Is it safe for any nurse to give allergy shots?

January 14, 2003

I very much appreciate your question. Patients as well as nurses need to be this studious when it comes to allergy injections being given by a nurse inexperienced in allergy.

When I send allergy extracts to another office for administration, I always have the patient's safety in mind. I take time to go over the paperwork with the patient, showing them what dose they received last and how they should expect the dose to be increased or if it is to stay the same. I explain about how many doses they should expect to be given from each vial, and that they should feel free to phone me if they have any questions about the administration of their extracts.

I also enclose carefully written instructions for the clinician who will be giving the injections. If the patient is hand-carrying the extracts, I leave the envelope unsealed so the patient can review these instructions also. We provide guidelines of what dose to start with or give next, how to increase the dosage, what dose to stop at, when to order more extract, and what to do in the event of a local or systemic reaction. Our instructions provide our phone number and encourage the nurse or physician to phone us if they have any questions. I attach a professional card with my name and office phone number as well.

Different allergists vary in the way they do things. Instructions for patient's doses may change with each new vial as well. The person giving the shots should always familiarize themselves with the way the allergist who prepared the extracts instructs the shots for this particular vial to be given.

Patients should never assume that just because a person is a medical professional they know all they need to know about giving allergy injections. Ask the person providing your allergy injections to allow you to watch them prepare the injection. Observe how prudent they are in examining the paperwork to be sure of the dosage, etc. Ask whether your dose is being increased, and at what point a new vial will be needed.

If your allergist has not already explained these things to you, ask your allergist or his nurse first. Then the answers from the person giving you the shots will help you see if they are following your allergists' instructions.

Be aware of what your dose looks like in the syringe. Any dose increases should occur slowly. One patient told me that he noticed the syringe looked bigger than we use, and was almost full, but he was reluctant to say anything. He had a severe systemic reaction after the injection. The documentation we received from the clinic indicated he was given the proper dose. But if an error was made, the patient may have prevented this by questioning the dose before it was given.

I am never bothered when a nurse phones me and says, "I'm new to this. Can you go over it with me." What bothers me is when the nurse doesn't take time to ask and I find out after she has made preventable errors in giving the injections.

I always insist that clinics who provide allergy injections for our patients fax copies of the documentation records of dates, doses, location, and reaction for each previous injection when ordering new extract from us. We provide the forms for them to record this information. I carefully examine these forms when we receive them back, and if I find anything amiss, I phone the clinic and ask to speak to one of the nurses who provides the injections. I use this as an opportunity to teach these nurses more about allergies and how the injections should be given. I find that most nurses appreciate the help.

It is our policy that a physician be immediately available for our patients receiving allergy injections in other facilities. The facility should be properly equipped to handle medical emergencies, including a reaction to the injection. Some allergists allow injections to be given without a physician being present as long as the patient has a prefilled epinephrine syringe. If this is the case, the clinician giving the injection should know what to watch for, when to administer the emergency medication, and what steps to take in the event of an emergency.

LPN's do provide allergy injections in our area and as far as I know they are able to do this in most areas. But you are right to be careful. If you are unsure about giving the injections, phone the physician's office who provides the injections. Ask to speak to an allergy nurse, be honest about your uncertainty, and ask the questions that are pressing on your mind.

If you are a patient, and the person giving your injections seems uncertain or hesitant, suggest that they phone your allergist's nurse and ask about anything they are unsure of.

When the allergy shots are given correctly and monitored appropriately, everyone rests better!

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