This document provides guidelines for administering allergy shots. It defines key terms like build-up and maintenance phases. During build-up, doses are increased weekly until the maintenance level is reached. Maintenance involves receiving the maximum dose at regular intervals. The document describes drawing up doses, injection instructions, expected reactions, and protocols for missed doses. It emphasizes safety measures and contacting the allergist with any severe reactions or questions.

1. ALLERGY SHOTS: THE BASICS

2. Define key terms for
allergen immunotherapy
(allergy shots), including
build-up, maintenance,
and shot sheets.
Provide guidelines
and instructions
on administering
allergy shots
Define the different
reactions that can
occur and distinguish
when to notify the
supervising allergist
Allergy shots require a strict schedule and time
commitment for patients and their families. Thank
you for your willingness to provide this service for
the convenience of our mutual patient.
Describe what allergy
shots are and how they
work.

3. Build-up Maintenance Allergy Shot Sheets
Build-up schedule means the
patient has not reached their
maintenance dose. This is
usually when they are in the
Silver, Green, Blue, and
Yellow vials and when
patients are increasing their
dose in the Red vial.
This is the highest dose the
patient will receive. This is
usually 0.5mL in the Red Vial
unless otherwise noted. Initially,
the patient will receive this dose
every week until the allergy
provider decides to change it.
This will be notated on the
injection flowsheet.
These sheets are mailed with each set of
vials. The sheets match the specific vial
name, concentration, and expiration for
each patient. They also contain important
information about doses to give and how
often the patient receive them. You will
use these sheets to document each
injection and any reaction the patient has.

4. • Allergen immunotherapy (allergy shots) is a series of shots that
contain the substances that cause the patient's allergies. Each
patient's serum is unique to their allergens.
• Allergy shots can help reduce allergic symptoms, asthma attacks,
and the amount of medicine the patient needs to control these
things.
• When the patient gets regular allergy shots, they build up
resistance, and it should make them less sensitive to them over
time.
• Treatment typically lasts 4 to 5 years
WHAT IS IT?

5. • Because the shots contain things they are allergic to, therapy starts with the weakest
(most diluted) doses first.
• Over time the amount increases in volume and concentration
• Each vial has 7 doses to complete starting at 0.05mL and increasing every week.
• Once the 0.5mL dose is given, the patient moves to the next more concentrated vial
and starts over at 0.05mL
• This continues until the patient receives their maintenance dose
• The maintenance dose for most patients is 0.5mL in the Red 1:1 vial
• The maintenance dose is given every week until the allergy provider decides it is safe
to get injections every other week, then every 3 weeks, and eventually every month.
HOW DOES IT WORK
1:1
1:10
1:100
1:1,000
1:10,000
START!
0.05mL 0.1mL 0.15mL 0.2mL 0.3mL 0.4mL 0.5mL

6. Local Reactions
• Swelling, redness, pain, or itching at the site of injection
• Local reactions measuring <30mm are common and are considered
tolerating injections
• These can usually be relieved by using an ice pack and/or
diphenhydramine cream applied to the injection site
• If local reactions are increasing in size or are frequent, ensure the patient
has taken anti-histamine prior to injection and give if not taken
• The patient may add ibuprofen, double up on antihistamine on shot
days, and/or add diphenhydramine 20-30min prior to injection
• If the reaction exceeds 30mm (3cm) wheal and/or persists beyond 24
hours, notify our office and reduce the dose to the previously tolerated
dose
• If you have any question or concern about local reaction snand dose
adjustments please do not hesitate to call our office 615-936-5697!

7. Systemic Reactions
• Itching distant from the injection site, hives, cough, wheezing, shortness of breath,
throat tightness, nausea, vomiting, dizziness, fainting, or altered mental status
• CALL 911 IMMEDIATELY
• Place the patient in a recumbent position
• Administer Epinephrine (1:1,000) 0.01mg/kg up to 0.3mg IM into the outer thigh
muscle; may repeat every 5-10 minutes if symptoms do not resolve
• Give diphenhydramine (Benadryl) 1mg/kg up to 50mg PO or IM
• Give single dose of corticosteroid PO or IM
• Additional measures that may be included:
⚬ bronchodilators (albuterol/levalbuterol)
⚬ Oxygen
⚬ IV fluids
⚬ airway maintenance
⚬ H2 blockers (famotidine)
• After ANY systemic reaction, the patient MUST be seen in our clinic before ANY
further injections can be administered

8. • Keep the antigen vial refrigerated. Individual doses may be warmed to room
temperature to reduce the pain of injection
• Check labels for correct patient information, concentration, and expiration date
• Check that the patient has an epinephrine auto-injector present at the
appointment
• Ensure the patient has taken an antihistamine prior to injection. Please
administer if none taken
• Check with the patient about any delayed reactions at home before increasing
the dose
GENERAL INFO/
PRECAUTIONS
• The patient has a fever or has had a fever in the last 48 hours (>100 degrees)
• The patient has hives
• The patient is wheezing, having bronchospasms, shortness of breath, or flu-like
symptoms
⚬ If sick, the patient should reschedule once they have been feeling better for
more than two (2) consecutive days
• Acute asthma symptoms present or has used a rescue inhaler (Albuterol or
Xopenex) in the past 24 hours
• The patient is taking a beta blocker or ACE inhibitor without prior approval
DO NOT ADMINISTER IF:
DO NOT
ADMINISTER

9. • Determine if the patient is building up in their vials or if they are receiving
their maintenance dose
• Patients who are building up:
⚬ Patients who are building up are late if it has been >10 days since their last
injection
⚬ If they are not late (< 10 days) - increase to the next dose
⚬ If they are late (> 10 days) - follow the missed dose instructions
• Patients who received their maintenance dose will have a different window
depending on how often they receive their injections.
⚬ Follow the missed dose protocol for maintenance injections to determine
if the patient is late
02
01
CALCULATING THE DOSE
• Draw up the dose in a 1mL syringe with a 25-27g, 3/8-1/2in needle
• Use the Clean Needle Technique, and change to a new needle
• Repeat this process for all vials of serum of the same concentration
• DO NOT COMBINE SHOTS
DRAWING UP THE DOSE

10. 04 • The patient MUST wait 30 minutes after receiving their injection
⚬ NO EXCEPTIONS
⚬ This is a safety measure in case of a severe allergic reaction
• After the 30-minute wait period, measure any reaction present
⚬ Use the millimeter end of the ruler provided by our clinic
⚬ Measure the largest diameter of the wheal or bump
⚬ Measure the larges diameter of the erythema
⚬ example: 3mm wheal 10mm erythema
03 • Administer the injection subcutaneously in the outer back region of
the upper arm.
⚬ injecting into the muscle causes more pain and local swelling.
• No more than 2 shots in each arm
• Rotate arms and injection sites each time
• You can apply Benadryl cream and/or ice to injection sites after to
relieve itching and/or pain
ADMINISTERING THE INJECTION
OBSERVATION

11. • During the build-up phase, the patient should come at least
every 10 days for their shot
• If it has been more than 10 days since the last shot, use the
table below for instructions
• If you have any questions, call our office at 615-936-5697
BUILD-UP
Days Since Last Shot What To Do
5-10 days Increase to next dose
11-14 days Repeat last dose
15-21 days Reduce 1 dose
22-28 days Reduce 2 doses
29-35 days Reduce 3 doses
36-42 days Reduce 4 doses
>42 days Call our office for instructions

12. • During the maintenance phase, the patient will come every week initially until their doctor says it is safe
to get allergy shots every other week, every 3 weeks, and eventually every month.
• This will be indicated on their allergy shot sheet under the “Maintenance Schedule” section.
• If it has been longer than their ordered schedule, use the table below to check what dose should be
given
• If you have any questions, call our office at 615-936-5697
MAINTENANCE
Days Since Last Shot Weekly Q2Weeks Q3Weeks Q4Weeks
8-10 days Repeat last dose Repeat last dose Repeat last dose Repeat last dose
11-17 days Repeat last dose Repeat last dose Repeat last dose Repeat last dose
18-24 days Reduce 1 dose Repeat last dose Repeat last dose Repeat last dose
25-31 days Reduce 2 doses Reduce 1 dose Repeat last dose Repeat last dose
32-38 days Reduce 3 doses Reduce 2 doses Reduce 1 dose Repeat last dose
39-45 days Reduce 4 doses Reduce 2 doses Reduce 1 dose Repeat last dose
46-52 days Call our office Reduce 3 doses Reduce 2 doses Reduce 1 dose
53-59 days Call our office Reduce 3 doses Reduce 2 doses Reduce 1 dose