For Adverse Drug Reaction and Desensitization Medical Professionals
Guidelines for Outside Desensitizations
Patients can only be evaluated as candidates for desensitizations by an allergist.
A risk assessment is necessary for each patient who needs desensitization: high risk patients have either a life threatening initial reaction with hypotension and/or desaturation, have cardiac risk and/or are on beta blockers, have low FEV1< 80%.
All high risk patients need to be placed in the Medical Intensive Care Unit for their desensitization.
Non high risk patients can be done in an outpatient infusion center with a 1:1 nurse to patient ratio and an attending allergist for care.
An allergist has to order the desensitization protocol and needs a consent from the patient at each desensitization.
The desensitization protocol needs to be explained to the nurse and pharmacist prior to desensitization.
The allergist needs to have a face to face interaction with the patient on the day of the desensitization, do a history, a physical exam and reassess the risk during desensitization. He/she needs to be at the site when the first dose is administered.
The allergist needs to be available during the entire desensitization at less than 3 minute distance from the desensitization site and come to the site if there is a reaction. Communication with the nurses needs to be immediate and cell phone contact is preferred.
Instructions are given to the nurses in writing regarding treatment for reactions but the allergist is responsible for the orders and once a reaction has occurred he/she needs to see the patient and assess if the desensitization can be continued.