Before using ATG-Fresenius C, it should be established whether the patient is allergic to rabbit proteins (see Allergic Test). During the first days of treatment, medical personnel, equipment, etc. should be available for emergency treatment if necessary.
ATG-Fresenius C can only be used as directed by a doctor under medical supervision. Particular attention should be paid to monitoring the patient with regard to the appearance of any symptoms of anaphylactic shock. Direct monitoring of the patient should continue at least 30 minutes after the end of the infusion.
Equipment for emergency therapy of anaphylactic shock should be available (see '' Emergency measures, symptoms and safety equipment '').
Emergency care in case of hypersensitivity reaction
With immunosuppression, the risk of developing bacterial, viral and fungal infections increases.These diseases should be treated using appropriate therapy (antibiotics, antiviral and antifungal drugs or immunoglobulins).
It should be noted that previous or simultaneous immunosuppressive therapy may cause the development of negative skin allergic tests, despite the patient's hypersensitivity.
Urgent measures in case of hypersensitivity reactions
Please refer to this table if an anaphylactic or anaphylactoid reaction develops.
| Degree and stages of symptoms in anaphylactic and anaphylactoid reactions |
| Stage | 0 | I | II | III | IV |
|
| Local reactions | Weak generalized reactions | Expressed generalized reactions | Heavy generalized reactions | Waiver of authorities |
| Symptoms | Limited reactions at the site of administration | Common skin reactions (redness, generalized rash, itching) irritation mucous membranes (nasopharynx, conjunctiva), general reactions (excitation, headache) | Violation of the cardiovascular system (lowering blood pressure, relaxation of the pulse), breathing disorders (mild dyspnea, beginning bronchospasm), urge to defecate and urinate) | Shock (severe hypotension, pallor), breathing disorders with severe dyspnoea, confusion or loss of consciousness with or without stool and urination | Stop respiration, vascular collapse |
| Doses of drugs and exemplary schemes of emergency therapy for anaphylactoid reactions |
| Stage | I | II | III | Preventively at the risk of relapse |
| Catecholamines: - Adrenaline / β-sympathomimetics, inhalation |
| Before the onset of tremors and / or tachycardia, adrenaline is preferred medihaler | Before the onset of tremors and / or tachycardia, adrenaline is preferred medihaler |
|
| - Adrenalin |
| 1mg / 10ml 0.1 mg / minь | 1mg / 10ml 0.1 mg / minь |
|
| - Dopamine |
|
| 2.5-5 mg / 70 kg body weight / min if necessary after 10 min |
|
| - Norepinephrine |
|
| 1 mg / 10 ml 0,05-1 mg / mind |
|
| Corticosteroids - parenterally (equivalents of prednisolone) | 50-125 mga | 250-500 mg | 1000 mg | Every 8-24 hours at 80-100 mg orally or parenterally |
| Theophylline |
|
| 5 mg / kg body weight, further 10 mg per kg body weight / day (follow the tachycardia) |
|
| Antagonists histamine - H1-antagonists | Dimethinden maleate 8mg Clemastin 4mg | Dimethindene maleate 8mgfrom Clemastin 4 mg | Dimethindene maleate≥8 mgd
Clemastine ≥ 4 mg | Every 8-24 hours, as in Art.II orally or parenterally. |
| - H2antagonists | Cimetidine 400 mg Ranitidine 100mg | Cimetidine 400 mgfrom Ranitidine 100mg | Cimetidine≥400mgd
Ranitidine≥100mg | Every 8-24 hours, as in Art.. II orally or parenterally |
| Volumetric substitutions: - Crystalloids |
| Ringer-lactate ≥500 ml | If possible, several liters of Ringer-lactate |
|
| - Colloids |
|
| For example, HES 1-2 liters, Ringer-lactate> 2 l |
|
| a With a certain predisposition to allergies (treatment with hyposensitization, an allergic test) b With the growth of cardiovascular failure, despite the introduction of volumetric solutions and H1 and H2histagon antagonists
from With the growth of cardiovascular failure, despite the introduction of volumetric solutions d At unsatisfactory results after introduction of volumetric solutions and adrenaline. |
Allergic testing
For allergic testing, use either a commercial preparation of rabbit immunoglobulin G or ATG-Fresenius C.
Management for intradermal samples
If from an anamnesis of the patient is aware of his predisposition to allergies, enter intradermally, preferably into the inner surface of the forearm, 0.05 ml of ATG-Fresenius C.
If the patient is suspected of increased sensitivity to rabbit protein, it is advisable to dilute ATG-Fresenius C 1 :100 0.9% solution of sodium chloride.
If other commercial preparations of rabbit immunoglobulin are used G, follow the instructions for their use.
Intradermal injection of a 0.9% solution of sodium chloride in the same place of the other hand serves as a control.
Test Evaluation
If the reaction (edema or hyperemia) develops at the injection site for 15 min and is absent at the site of the control injection, the patient is hypersensitive to rabbit proteins.
Reactions on both hands indicate a generalized hypersensitivity of the patient.