Should Gloves Be Worn When Giving Allergy Shots?

A common question patients ask is whether nurses and or other medical staff be wearing gloves when giving allergy shots (or other forms of immunization).
According to the CDC:

"Gloves are not required when administering vaccinations, unless persons administering vaccinations are likely to come into contact with potentially infectious body fluids or have open lesions on their hands." [link]

As such, the practice of wearing gloves is left up to the discretion of the person administering the shot.

Test Video


Some offices/hospitals may have a policy in place that makes it mandatory, but technically it is not required.

Of course, many individuals will point out a conflicting policy based on "Universal Precautions" which can potentially be interpreted as mandatory use of barrier protection (like gloves) whenever there is the possibility of bloodborne pathogen transference (which some may interpret as risk is always present).

However, if one actually reads the Universal Precautions put out by the CDC as it relates to blood drawing (considered higher risk than immunizations),

"In universal precautions, all blood is assumed to be potentially infective for bloodborne pathogens, but in certain settings (e.g., volunteer blood-donation centers) the prevalence of infection with some bloodborne pathogens (e.g., HIV, HBV) is known to be very low. Some institutions have relaxed recommendations for using gloves for phlebotomy procedures by skilled phlebotomists in settings where the prevalence of bloodborne pathogens is known to be very low. Institutions that judge that routine gloving for all phlebotomies is not necessary should periodically reevaluate their policy. Gloves should always be available to health-care workers who wish to use them for phlebotomy." [link]

Not quite the "mandatory" use of gloves some people stipulate when quoting Universal Precautions policy.


References:
General Recommendations on Immunization. CDC 2/8/02

Perspectives in Disease Prevention and Health Promotion Update: Universal Precautions for Prevention of Transmission of Human Immunodeficiency Virus, Hepatitis B Virus, and Other Bloodborne Pathogens in Health-Care Settings. CDC 6/24/88

Should Gloves Be Worn When Giving Allergy Shots?

A common question patients ask is whether nurses and or other medical staff be wearing gloves when giving allergy shots (or other forms of immunization).

According to the CDC:

"Gloves are not required when administering vaccinations, unless persons administering vaccinations are likely to come into contact with potentially infectious body fluids or have open lesions on their hands." [link]

 As such, the practice of wearing gloves is left up to the discretion of the person administering the shot.

Some offices/hospitals may have a policy in place that makes it mandatory, but technically it is not required.

Of course, many individuals will point out a conflicting policy based on "Universal Precautions" which can potentially be interpreted as mandatory use of barrier protection (like gloves) whenever there is the possibility of bloodborne pathogen transference (which some may interpret as risk is always present).

However, if one actually reads the Universal Precautions put out by the CDC as it relates to blood drawing (considered higher risk than immunizations),

"In universal precautions, all blood is assumed to be potentially infective for bloodborne pathogens, but in certain settings (e.g., volunteer blood-donation centers) the prevalence of infection with some bloodborne pathogens (e.g., HIV, HBV) is known to be very low. Some institutions have relaxed recommendations for using gloves for phlebotomy procedures by skilled phlebotomists in settings where the prevalence of bloodborne pathogens is known to be very low. Institutions that judge that routine gloving for all phlebotomies is not necessary should periodically reevaluate their policy. Gloves should always be available to health-care workers who wish to use them for phlebotomy." [link]

Not quite the "mandatory" use of gloves some people stipulate when quoting Universal Precautions policy.


References:
General Recommendations on Immunization. CDC 2/8/02

Perspectives in Disease Prevention and Health Promotion Update: Universal Precautions for Prevention of Transmission of Human Immunodeficiency Virus, Hepatitis B Virus, and Other Bloodborne Pathogens in Health-Care Settings. CDC 6/24/88

Skin Patch Immunotherapy for Allergy Cure

Over the years, there have been a variety of systems via which physicians and researchers have attempted to cure patients of their inhalant allergies.

These include (click here for a description of each):

• Allergy shots
• Under the tongue allergy drops (SLIT)
• Intra-Lymphatic Injections (ILIT)
• Allergy Tablets
• Epicutaneous Immunotherapy (EPIT)
• Intra-Nasal Spray
• Bronchial Inhalers

Well... we can now add skin patches to the list.

European researchers conducted a placebo-controlled, double-blinded trial involving 132 patients with grass pollen allergies. The patients were randomly divided into one of four groups: placebo, low-dose, medium-dose or high-dose patches. Patients applied six weekly patches prepared with grass allergens prior to and during the 2008 grass season and ALL reported improvement in their symptoms (30% in 2008) though one year later, there was a dose-dependent improvement with essentially no improvement in low-dose and placebo groups.

Unfortunately, higher-dose patches had higher rates of adverse events including pruritus, erythema, wheal, or eczema leading to an overall drop-out rate of 8.3% from the study.

This all may sound good and promising, but two of the study's authors hold patents on patch-based immunotherapy which may lead to study bias.

My take? More study is needed...

Reference:
Epicutaneous allergen-specific immunotherapy ameliorates grass pollen–induced rhinoconjunctivitis: A double-blind, placebo-controlled dose escalation study. The Journal of Allergy and Clinical Immunology Volume 129, Issue 1 , Pages 128-135, January 2012

Bottles / Vials for Allergy Drops (Under Tongue) Immunotherapy

We have received a number of requests of where one can obtain allergy vials for use in SLIT (sub-lingual immunotherapy) whereby a drop is placed under the tongue to try and achieve allergy cure. This mode of treatment is an alternative to the more traditional allergy shots.

Our office provides both modes of immunotherapy.

Regarding the allergy vials themselves, you can obtain them from Edge Pharmaceuticals. They offer a number of different vial types as shown in the picture. They range in sizes from 15cc to 20cc and provide 40ul to 200ul drops with each dispensation.

Contact Info:

7264 NW 63rd Terrace

Parkland, FL 33067

Phone: 877-580-3343

Fax: 877-581-3343

Migraine Headaches Associated with Allergies & Response to Allergy Shots

A recent study published this month in the journal Headache reported an association of migraine headaches with allergy severity and response to allergy shots... but only in those less than 45 years of age.

The study suggested that lower "degrees of atopy" (or allergy) were associated with less frequent and disabling migraine headaches in younger subjects while higher degrees were associated with more frequent migraines. The administration of allergy shots was associated with a decreased prevalence, frequency, and disability of migraine headache in younger subjects.

The age cut-off used to described "younger" subjects depending on the measure described was either 40 years or 45 years.

Read the abstract here.

Of course, one must consider the possibility that perhaps what these patients are suffering from is not migraine headaches, but allergy triggered sinus headaches.

Our office provides allergy testing, allergy shots, and allergy drops. We also offer botox injections in the treatment of migraine headaches.

Reference:
Allergy and immunotherapy: are they related to migraine headache? Headache. 2011 Jan;51(1):8-20. doi: 10.1111/j.1526-4610.2010.01792.x. Epub 2010 Nov 4.

Different Types of Immunotherapy for Allergy Cure

Most people are already familiar with allergy shots and even sublingual (under the tongue) allergy drops as treatment to try and achieve cure (or tolerance) to the things they are allergic to.

However, there are other forms of immunotherapy that may one day provide just as good if not better allergy cure rates. These include (most currently under research):

- Intra-Lymphatic Injections (ILIT): Rather than weekly shots in the arm, one research paper reported only 3 injections into a groin lymph node over 2 months provided equivalent results to allergy shots in the arm after 3 years!

- Allergy Tablets: Potentially in the next year or 2, tablets may become available to treat certain allergies. Grazax by Merck which treats grass allergy is the first which is currently undergoing FDA approval.

- Epicutaneous immunotherapy (EPIT) involves lightly scraping a patient’s skin and then applying a patch that delivers the allergens through the bloodstream.

- Intra-Nasal Spray: Declared effective and safe by WHO.

- Bronchial Inhalers: Marginal effectiveness and risky.

At this time, our office only provides allergy shots and allergy drops.

Can A Person Have Allergies Even if Allergy Testing Comes Back Negative?

YES!!! But how can that be?!! Well, here is the simplified answer. When allergy testing is performed whether by skin prick or blood testing (RAST), one is testing to certain specific proteins known to cause allergic reactions in majority but not all patients (these are called major allergen).

Patients need to remember that for a given allergy like CAT (or tree, mold, dust, etc)... there are millions of proteins (minor allergen) that have the potential to cause an allergic reaction in people. Allergy testing to cat ONLY tests for ONE of these proteins called Fel d1 as well as a few other minor allergens. As such, if a patient is CAT allergic, but not to the Fel d1 protein, then the allergy testing will come back normal!

Given this information, that's why skin testing is a bit more "accurate" when it comes to determining whether a patient has allergies or not as there are more "proteins" for a given allergen like CAT being tested than the blood test like RAST which STRICTLY tests for a single protein.

Of course, it is possible that a patient may TRULY not have any allergies. So, how can a person tell? Look at the total IgE serum levels. If it is high, than you most likely have allergies even if everything comes back negative.

One-Size-Fits-All Injection that Can Cure Allergies!

Cytos Biotechnology has recently completed patient trials that suggests that a one-size-fits-all allergy injection can alleviate and potentially cure allergies, asthma, eczema and other allergy conditions including even food allergies!

This innovative medical treatment is known only as CYT003-QbG10. It is composed of pieces of synthetic DNA similar to those found in the bug that causes tuberculosis. The DNA fools the body into thinking it is under attack from a dangerous bug, kick-starting a multi-pronged immune response. The ability of a single formula to protect against more than one allergy suggests the jab is reprogramming the immune system by tackling the root cause of allergies.

Current allergy shots (as well as allergy drops) work by injecting the actual proteins that cause allergy in small doses that are slowly increased. For example, if you are allergic to cat, than actual cat protein is injected into you in slowly increasing amounts over time.

With CYT003-QbG10, there would be no need for allergy testing and in essence, if truly successful, patients can be cured of allergies with this type of vaccination, just like the childhood vaccines have near-eradicated polio, mumps, measles, etc. It is not clear how often the new vaccine would have to be given. But scientists envisage an initial short course of jabs, followed up by a booster session two or three years later.

Large scale human trials are supposed to begin in 2011.

Read more in this media report here.

Hidden Costs of Allergy Shots

Many people know what allergy shots are and do. What many may not realize are the hidden costs associated with them and it behooves a patient interested in getting them to know what they are getting into, not just in terms of medical, but also financial.

For those who don't know... Allergy shots are typically 1-2 injections administered to the upper arm once a week for a period of years… potentially as long as 5-10 years. These shots are given in an attempt to “cure” a person of their allergies such that after the shots are completed, there will be no more allergies OR the allergies have improved to the point that medications work quite well and taken only when needed. These shots MUST be administered in a medical office.

And as such, that's where the hidden costs behind the allergy shots begin. First, there are the copays involved with EACH allergy shot administered in the office as well as making of the allergy vials themselves. Given you have to be in a medical office to get them, there is also the time, travel, gas, and missed time from work to also take into consideration. At least in our office, we require all patients to have an up-do-date epipen at all times, so there's the prescription cost of this as well.

Ways to minimize or at the very least, anticipate the potential costs involved are as follows:

- Once you get established with the shots (in our office, typically 4 injections), you can get the shots administered in a medical office closer to your place of residence or work (thereby saving time, gas, and travel).
- Ask if it's possible to get the shots at home once you reach maintenance.
- See if you are a candidate for allergy drops (SLIT) which is NOT covered by insurance, but is a fixed cost AND they do not need to be administered in a medical office, but rather the comfort of your home/work.

Regarding possible copays, please check with your insurance company regarding amount of copays involved with allergy shots such that there won’t be any surprises with any bills you may receive due to this treatment.

The CPT codes to inquire with your insurance regarding potential copay amounts are:

95165 (Allergy Vial)
95115 (1 shot)
95117 (2+ shots)

Typically, the copays are much smaller than what you pay for a physician office visit, but rarely is it free.

For more information on allergy shots and testing, click here.

For more information on allergy drops, click here.