With specific immunotherapy, allergic injections are administered subcutaneously to the lower third of the shoulder.Dilutions of the allergoid are prepared using a diluent fluid for an allergoid. Dilutions of the allergoid should be stored at a temperature of 2 to 8 ° C, the period of use is not more than 1 month.
For the correct preparation and use of dilutions of the allergic with observance of asepsis, the allergist doctor is responsible. Specific immunotherapy is performed in the stage of remission of the underlying disease in the conditions of an allergological room or a specialized department of the hospital.
The dilutions of the drug, the volume administered (dose) and the recommended scheme of application are given in the table.* a) The determination of the initial dose is carried out by the method of allergometric titration.
b) In patients with high sensitivity (high degree of skin test), treatment begins at the discretion of the doctor, with a dilution of 1: 100,000 or 1: 1 million.
Precautions for use.
If, during the introduction of the allergoid or during follow-up for 60 minutes, the patient experiences general weakness or agitation, restlessness, a feeling of fever throughout the body, redness of the face, rash, cough, shortness of breath, abdominal pain, the following Events:
Pre-hospital care for anaphylactic shock.
1. Immediately stop the injection of the allergoid 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 allergoid injection, if possible.
3. To the extremity free from the tourniquet, to conduct 0.3-0.5 ml of 0.1% solution of adrenaline (children 0.01 mg / kg, maximum to 0.3 mg, if necessary, the administration of these doses is repeated every 15 minutes (up to 3 times)) IM or IV with an interval of 10-20 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.
4. 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 0.9%).
5. Apply an ice pack to the injection site.
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 care for 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 (BP) does not stabilize, urgently begin intravenous drip injection of norepinephrine (phenylephrine, dopamine) 0.2% 1.0-2.0 ml per 500 ml of 5% glucose solution for infusion or sodium chloride solution 0.9 %.
3. Intravenously inject glucocorticosteroids intravenously: 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 inject 2.0 ml of a 2% solution of chloropyramine (5-6 years - 0.5 ml, 7-18 years - 0.5-1.0 ml) or 0.1% klemastin (children 0,025 mg / kg / day for two injections).
5. Symptomatic therapy according to indications. In bronchospasm, 10.0 ml of a 2.4% solution of aminophylline on a 0.9% sodium chloride solution (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-adrenoblockers showed additional administration of salbutamol and / or glucagon (i) in 1 ml.
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 drugs administered and the tactics of the doctor are determined by the clinical picture, but in all cases it is necessary, first of all, the introduction of adrenaline, glucocorticosteroid preparations. The administration of preparations of phenothiazine series and calcium preparations is contraindicated.