Is It Allergy? Get to the root of your patients allergy-like symptoms with Allergen-Specific IgE Blood Testing.

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1 Is It Allergy? Eczema About 27% of children who have food allergy also have eczema or a skin allergy. 1 Atopic dermatitis affects between 10% and 20% of children. 2 Food The prevalence of food allergy has increased 18% from Kids with food allergy are two to four times more likely to have conditions such as asthma and other allergies. 1 Rhinitis Allergic Rhinitis affects as many as 40% of children. 3 Wheeze/ Asthma About 70% of asthmatics also have allergies million school days are missed each year due to asthma. 5 The Allergic March is a term that describes how allergic diseases progress throughout one s life. Leap Study. For more information, please visit Get to the root of your patients allergy-like symptoms with Allergen-Specific IgE Blood Testing.

2 Who Should Be Allergy Tested? Specific IgE blood test should be strongly considered for patients with: Nasal or other allergy-like symptoms Recurrent or chronic rhinitis, sinusitis, eczema or asthma Food Intolerances Is Allergen Immunotherapy Right for Your Patients? Consider immunotherapy for patients with the following: Allergies that persist for most of the year Positive allergy test results combined with clinical experience Allergy symptoms that are uncontrolled by routine allergy medication Physician Convenience Maintain your patient base Offer your patients immunotherapy provided in a convenient and familiar location Collect reimbursement for immunotherapy Allergen immunotherapy is considered a safe and effective way of treating children with allergies Treat the cause not just the allergy symptoms of your patient Improve overall quality of life for your allergy patients 1. Branum AM, Lukacs SL. Food allergy among U.S. children: Trends in prevalence and hospitalizations. NCHS data brief, no 10. Hyattsville, MD: National Center for Health Statistics Disease Management of atopic dermatitis: An updated practice parameter. Ann Allergy Immunol. 2004; 93: S1-S The Diagnosis and Management of Rhinitis: An Updated Practice Parameter. Joint Task Force on Practice Parameters. J Allergy Clin lmmunol. 2008; 122: World Health Organization. Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach, Akinbami, L. Asthma prevalence, health care use and mortality: United States , CDC National Center for Health Statistics, 2006.

3 Collect blood for initial allergy panel. Current medications will not affect test results Pre-Paid shipping supplies are provided at no extra charge. Some or all tests are positive. Consider additional allergy testing. Serum is kept for 6 months. No need to re-draw the patient. lmmunotherapy Treatment selected. Sign the order and fax to the extract company to prepare. lmmunotherapy Vials are shipped and billed directly to your office to begin patient treatment. Patient Arrives Ship Specimen Results Faxed Patient Treatment Treatment Vials for appointment Options All inhalant test results are negative consider nonallergic causes for symptoms. Patient declines immunotherapy treatment. Allergen avoidance and pharmacotherapy are the best treatment options. Patient Educational Brochures are complimentary. MD AllergyPro connects allergy testing and treatment through partnerships with leaders in the allergy field. Our partners are highly regarded as experts with a particular focus on customer service.

4 Definitive Allergy Diagnosis combined with Definitive Allergy Treatment *Connect In Vitro Allergy Test Results to Appropriate Treatment *Access the largest source of allergen test selection in the United States *Order immunotherapy from a FDA licensed pharmaceutical manufacturer *Gain assistance in all aspects of patient care and office support from the initial allergy blood test to immunotherapy treatment, if indicated Physician and Patient Benefits Provide treatment for the cause of allergy not just the symptoms Continuity of Care Improve Patient Outcomes and Satisfaction Increase Access to Personalized Medicine

5 Panel #1 6 Foods F1 Egg White F2 Cow s Milk F4 Wheat F8 Corn (flour) F13 Peanut F14 Soybean *Suggested Panel Only Panel #2 15 Foods F1 Egg White F2 Cow s Milk F3 Cod Fish F4 Wheat F7 Oat F8 Corn (flour) F10 Sesame Seed F13 Peanut F14 Soybean F20 Almond F24 Shrimp F25 Tomato F33 Orange F49 Apple F256 Walnut *Suggested Panel Only

6 Panel #3 Georgia and Alabama Animals/ Dust Mites Grasses Trees Weeds Molds Dl D Pteronyssinus G2 Bermuda T7 White Oak Wl Common Ragweed Ml Penicillium Notatum D2 Farinae G6 Timothy T8 American Elm W6 Mugwort M2 Cladosporium Herbarum El Cat hair/ standardized GlO Johnson TIO White Birch W9 English Plantain M3 Aspergillus Fumigatus E2 Dog Epithelium G17 Bahia T27 Red Maple W20 Nettle M4 Mucor Racemosus IlOO American Cockroach T 41 White Hickory W14 Rough Pigweed M6 Altemaria Tenuis T61 Sycamore W18 Sheep Sorrel MIO Stemphylium Botryosum T71 Red Mulberry T219 Red Cedar T211 Sweet Gum The Hycor enzyme immunoassay (EIA) detects the presence of specific IgE antibodies in the patient s serum to allergens being tested. Activity of IgE antibodies may cause many of the symptoms associated with allergy. Knowin which allergens trigger and IgE response allows the physician to determine if the appropriate treatment drugs, avoidance or immunotherapy. *Suggested Panel Only.

7 Panel #4 North and South Carolina Animals/ Dust Mites Grasses Trees Weeds Molds Dl D Pteronyssinus G2 Bermuda T7 White Oak Wl Common Ragweed Ml Penicillium Notatum D2 Farinae G6 Timothy T8 American Elm W6 Mugwort M2 Cladosporium Herbarum El Cat hair/ standardized GlO Johnson TIO White Birch W9 English Plantain M3 Aspergillus Fumigatus E2 Dog Epithelium G17 Bahia T27 Red Maple W20 Nettle M4 Mucor Racemosus IlOO American Cockroach T 41 White Hickory W14 Rough Pigweed M6 Altemaria Tenuis T61 Sycamore W18 Sheep Sorrel MIO Stemphylium Botryosum T71 Red Mulberry T219 Red Cedar T211 Sweet Gum Total IgE is included in this panel. The Hycor enzyme immunoassay (EIA) detects the presence of specific IgE antibodies in the patient s serum to allergens being tested. Activity of IgE antibodies may cause many of the symptoms associated with allergy. Knowin which allergens trigger and IgE response allows the physician to determine if the appropriate treatment drugs, avoidance or immunotherapy. *Suggested Panel Only.

8 MD AllergyPro Test Panels: Pollens:(25) Bermuda Grass G002 Fescue Meadow G004 Rye Grass G70 Timothy Grass G006 Bahia Grass G17 D. Pteronyssinus D001 D. Farinae D002 House Dust H001 Cat Hair/Dander E001 Dog Epithelium E002 Cockroach American 1100 Maple/Box Elder T001 Mountain Cedar T006 White Oak TOO? American Elm T008 Cottonwood Tree T014 Pecan T022 Ragweed, Short W001 English Plantain W009 Lamb s Quarter W010 Pigweed W014 Sheep Sorrel W018 Cocklebur W013 Dog Fennel W046 Sycamore T061 Molds:(12) Aspergillus Fumigatas M003 Alternaria Tenuis M006 Rhizopus Nigricans M011 Mucor Racemosus M04 Stemphylium Botryosum M10 Aureobasidium Pullulans M012 Curvularia Lunata M016 Fusarium Moniliforme M09 Helminthosporium Halodes MOB Cephalosporium Acremonium M202 Hormodendrum (Cladisprium) M002 Botrytis Cinerea M007 Foods(17) Milk, Cow F002 Wheat F004 Corn (flour) FOOS Peanut F013 Soybean F014 Shrimp F024 Tomato F025 Baker s yeast F045 Cheddar Cheese F081 Egg White F001 Egg Yolk F075 Rice F009 Banana F092 Apple F049 Garlic F047 Onion F048 Cod F003

9 Client Name MARIA MEDICAL CTR- SPRINGLAKE (1364) NC HWY 210 S SPRING LAKE, NC A Pelham Road, Greenville, SC Phone: Fax: CLIA ID#: 42D COLA#: Accession No Report Status COMPLETE Printed Date/Time 1/21/ :31 Patient Name DOE, JOHN Physician TEST PHYSICIAN (962) Patient ID No Date/Time Collected 11/5/2015 Patient Phone (000) Date/Time Received 11/6/2015 Date of Birth 06/29/1999 Date/Time 11/10/2015 Age 16 Sex Male Comment TEST NAME WITHIN RANGE OUTSIDE RANGE REFERENCE RANGE UNITS Allergy Full Panel (Q) D. pteronyssinus (D1) 0.0 <0.05 CLASS CONC IU/ML INTERPRETATION NEGATIVE<0.05 NEGATIVE O/I EQUIVOCAL I POSITIVE II WITH III INCREASING IV ANTIBODY V CONCENTRATION VI >62.50 Farinae (D2) 0.0 <0.05 Cat Hair (E1) H 0.57 <0.05 Goose Feathers (E70), Q <0.35 <0.35 Bermuda (G2) H 0.64 <0.05 Meadow Fescue (G4), Q H <0.35 Rye Grass (G5), Q H <0.35 Timothy (G6) H <0.05 Redtop, Bentgrass (G9), Q H <0.35 Bahia (G17) H 2.96 <0.05 House Dust, Hollistier (H2), Q H 4.48 <0.35 A. fumigatus (M3) 0.01 <0.05 Candida albicans (M5), Q <0.35 <0.35 A. tenius (M6) 0.0 <0.05 Helminthosporium halodes (M8), Q <0.35 <0.35 S. botryosum (M10) 0.0 <0.05 Curvularia lunata (M16), Q <0.35 <0.35 White Oak (T7) 0.0 <0.05 American Elm (T8) 0.0 <0.05 Sycamore (T61) 0.0 <0.05 Common Ragweed (W1) H 6.49 <0.05 English Plantain (W9) H 0.07 <0.05 Lamb's Quarter (W10), Q <0.35 <0.35 Golden Rod (W12), Q H 1.07 <0.35 Dog Epitheilum (E2) H 7.09 <0.05 Box Elder (T1) 0.0 <0.5 Allergy, Food (Dr Maria) IgE, Total H Egg White (F1) H 0.09 <0.05 CLASS CONC IU/ML INTERPRETATION NEGATIVE<0.05 NEGATIVE O/I EQUIVOCAL I POSITIVE II WITH III INCREASING IV ANTIBODY V CONCENTRATION VI >62.50 Cow's Milk (F2) H 0.06 <0.05 Cod Fish (F3) 0.0 < DOE, JOHN Page 1 of 2

10 American College of Allergy, Asthma, & Immunolog SOURCE: Fact Sheet: Efficacy and Safety of Immunotherapy Immunotherapy, provided by qualified physicians, is an effective and safe treatment for asthma, allergic rhinitis and insect venom allergy. Effective Treatment for Asthma A meta-analysis of 20 published prospective studies showed that allergen immunotherapy is effective in the treatment of asthma.(1) The American College of Allergy, Asthma & Immunology (ACAAI) recently compiled an annotated bibliography of 59 articles from the medical literature indicating the value of expert care and immunotherapy for asthma.(2) A meta-analysis of 23 published studies involving 935 asthmatic patients with documented allergy indicated that immunotherapy is effective in a selected population of allergic asthmatic patients.(3) Effective Treatment for Allergic Rhinitis An extensive review of immunotherapy for allergic rhinitis in children showed that the only treatment able to affect the natural cause of the disease is immunotherapy, and that immunotherapy may prevent the onset of asthma.(4) A meta-analysis of 1 8 published studies involving 789 patients concluded that immunotherapy is highly effective in the treatment of allergic rhinitis.(5) Effective Treatment for Insect Venom Allergy Immunization with insect venom is an extremely effective treatment for preventing future systemic reactions to insect stings in individuals with previously demonstrated susceptibility.(6) A meta-analysis of nine published studies indicated that a course of immunotherapy is highly effective in the management of insect sting hypersensitivity.(7) Immunotherapy Safety A report from the Mayo Clinic on 79,593 immunotherapy injections over a 10-year period showed the incidence of adverse reactions to be less than two-tenths of 1 percent ( percent). Most of the reactions were mild and responded to immediate medical treatment. There were no fatalities.(8) More than 1 million injections were given without a fatality to 8,706 patients in allergy clinics at Roosevelt Hospital, New York City, between 1935 and 1955.(9) Comparative Risks of Immunotherapy Nevertheless, rare occurrences of fatal anaphylactic episodes related to immunotherapy continue to be reported and studied. A total of 35 deaths following immunotherapy administration were reported for the years 1985 through It has been estimated that during that period there were 52.3 million immunotherapy procedures, making the incidence of fatality less than one per million ( per million).(10) Data recently compiled by the Allergen Products Manufacturers Association (APMA) estimated the incidence of fatalities to be about three per 190 million annual injections, or approximately one per 63 million injections.(11) Another study evaluating 13 international fatalities related to

11 immunotherapy between 1992 and 1996 identified an elevated risk for patients with active asthma and being switched to high doses.(12) For perspective, it is useful to compare these statistics with the incidence of fatalities related to other kinds of injections. Studies of fatal anaphylaxis reactions to injected penicillin have ranged from 0.4 fatalities per million injections(13), to 1 fatality per 7.5 million injections.(14) Fatalities related to radiocontrast dyes used in intravascular radiologic studies in the early 1980s varied from 1 in 13,000 procedures(15) to 1 in 75,000 procedures.(16) A more recent study showed a substantial improvement to about 1 fatality in 169,000 procedures.(17) References 1. Abramson MJ, Puv RM, Weiner JM. Allergen immunotherapy effective in asthma? A meta-analysis of randomized controlled trials. Am J Respir Crit Care Med 1995;1 5 1 : Sullivan TJ, Seiner JC, Patterson R, Portnoy J, Seligman M. Expert Care and lmmnnotherapy for Asthma. A review of published studies with emphasis on patient outcome and cost. ACAAI Monograph, Nov 1 996, Ross RR. Effectiveness of immunotherapy in the management of asthma: A meta-analysis of the literature. May Data on file with American Academy of Allergy, Asthma & lmmnnology (AAAAI) and American College of Allergy, Astlnna and lmmnnology (ACAAI) and submitted for publication. 4. Bousquet J, Demoly P. Specific immunotherapy for allergic rhinitis in children. Allergy Clin lmmnnol Inter 1996; 8: Ross RR. Effectiveness of immunotherapy in management of allergic rhinitis: A meta-analysis of the literature. May Data on file with AAAAI and ACAAI and submitted for publication. 6. Valentine MD. Anaphylaxis and stinging insect hypersensitivity. JAMA 1992; 268: Ross RR. Effectiveness of immunotherapy in the management of insect venom hypersensitivity: A meta-analysis of the literature. May Data on file with AAAAI and ACAAI and submitted for publication. 8. Valyaservi MA, Yocum MW, Gosselin VA, Hunt LW. Systemic reactions to immunotherapy at the Mayo Clinic. J Allergy Clin lmmunol 1 997; 99:S Van Arsdel PP, Sherman WB. The risk of inducing constitutional reactions in allergic patients. J Allergy 1957; 28: Turkeltaub P. Deaths associated with allergenic extracts. FDA Medical Bulletin 24, May Data on file with the Allergen Products Manufacturers Association. April Communication. 12. Kordash T, Miller J. Allergenic extracts used in immunotherapy fatalities. J Allergy Clin Immunol 1997; 99:S Orange RP, Donsky GJ. Anaphylaxis. In Middleton E, Reed CE, Ellis EF, editors. Allergy: principles and practice. St. Louis 1 978, Mosby. 14. Idsoe 0, Grothe T, Wilcox RR, et al. Nature and extent of penicillin side-reactions with particular references to fatalities from anaphylactic shock. Bull WHO 1968; 38: Shehadi WH. Death following intravascular administration of contrast media. Acta Radio! Diagn 1982; 26: Hartman GW, Hattery RR, Witten OM, Williamson B. Mortality during excretory urography: Mayo Clinic Experience. AJR 1982; 139: Katayama H, Yamaguchi K, Kozuka T, et al. Reactions to ionic and nonionic contrast media: A report from the Japanese Committee on the Safety of Contrast Media. Radiology 1990; 175 : Joint task force on practice parameters representing the American Academy of Allergy, Asthma & Immunology and the American College of Allergy, Asthma & Immunology. Nichlas RA, Bernstein IL, Blessing-Moore J, Fineman S, editors. J Allergy Clin Immunol!996; 98: Executive Committee, American Academy of Allergy, Asthma & Immunology. The waiting period after allergen skin testing and immunotherapy. J Allergy Clin Immunol 1990; 85 : Board of Directors, American Academy of Allergy, Asthma & Immunology. Position Statement. Guidelines to minimize the risk from systemic reactions caused by immunotherapy with allergenic extracts. J Allergy Clin Immunol 1994; 93 :

12 PRACTICE INFORMATION Lab Use Only Sample ID# 6000A Pelham Road Greenville, SC Phone: Fax: CLIA ID# 42D BILL TO MY ACCOUNT MEDICARE WORKERS COMP PATIENT MEDICAID OTHER INSURANCE ICD-10 CODES / / DATE COLLECTED TIME COLLECTED COLLECTOR NAME SPECIMEN INFORMATION SPECIMEN HANDLING FEE CPT PATIENT INFORMATION 3. RELEASE PATIENT SOCIAL SECURITY # / AR# PATIENT NUMBER / EMR NUMBER PRINT PATIENT LAST NAME PRINT PATIENT FIRST NAME (Full Legal) MIDDLE ADDRESS CITY STATE ZIP PATIENT PHONE PATIENT ADDRESS DATE OF BIRTH GENDER PRINT NAME OF INSURED /RESPONSIBLE PARTY (LAST, FIRST, MIDDLE) IF OTHER THAN PATIENT Consent/lnsurance Release: I voluntarily consent to the collection and testing of my specimen and certify that the specimen identified on this form is my own; it is fresh and has not been adulterated in any manner. I certify that the information provided on this form and on the specimen container is accurate. I further authorize Premier Medical Laboratory Services to release the results of this testing to the ordering facility. Furthermore, I hereby authorize my insurance benefits to be paid directly to Premier Medical Laboratory Services. I acknowledge that Premier Medical Laboratory Services may be an out-of-network provider for my insurance plan. I have been informed that in certain circumstances my insurance company may send the payment for services provided, directly to me instead of to Premier Medical Laboratory Services. Under law, I acknowledge that this does not release me from responsibility of my debt. I agree to endorse the insurance check and forward it to Premier Medical Laboratory Services within 30 days of receipt. Failure to do so could result in my account being forwarded to collections and reported to a Credit Bureau. PATIENT SIGNATURE: DATE: ORDERING PHYSICIAN: ORDERING PHYSICIAN SIGNATURE: DATE: GRASSES 1325 Bermuda Grass 1432 Perennial Rye Grass 1326 Timothy Grass 1373 Bluegrass, Kentucky 1433 Red Top 1327 Johnson Grass 1328 Bahia Grass TREES 1434 Maple/Box Elder 1374 Beech 1435 Cedar, Mountain 1329 Oak, White 1331 Elm, American 1375 Walnut 1436 Cottonwood Tree 1376 Ash, White 1377 Mesquite 1378 Pecan Tree 1333 Maple, Red 1332 Birch, White 1379 Elm, Chinese 1334 Hickory, White 1335 Sycamore 1437 Mulberry, White 1386 Oak, Live VA Alder, Smooth 1388 Privet 1338 Sweet Gum 1337 Cedar, Red MD ALLERGYPRO MASTER ALLERGENS LIST MD ALLERGYPRO PANELS 1550 Southeast Panel 1560 Basic Foods 1570 Common Foods D. Pteronyssinus, Farinae, Cat Hair, Dog Dander, American Cockroach, Bermuda, Timothy, Johnson, Bahia, White Oak, American Elm, White Birch, Red Maple, White Hickory, Sycamore, Red Mulberry, Red Cedar, Sweet Gum, Common Ragweed, Mugwort, English Plantain, Nettle, Rough Pigweed, Sheep Sorrel, Penicillium Notatum, C. Herbarum, A. Furnigatus, M. Racemosus, A. Tenius, S. Botryosum WEEDS 1339 Ragweed, Short/Common 1389 Wormwood/Sagebrush 1347 Mugwort 1348 Plantain, English 1438 Lamb s Quarters 1439 Thistle, Russian 1350 Pigweed, Rough 1351 Sheep Sorrel 1349 Nettle 1391 Pigweed, Spiny 1392 Sagebrush 1393 Careless Weed MOLDS 1352 Penicillium Notatum 1353 Cladosporium Herbarum (Hormodendrum) 1354 Aspergillis Fumigatus 1355 Mucor Racemosus 1440 Candida Albicans 1356 Alternaria Tenuis 1441 Helminthosporium 1357 Stemphylium Botryosum 1394 Phoma Betae 1442 Curvularia Lunata 1396 Fusarium Oxysporum 1397 Epidermophyton Flocossum 1398 Wheat Smut 1399 Trichophyton Rubrum 1400 Stachybotrus Chartarum DUST MITES/ANIMALS 1320 D. Pteronyssinus 1321 D. Farinae 1322 Cat Hair, Standardized 1401 Dog Epithelium 1323 Dog Dander 1443 House Dust, H.S Cockroach, American FOODS 1358 Egg White 1361 Cow s Milk 1368 Cod Fish 1359 Wheat 1364 Oat 1362 Corn (Flour) 1402 Rice 1369 Sesame Seed 1360 Peanut 1363 Soybean 1403 Filbert/Hazelnut 1404 Cayenne Pepper 1366 Almond 1405 Sugar, Cane 1370 Shrimp 1372 Tomato 1406 Beef 1407 Watermelon 1365 Orange 1408 Potato, White 1409 Baker s Yeast 1411 Garlic Egg White, Cow s Milk, Wheat, Corn (Flour), Peanut, Soybean 1367 Apple 1444 Chocolate/Cocoa 1445 Scallop 1412 Potato, Sweet 1413 Gluten 1414 Cheese, Blue/Cheese/Mold 1415 Kiwi 1446 Banana 1416 Peach 1417 Avocado 1418 Cheese, American 1419 Brewer s Yeast 1447 Pecan 1421 Pineapple 1422 Whole Egg 1423 Honey 1371 Walnut 1424 Pepper, Black 1425 Blueberry 1426 Sweet Chestnut ASTHMA J4520 Mild intermittent asthma, uncomplicated J4522 Mild intermittent asthma with status asthmaticus J4521 Mild intermittent asthma with (acute) exacerbation J45991 Cough variant asthma J45909 Unspecified asthma, uncomplicated J45998 Other asthma J45902 Unspecified asthma with status asthmaticus J45901 Unspecified asthma with (acute) exacerbation RHINITIS J310 Chronic rhinitis J301 Allergic rhinitis due to pollen J3081 Allergic rhinitis due to animal (cat) (dog) hair and dander J302 Other seasonal allergic rhinitis J3089 Other allergic rhinitis J300 Vasomotor rhinitis J309 Allergic rhinitis, unspecified SINUSITIS J320 Chronic maxillary sinusitis J321 Chronic frontal sinusitis J322 Chronic ethmoidal sinusitis J323 Chronic sphenoidal sinusitis J328 Other chronic sinusitis J329 Chronic sinusitis, unspecified URTICARIA L500 Allergic urticaria L501 Idiopathic urticaria L506 Contact urticaria L508 Other urticaria Egg White, Cow s Milk, Cod Fish, Wheat, Oat, Corn (Flour), Sesame Seed, Peanut, Soybean, Almond, Shrimp, Tomato, Orange, Apple, Walnut ALLERGIES T782XXA Anaphylactic shock, unspecified, initial encounter Z888 Allergy status to other drugs, medicaments and biological substances status Z91010 Allergy to peanuts Z91011 Allergy to milk products Z91012 Allergy to eggs Z91013 Allergy to seafood Z91018 Allergy to other foods Z91038 Other insect allergy status Z91040 Latex allergy status Z91041 Radiographic dye allergy status DRUG / OCCUPATIONAL 1427 Penicillin G 1428 Penicillin V 1429 Ascorbic Acid 1430 Latex 1431 Orris Root

13 ALLERGEN IMMUNOTHERAPY PRESCRIPTION SERVICE Allergy Treatment Sets supplied according to your prescription! Let us do the work. Mixing allergy shot vials is technically demanding work. Our prescription service is available to those practices that prefer not to mix their own treatment sets. Each prescription is made to exact specifications in our sterile products facility and undergoes the same rigorous sterility testing as all other extracts. Please allow 3 to 4 weeks for completion of your order on account of the FDA-mandated 14-day sterility testing protocol. A signed prescription from a physician is required to have your order filled and shipped. Special requests? No problem. Our prescription department will manufacture a 4-vial set of graduated dilutions in 5 ml vials as prescribed, with a maximum of 12 antigens. We can also accommodate special requests. Maintenance refills are supplied in 5 or 10 ml sizes. Need technical help? Technical assistance is also available through our Customer Service Department and staff pharmacist. How can MD AllergyPro prescription service benefit your practice? Economical and Efficient Our service enables you to capture allergy patients currently being referred. Immunotherapy is profitable for the prescribing physician. Safe, Sterile and Accurate Our prescription service takes the mystery out of clinical immunotherapy. Quality assurance continually monitors systems and activities, and tests every patient vial for sterility. Convenient We deliver patient-specific shot vials from our FDAlicensed facility to your doorstep with clear dosage instructions. Simple Order Procedure Fax forms make order placement fast and efficient. Orders are acknowledged shortly after receipt and shipped to your office in approximately 21 to 28 days Fax: A Pelham Road Greenville, SC 29615

14 ALLERGEN IMMUNOTHERAPY PRESCRIPTION SERVICE Frequently Asked Questions Q: WHAT IS A TREATMENT SET? A treatment set is a custom compounded set of vials prepared specifically for one patient. The vials are filled with the proportions of allergens prescribed by the physician. Typically, a set consists of four color-coded vials of increasing concentrations which are subcutaneously injected over a 25-week period. Q: WHAT IS THE DOSAGE SCHEDULE? The physician will specify the schedule. We have a suggested dosage schedule in our package insert which outlines a typical injection schedule. Q: WHAT IS THE MAXIMUM NUMBER OF ALLERGENS THAT CAN BE MIXED INTO ONE TREATMENT SET? The maximum is 12 per set. It is not uncommon for very allergic patients to have two treatment sets. Q: WHAT IS THE AVERAGE EXPIRATION DATE FOR A TREATMENT SET? The expiration date is no more than one year. Q: HOW SOON CAN I EXPECT DELIVERY AFTER SUBMITTING THE PRESCRIPTION? Each patient s treatment set will require 21 to 28 days. This includes the FDA-mandated 14- day sterility testing period. Q: CAN I BILL PRESCRIPTION TREATMENT SETS EVEN THOUGH THEY WERE PREPARED BY MD ALLERGYPRO? Yes, our Customer Service Department will be happy to assist you with any questions. Q: CAN I BILL FOR THE WEEKLY INJECTION? Yes, our Customer Service Department will be happy to assist you with any questions. Q: ARE THERE ANY SPECIAL STORAGE CONDITIONS? Although the extracts and treatment sets we produce are very stable, it is recommended that they be stored in a refrigerator. Q: WHICH ALLERGY TESTING METHOD CORRESPONDS WITH MD ALLERGYPRO S TREATMENT SETS? Physicians use a number of diagnostic methods to determine if a patient s symptoms are caused by allergy. Common methods are patient history and skin testing or in vitro testing (usually a RAST test). Patient prescriptions can be formulated from any of these allergy testing methods. Q: HOW LONG DO PATIENTS STAY ON INJECTIONS AND HOW DO I HANDLE REFILLS? The physician will specify the duration. History has shown that 3 years is average. However, each patient is different and no definitive period has been established. Refills may be requested by phone or fax Fax: A Pelham Road Greenville, SC 29615

15 (7) Dose adjustments: Since the individual components of the extract are those to which the patient is allergic and to which he will be exposed, typical allergic symptoms may follow shortly after the injection, particularly those experienced by the patient during exposure when the antigen from the environment plus the injected antigen exceeds the patient s tolerance to the antigen. In such cases, decrease the size of the next scheduled dose by at least one-half of the previous dose. (8) Administration: Use aseptic precautions when diluting and/or preparing an injection. To avoid crosscontamination, do not use the same needle to withdraw materials from multiple vials. Use a sterile tuberculin syringe with a needle at least 5/8 long and graduated in 0.01 ml units to measure each dose. (9) Custom formulations: Contact customer service to request customized formulations. HOW SUPPLIED Our standard treatment set Is a 4-vial dilution series; each vial formulated to 5 ml in increasing dilutions as follows: Vial 1 RAST -2 (green seal), Vial 2 RAST -1 (blue seal), Vial 3 RAST o (gold seal) and Vial 4 RAST +1 (red seal). Our standard maintenance vial is 5 or 10 ml, RAST +1 (red seal). The vials and sealed boxes are labeled with patient and prescription identification. A description of the formula Is provided for each prescription. Customized formulations may by identified by other dilutions, seal colors and volumes. To Insure the maximum potency of extract dilutions, it is re commended that they be maintained at a temperature of 2 to 8 degrees Celsius. Do not freeze. Do not use after the expiration date shown on the vial label. SUGGESTED DOSAGE SCHEDULE There are approximately 40 doses in our standard treatment set when the following suggested dosage schedule is followed. If the patient reaches maintenance by dose 40, then 0.50 ml can be repeated weekly. VIAL 1 RAST-2 VIAL 2 RAST-1 VIAL 3 RAST 0 VIAL 4 RAST +1 DOSE # Vol. (ml) DOSE # Vol. (ml) DOSE # Vol. (ml) DOSE # Vol. (ml) Continue 0.50 ml for weekly maintenance.

16 Today, millions of people across the globe suffer from allergies, asthma, and other related immunologic disease. Though clinical practice of sublingual immunotherapy in the United States dates back nearly 100 years, research validating what was learned clinically has only begun to garner attention in the past few decades. Mark s Experience with Allergy Drops I was told that I could do standard allergy shots or sublingual allergy drops. While both shots and drops have to be taken for three to five years, there were reasons I chose the allergy drops. The downside for allergy shots was that I had to go to my doctor s office to get the shot, I would have a co-pay each time and let s face it, it s a shot. It made more sense to me to get allergy drops. It was easier than trying to constantly get appointments. While the drops are not covered under my insurance, when you price it out I would have spent the same amount of money in co-pays for allergy shots. A large number of controlled clinical trials in Europe have shown the effectiveness of sublingual immunotherapy in the treatment of allergic rhinitis and asthma for single a antigens. More studies are underway in the United States and globally today, including studies that have explored food allergies. Additional research has shed light on the mechanisms behind sublingual immunotherapy, notably the unique role dendritic cells under the tongue play in building tolerance. A number of modern research references for sublingual immunotherapy, including recent findings through the Agency for Healthcare Research & Quality (AHRQ) can be found in our Bibliography; studies that specifically address the key tenets of the La Crosse Method can be found in our Supporting Evidence section, and we will continue to share information on new research in Ongoing Studies. Expand your practice and help more allergy patients.

17 Who should take allergy drop immunotherapy? Although most allergy sufferers can benefit from allergy drops, they re especially ideal for people who can t tolerate or don t respond to allergy shots, as well as people who are unable to commit to allergy shot therapy. These people include: Infants and children* Asthmatics Highly sensitive people Those with chronic conditions including sinusitis People with food and mold allergies People with multiple allergies including dust, pollen and animals. *Allergy drops have proven especially helpful for children with eczema and recurrent ear infections, which often have underlying allergic causes. Research shows that many children with untreated eczema and allergies will develop asthma and other chronic conditions later in life, so treating them early can have life-long preventive benefits. What are the advantages of allergy drops? In addition to being able to treat patients of all ages safely and effectively, there are other advantages to allergy drops. Lower cost, fewer clinic visits. Compared to shots, allergy drops cost less and require fewer clinic visits. Patients using allergy drops can avoid weekly or monthly office visits that typically occur with allergy injections, and enjoy the financial benefits of reduced use of symptom relieving medication. More convenient. You can take allergy drops at home or wherever you need to be, making it much easier to stay with your treatment. Less medication. Our patients report, and research confirms, that most patients need less medication to control symptoms after beginning allergy drops. Are allergy drops safe? Is there research validating their effectiveness? Allergy drops have been used around the world for more than 60 years, with more than 300 citations including over 90 peer-reviewed studies published since Internationally, allergy drops are used widely (50% in some European countries), with full regulatory and government backing. The World Health Organization (WHO) endorsed it as a viable alternative to injection therapy. In 2007, an international workgroup that included U.S. allergists published the ARIA (Allergic Rhinitis and its Impact on Asthma) guidelines indicating SLIT as a viable treatment approach. The ARIA paper indicates that not only is there more modern research on allergy drops compared to allergy shots, but it is also of higher quality in terms of the WHO guidelines for research studies. A Cochrane Review, the most trusted independent, evidence-based, metaanalysis organization in the world, released their analysis in 2003, that determined the treatment both safe and effective. How long will I need to take my drops? Most patients take allergy drops each day for three to five years, but it varies according to the severity of their allergies and the seasonality, and how compliant they are with treatment. Many patients feel improvement within a few months. Will medical insurance cover the costs? At this time, most insurance companies cover the testing and office visit charges, but not the cost of drops. Since the cost of drops is affordable, most patients are willing to pay out of pocket for the benefit of the treatment and reduction in long-term costs. Now you can treat the cause of your allergies safely and effectively-without shots. Enjoy healthier days. The end benefit? Feeling better: Patients typically report fewer clinic visits, hospitalizations, and less time lost from work and school after taking their drops consistently.

18 Now you can treat the cause of your allergies safely and effectively-without shots. We re pleased to offer our patients allergy immunotherapy that you can take at home. It s called sublingual immunotherapy-or allergy drops. Allergy drops work similar to allergy shots, slowly helping you build tolerance to the substance that causes your allergic reactions. The difference is that the antigen is placed under your tongue in liquid form. Not only are allergy drops more convenient, research also shows they are safe and effective for people of all ages. Is sublingual immunotherapy homeopathic? No. We follow the La Crosse Method protocol which uses dosing that is comparable to or higher than that used in allergy shots. It is not homeopathic. This protocol is based on more than 40 years of clinical experience and research, with more than 135,000 patients safely treated and is the most widely used sublingual immunotherapy protocol in the U.S. Enjoying health benefits that last. Since immunotherapy using allergy drops uses carefully measured, frequent doses to treat allergic conditions effectively, our patients often notice improvement relatively quick1y. Although it s tempting to stop treatment once you start feeling better, it s important that you continue your treatment through its full course to ensure longterm effects. How do I begin? Allergy drop immunotherapy should be administered by a doctor who specializes in treating allergies with allergy drops. Your doctor will want to examine you and test you for your specific allergies to develop a treatment program that is customized for you. Patients can choose to order drops from the Allergychoices Pharmacy to ensure the high integrity and quality of their custom-formulated allergy drop prescription. Research shows allergy drops are safe and effective for people of all ages.

19 Allergy Testing Reimbursement Use procedure code for the actual drawing of blood on patient for allergy testing. Use codes, Rast IGE, for single and each allergen, and for the Total IGE score. These codes are used only by the Lab for billing the patient s insurer. Once you receive the results and decide to purchase the allergy serum: Use codes for reimbursements for the doses and allergy shots just like vaccinations and boosters below. Description Code Average Reimbursement Single Injection $12-15 private pay $6.00 Medicaid $14.02 Medicare Two or More Injections $15-22 private pay $9.00 Medicaid $14.43 Medicare Immunotherapy Doses $ private pay $4.57 per dose Medicaid $6.56 per dose Medicare Physician Visits $55.94 as plan dictates Year patients tested per year (1 per day) *75 patients are candidates (30%) *45 patients choose therapy 1 injection per 50 pts $13.50 x 50 = $675 Doses $8.00 x 50 = $400 2 injections per 50 pts $17.50 x 50 = $875 Doses $8.00 x 100 = $800 Physician 4 per yr $55.00 x 4 = $220 Totals: Injections: $35,775 Doses: $28,800 Visits: $9,900 Totals: $74,475 Cost for doses: 18pts x 50 = 900 doses 27 pts x 100 = 2700 doses 3600 doses x $2.35/dose = $8,460 You may choose to bill for reimbursement of the entire 40 doses up front which includes the 4 vial kit of allergy serum. This billing code listed above is However, each individual injections; shots, must be collected after the single or multiple shots are administered from each patient visit, just like vaccinations and boosters. This allows a patient to take the serum with them if they have to move for some reason and find an alternate physician or group to administer the remaining allergy shots individually. Obviously, the alternate physician may not bill for those doses as your practice has already done so, just like an ENT or allergist does. They can bill only for the remaining allergy shots. Get to the root of your patients allergy-like symptoms with Allergen-Specific IgE Blood Testing.

20 (SLIT) Allergy Shots Reimbursement: One Treatment Set 40 doses Average per Dose (CPT 95165) $10.00 Per 75 patients $30, Injections for 75 patients 3,000 injections Average for Injection (CPT 95115) $13.00 Per 75 patients $39,000 Two Physician Visits Per Year 150 visits Physician Visit (CPT 99213) $50.00 Per 75 Patients $7,500 Total Cost: $12,240 Total Reimbursement: $76,500 Gross Profit: $64,260 If half of the above continue and 75 new patients are identified, the next 40 weeks yield approximately $105,300. (SLIT) Allergy Drops Reimbursement: Cash based no insurance billed or required for therapy One Treatment Set (3 Mo/supply) (2 Daily Doses) Physicians Cost/Month $56.66 Patients Cost/Month $99.99 Profits: Per 100 Patients/monthly $ 4,333 Per 100 Patients/Year $ 51,996 Two Physician Visits Per Year $ 100 Physician Visit (CPT 99213) $50.00 Per 100 Patients $10,000 Total Cost: $67,992 Total Reimbursement: $129,999 Gross Profit: $62,007 If half of the above continue and 100 new patients are identified, the next 50 weeks yield approximately $93,000. Get to the root of your patients allergy-like symptoms with Allergen-Specific IgE Blood Testing.