Note:
* Degree of severity of reaction:
- Negative;
+ Weakly positive;
++ Positive;
+++ Sharply positive;
++++ Very sharply positive;
+ - Doubtful.
II. Specific immunotherapy. Specific immunotherapy is carried out in those cases,when it is impossible to exclude the contact of a sensitized patient with an allergen. Allergen for specific immunotherapy is administered subcutaneously.
For the preparation and use of dilutions of the allergen in aseptic conditions, the responsibility is borne by the allergist doctor.
An approximate scheme of specific immunotherapy with pollinosis.
| Breeding | Dose (ml) | Notes |
| allergen |
|
|
| 1 | 2 | 3 |
| 10-5 1:100000 0.1 PNU / ml | 0,1 0,2 0,4 0,8 | Specific immunotherapy is initiated after the diagnosis of atopic disease is not later than 3-4 months before the beginning of flowering and completed no later than 1.5 months before the commencement of the flowering plants. Injections are made strictly subcutaneously in the external the surface of the lower third of the shoulder. The first injections (when diluting the allergen 10-5, 10-4, 10-3) do daily or every other day injections (dilutions 10-2, 10-1) - with an interval of 7-10 days. The dose of the allergen is 0.9-1.0 ml in dilution 10-1 repeat with an interval of 5-7 days before the flowering of trees and grasses. The period of use of the allergen after its dilution is 1 month. After each injection of the allergen, the patient is observed in the office for 60 minutes. The doctor notes the skin reaction at the site of the allergen injection and the general condition of the patient. Contraindication for increasing the dose is a local reaction in the form of an infiltrate larger than 25 mm, the general reaction of the body, the aggravation of the underlying disease. In these cases, the dose is reduced, the intervals between injections are extended until good tolerability is established. |
| 10-4 1:100000 1.0 PNU / ml | 0,1 0,2 0,4 0,8 |
| 10-3 1:100000 10 PNU / ml | 0,1 0,2 0,4 0,8 |
| 10-2 1:100000 100 PNU / ml | 0,1 0,2 0,3 0,4 0,5 0,6 0,7 0,8 0,9 1,0 |
| 10-1 1:100000 1000 PNU / ml | 0,1 0,2 0,3 0,4 0,5 0,6 0,7 0,8 0,9 1,0 |
Precautions for use.
In case of doubtful results of skin tests, they can be repeated 2 days after the local response to the previous samples subsided. In case of positive results, it is allowed to repeat skin tests with pollen allergens no more than once a month.
In particularly sensitive patients, a systemic allergic reaction and anaphylactic shock may occur. In this regard, in the office, where specific diagnostics and specific immunotherapy of patients are carried out, there should be pharmacological preparations and tools for providing urgent assistance.
Assisting with general reactions and anaphylactic shock.
After the introduction of the allergen, symptoms of clinical manifestations of hypersensitivity to the allergen may develop. With parenteral administration of an allergen, it is possible to develop an immediate-type reaction, incl.anaphylaxis, which manifests itself in the form of urticaria and vascular edema, laryngeal edema, shortness of breath and suffocation. These symptoms often occur after feeling generalized itching, burning sensation, skin flushing, and a sense of fear of death.
As a result of anaphylactic shock, non-occuring bronchospasm, asphyxia due to edema of the upper respiratory tract, and collapse can develop.
In this case, urgent medical measures are required.
Pre-hospital help with anaphylactic shock.
1. Immediately stop the introduction of the allergen that caused the reaction, put the patient on the couch (head below the legs), turn the head to the side, push the lower jaw, remove the existing dentures.
2. Apply the tourniquet in place above the allergen injection, if possible.
3. Finish the injection site with 0.3-0.5 ml of adrenaline solution (1 ml of 0.1% solution of epinephrine diluted in 3-5 ml of sodium chloride solution).
4. Apply an ice pack to the injection site.
5. Enter 0.3-0.5 ml of a 0.1% solution of epinephrine (children 0.05-0.1 ml / year of life) in / m or IV with an interval of 5-10 minutes. The multiplicity and dose of adrenaline administered depends on the severity of the shock and blood pressure.The total dose of epinephrine should not exceed 1 ml of 0.1% solution. Repeated administration of small doses of epinephrine is more effective than single administration of a large dose.
6. Provide access to fresh air or give oxygen. If the rhythm of breathing is disturbed or if it is difficult, perform artificial ventilation (IVL).
7. Urgent call the doctor, simultaneously called the resuscitation team.
Before the arrival of the resuscitation team, it is necessary to provide medical care and carry out constant monitoring of hemodynamic parameters and the state of the function of external respiration (FVD).
Hospital help with anaphylactic shock.
1. In extremely severe condition of the patient and with severe hemodynamic disorders, 5 ml of 0.01% solution of epinephrine are injected slowly into IV, when the effect is achieved, the administration is terminated. Children 0.1 ml / kg 0.01% solution slowly for a few minutes.
2. If blood pressure does not stabilize, urgently begin intravenous drip injection of norepinephrine (phenylephrine, dopamine) 0.2% 1.0-2.0 ml per 500 ml of a 5% solution of glucose or sodium chloride solution of 0.9%.
3. Intravenously inject glucocorticosteroids: prednisolone - 60-180 mg (children 5 mg / kg), or dexamethasone - 8-20 mg (children 0,3-0,6 mg / kg), or hydrocortisone - 200-400 mg (children 4-8 mg / kg). As of the introduction of hormones, repeat and continue at least 4-6 days to prevent allergic reactions by immunocomplex or delayed type.
4. Only with the stabilization of blood pressure intramuscularly enter 2.0 ml of a 2% solution of chloropyramine (1-12 months - 0.25 ml, 1-6 years 0.5 ml, 7-18 years -0.5-1 ml) or 0 , 1% clemastine (children 0,025 mg / kg / day for two injections).
5. Symptomatic therapy according to indications. At bronhospazme 10.0 ml of a 2.4% solution of aminophylline on sodium chloride solution 0.9% (2-3 mg / kg for children) is injected intravenously. If necessary, enter cardiac glycosides, respiratory analeptics.
6. If necessary, suck from the respiratory tract accumulated secret and vomit, begin oxygen therapy.
7. Patients receiving β-adrenoceptor blockers, additional administration of salbutamol and / or glucagon to / in 1 ml is indicated.
All patients with anaphylactic shock are subject to compulsory admission for a period of at least 10 days in order to continue monitoring and treatment. In 2-5% of patients who have had anaphylactic shock, late allergic reactions are observed.
Doses of injectable drugs and tactics of the doctor are determined by the clinical picture, but in all cases, first of all, the introduction of adrenaline,glucocorticosteroid preparations. The administration of preparations of phenothiazine series and calcium preparations is contraindicated.