Administer the venom solution subcutaneously, using a suitable sterile syringe with a 0.1 ml graduations and a 25-27 gauge 1/4 to 5/8 inch needle. This self treatment might be necessary before patients have reached a maintenance dose of venom, and partially treated patients should be advised to carry an emergency epinephrine kit during the Hymenoptera season. See also Warnings, Precautions, and Adverse Reactions. During skin testing and the build-up to maintenance dose, before tolerance of the extract is established.

Immunotherapy also produces an initial rise in specific IgE levels, which then decrease as therapy continues.

'Nip it in the butt' or 'Nip it in the bud'? : J Allergy Clin Immunol. The single-venom extracts are intended for both diagnosis and immunotherapy; the mixed vespid product is intended for immunotherapy only. Make sure the patient understands that serious delayed reactions can occur later on, how to recognize them, and what to do if they occur.


Norman, P.S., and Van Metre, T.E. Apply a tourniquet proximal to the injection site; loosen it at least every 10 minutes. Care must be taken to control the preparation, labeling, storage, and use of dilutions. Patients who are receiving beta-blocking medication are high-risk patients for immunotherapy, because systemic reactions to the extract may be more severe in such patients9, and because the beta-blocker may impair the ability to reverse the reaction10. When changing to a freshly-reconstituted extract; all extracts lose potency over time, and a fresh extract could have an effective potency that is substantially greater than that of the old extract. and stems of plants. Carcinogenesis, mutagenesis, impairment of fertility: Note that a needle that has been inserted into a vial of venom must not be re-inserted into a stock bottle of diluent, or into a vial containing another type of extract. To be fair to bees, most stings are carried out by vespids, a classification of insects that includes things like wasps, yellow jackets, and hornets. Then calculate the appropriate shelf life based on the information in Table 4, and write that on the label as well. Data sources include IBM Watson Micromedex (updated 1 Oct 2020), Cerner Multum™ (updated 1 Oct 2020), Wolters Kluwer™ (updated 30 Sep 2020) and others. The therapeutic action of allergenic extracts may be related to the production of IgG (blocking) antibodies.

Yellow Hornet (Dolichovespula arenaria)  Perform a preliminary skin prick test with each preparation at the 1.0 µg/ml concentration, with the diluent as a negative control, and with histamine base at 1 mg/ml as a positive control. Because of the possibility of severe systemic reactions, the patient should be instructed in the recognition of anaphylactic symptoms, observed in the office for at least 30 minutes after each injection, and warned to return to the office if symptoms of an allergic reaction occur. Unlike bees, vespids can be frequently found near open cans of soft drinks and sweet food and garbage. Among other systemic reactions that have occurred are laryngeal edema, fainting, pallor, bradycardia, hypotension, bronchospasm, angioedema, cough, sneezing, conjunctivitis, rhinitis, and urticaria. Patients reacting to the prick test at 1.0 µg/ml of venom should be considered highly sensitive to the venom, and suitable precautions should be taken. If it does, remove the syringe and repeat the procedure at a different site. When the patient has an unexpectedly severe local or any systemic reaction to the previous dose. DK-2970 Hørsholm, Denmark. Severe anaphylactic reactions to this extract can occur in extremely allergic patients and at any dosage level. All patients receiving venom immunotherapy should be instructed in the procedure for emergency self-injection of subcutaneous epinephrine. If a single dose results in more than a moderate local reaction (>5.0 cm wheal) within ½ hour, an additional dose should not be given during that visit. See “Precautions”, above. The skin test reaction occurring in previously sensitized individuals is probably related to the interaction of antigen with IgE antibody and the subsequent release of histamine from mast cells. Patients are most at risk of serious systemic reactions: Observe the patient for at least 30 minutes after injection, and be alert for the signs of impending reaction.

For each vial, record the data of reconstitution or dilution on the label.

Therapy cannot be recommended in the absence of either of those conditions. Inject no more than 0.1 ml of 1:1000 epinephrine at the injection site, to delay the absorption of the remaining extract.

'All Intensive Purposes' or 'All Intents and Purposes'? The presence of the latter indicates marked hypersensitivity. C.V. Moseby Co. Hoffman, D.R., et al. Before injecting the extract subcutaneously, retract the plunger on the syringe slightly and verify that no blood enters the syringe. Read the test response after 15 minutes, and determine the degree of response to the injection, in comparison to the negative control. Slowly inject approximately 0.05 ml. A suggested grading system appears in Table 2. It is also not known whether allergenic extracts can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. It is not known whether such patients may be resensitized by future stings, and such patients should be retested after any subsequent sting. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. This is the concentration from which full maintenance doses are typically drawn. However, vespids aren’t all evil. Allergenic extracts should be given to a pregnant woman only if clearly needed. Local reactions, even relatively severe but transient redness, swelling and discomfort, are the normal physiologic response to the allergens and to the volume of the fluid injected, and in their milder form is evidence of the effectiveness of the therapy.

The stinger of these insects is another method of identification. If a single dose results in more than a moderate local reaction (>5.0 cm wheal) within ½ hour, no additional dose of the venom should be given during that visit, and the same dose should be repeated at the next visit – or visits – until the patient has tolerated it. Delayed (24-48 hrs.) Such changes should not be made without establishing the proper dosage by skin testing. In such patients, this risk should be carefully weighed before a decision to treat is reached. Among those conditions are acute infections, immune disease, severe cardiac disease, and treatment with β-adrenergic antagonist drugs (beta-blockers) and angiotensin inhibitors (ACE-inhibitors). All these preparations must be diluted before use in diagnosis or in the initial stages of treatment.


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