE NOTE: IF ANY MAJOR SYSTEMIC ALLERGIC REACTION OCCURS, YOU MUST RETURN TO OUR OFFICE FOR FURTHER INSTRUCTIONS PRIOR TO TAKING ANY MORE SUBLINGUAL IMMUNOTHERAPY.

5 ALLERGY & ASTHMA CENTER OF WESTERN COLORADO, P.C. Adult & Pediatric Allergy, Asthma & Immunology Name: DAVID R. SCOTT, M.D. (last) (first) (MI) WILLIAM A. SCOTT, M.D. CATHRYN E. SCHNELL, P.A.-C DOB: Bottles: 1120 Wellington Ave., Suite 204; Grand Junction, CO Telephone: (970) OR FAX (970) SLIT DOSING LOG FOR MAINTENANCE DOSE 7 ML BOTTLE CONTAINS 28 DOSES (5 drops = 0.25 ml) 5 DROPS OF RED BOTTLE (1:1) IS USUAL MAINTENANCE DOSE 1. 5 drops 2. 5 drops 3. 5 drops 4. 5 drops 5. 5 drops 6. 5 drops 7. 5 drops 8. 5 drops 9. 5 drops drops drops drops drops drops drops drops drops drops drops drops drops drops drops drops drops drops drops drops Additional comments: Please request next refill at least 2 weeks before needed A copy of your dosing log and pre-payment are required before we can prepare your next bottles

6 TREATMENT OF SYSTEMIC ADVERSE REACTIONS TO ALLERGEN IMMUNOTHERAPY There is always the possibility of a systemic allergic reaction (anaphylaxis) to one of the doses, even though the same dose may have been previously well tolerated. Anaphylactic symptoms may include progressive itching (nose, throat, eyes, skin, palms of hands, soles of feet, etc.), sneezing, coughing, nasal congestion/drainage, throat swelling or tightness, wheezing, asthma, shortness of breath, nausea, vomiting, abdominal cramping, diarrhea, generalized hives. Rarely, decreased blood pressure (hypotension) and fainting may occur. At the first signs of any major systemic reaction, give epinephrine in the leg and CALL 911 or have some drive you to the E.R. The most dangerous symptoms of a major systemic reaction are throat swelling, shortness of breath, major wheezing or raspy breathing, major hives or fainting. Depending on the nature and severity of the reaction, this dose of epinephrine may be repeated in 10 minutes. An antihistamine should also be given by mouth. PLEASE NOTE: IF ANY MAJOR SYSTEMIC ALLERGIC REACTION OCCURS, YOU MUST RETURN TO OUR OFFICE FOR FURTHER INSTRUCTIONS PRIOR TO TAKING ANY MORE SUBLINGUAL IMMUNOTHERAPY. DOSE CHANGE BASED ON MISSED DOSES OR ADVERSE REACTIONS MISSED DAYS DOSAGE ADJUSTMENT 1-7 Days Continue advancement or repeat if at the maintenance dose Days Decrease drop dosage by ½ the number of drops and then advance by one drop each day to former dose. More than 21 Days Call our office for instructions. LOCAL REACTION No Reaction Minimal reaction (itching of mouth) Mild reaction (swelling of lips/tongue) Severe Systemic reaction (major hives, major oral swelling, major throat tightness, major wheezing, major shortness of breath) RESPONSE Dose according to schedule or continue maintenance dosing. Take an oral antihistamine as needed Take an oral antihistamine as needed. Reduce the dosage to last tolerated dose, repeat x 2, then continue advancement. Take an oral antihistamine, use epinephrine injection on way to ER/911. If you have asthma, use your albuterol inhaler every 30 seconds up to 10 times in an hour. Call our office and arrange a follow-up visit before further dosing

7 TREATMENT OF SYSTEMIC ADVERSE REACTIONS TO ALLERGEN IMMUNOTHERAPY There is always the possibility of a systemic allergic reaction (anaphylaxis) to one of the doses, even though the same dose may have been previously well tolerated. Anaphylactic symptoms may include progressive itching (nose, throat, eyes, skin, palms of hands, soles of feet, etc.), sneezing, coughing, nasal congestion/drainage, throat swelling or tightness, wheezing, asthma, shortness of breath, nausea, vomiting, abdominal cramping, diarrhea, generalized hives. Rarely, decreased blood pressure (hypotension) and fainting may occur. At the first signs of any major systemic reaction, give epinephrine in the leg and CALL 911 or have some drive you to the E.R. The most dangerous symptoms of a major systemic reaction are throat swelling, shortness of breath, major wheezing or raspy breathing, major hives or fainting. Depending on the nature and severity of the reaction, this dose of epinephrine may be repeated in 10 minutes. An antihistamine should also be given by mouth. PLEASE NOTE: IF ANY MAJOR SYSTEMIC ALLERGIC REACTION OCCURS, YOU MUST RETURN TO OUR OFFICE FOR FURTHER INSTRUCTIONS PRIOR TO TAKING ANY MORE SUBLINGUAL IMMUNOTHERAPY. DOSE CHANGE BASED ON MISSED DOSES OR ADVERSE REACTIONS MISSED DAYS DOSAGE ADJUSTMENT 1-7 Days Continue advancement or repeat if at the maintenance dose Days Decrease drop dosage by ½ the number of drops and then advance by one drop each day to former dose. More than 21 Days Call our office for instructions. LOCAL REACTION No Reaction Minimal reaction (itching of mouth) Mild reaction (swelling of lips/tongue) Severe Systemic reaction (major hives, major oral swelling, major throat tightness, major wheezing, major shortness of breath) RESPONSE Dose according to schedule or continue maintenance dosing. Take an oral antihistamine as needed Take an oral antihistamine as needed. Reduce the dosage to last tolerated dose, repeat x 2, then continue advancement. Take an oral antihistamine, use epinephrine injection on way to ER/911. If you have asthma, use your albuterol inhaler every 30 seconds up to 10 times in an hour. Call our office and arrange a follow-up visit before further dosing