Analysis of Anaphylaxis to Subcutaneous Immunotherapy: A Case Study

This case study examines a patient, Jim, diagnosed with allergic rhinitis and undergoing subcutaneous immunotherapy (SCIT). The analysis delves into the pathophysiology of allergic rhinitis and the SCIT treatment, including the patient's adverse reaction to injections, characterized by symptoms like stomach cramps and an itchy throat. The study highlights the importance of health assessment data, patient education, and health management protocols. It discusses the nurse's role and professional responsibilities in managing the patient's care, emphasizing the need for thorough assessment, patient safety, and appropriate decision-making. The case underscores the importance of patient education regarding medication, potential side effects, and the significance of immediate consultation for any adverse reactions, as well as the importance of staff safety and adherence to protocols to prevent complications and ensure effective patient outcomes.

Anaphylaxis to Subcutaneous
Immunotherapy

TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
Body of the essay.............................................................................................................................1
Pathophysiology..........................................................................................................................1
Health assessment data................................................................................................................2
Health management.....................................................................................................................2
Patient education.........................................................................................................................3
Patient and staff safety................................................................................................................4
Role and professional responsibilities of the allergy nurse.........................................................4
Scope of practice and decision making related to allergy nurse.................................................5
Other concepts related to the case study.....................................................................................6
CONCLUSION................................................................................................................................7
REFERENCES................................................................................................................................8

INTRODUCTION
The case study is about Jim who has been diagnosed with eczema as an infant and
afterwards, he has been diagnosed with mild asthma and after than with allergic rhinitis.
Although, he is used to take specified medicines for the issues he is facing. Although, it has been
observed that because of taking anti histamine in between before the injection, he had to face
some troubles as there was a lump on the HDM arm. But with the help of some therapies,
condition of Jim has been improved to a high extent (Dong, Huang and Zhu, 2016). The final
diagnosis Jim was taking is subcutaneous immunotherapy. Although, there were some aspects
that were quite inconsistent while the treatment. So, the report is about discussing aspects that
Jim had undergone that are inconsistent enough. Also, recommendation for the same have also
been included in report.
BODY OF THE ESSAY
Pathophysiology
As Jim has been diagnosed with allergic rhinitis, he was undergoing the Subcutaneous
immunotherapy treatment (SCIT). Some very common symptoms of allergic rhinitis includes
sneezing, itchy nose, headaches etc. There are various risk factors associated with allergy
rhinitis. Also, it throws an impact on the basic factors of the lifestyle as well because it affect the
sleeping pattern of the person. Allergic rhinitis is also considered as a symptomatic disorder.
There are various factors that can actually make the condition worse for the person suffering
from allergic rhinitis and these involve smoking, very cold temperature, use of perfumes or
sprays etc. as their fragrance can also enter the nose with the air and can make the whole
condition worsened enough. Some popular treatments for the issue includes the use of OCT anti
histamines and so, the doctor have referred one Cetrizine tablet to him but that day Doctor
prescribed to wait after the injections for about 30 minutes (Ozdemir, Kucuksezer and Akdis,
2016).
So, while Jim face any headache, he used to take Aspirin and if in case of any pain etc.,
he used to take Ibuprofen but on an occasional basis. The treatment procedure of allergic rhinitis
also includes decongestants, nasal sprays etc. As in between the dose scheduled for injections, in
the fourth week, Jim received two injections on the same day and that too were of increased
doses. After some time, he realised high stomach cramps and an itchy throat. So, this should be
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ensured by the nurse because Jim told her that before 15 minutes only, he had his anti-histamine.
Then, Jim was administrated and some vital signs were observed. As the normal respiratory rate
comes within the range of 12 to 20 breaths per minute but in case of Jim, it has been evaluated
that his respiratory rate was 26, which means higher than the normal range. The blood pressure
rate of Jim was evaluated as 120/65 whereas the normal range for the same is observed as
120/80. It means the blood pressure range of Jim was also low and it might be because of the
higher dose of the injections.
Health assessment data
As Jim was having eczema when he was a baby but the flares can be observed very
usually. After some years, Jim has been diagnosed with allergic rhinitis. Although for preventing
any further symptoms of the allergic rhinitis, Jim has been undergoing subcutaneous
immunotherapy treatment. It is because this is considered as one of an efficient treatment for
providing some sort of help in providing relief to some of the symptoms. The therapy is said to
be effective enough that there is no as such need for the medication etc. for coping up with the
symptoms. Usually, the bad effects of the allergic rhinitis are observed in the time of spring etc.
because at that time, because of the existence of pollens, the situation can go even worse. In this,
some sorts of injection are provided to the patient. As in this case, Jim was also having one
injection (Bahceciler and Barlan, 2015). The composition of the injection was grass mix along
with the house dust mite HDM. When he had two injections of high dose on the same day just
before his antihistamines, he had some issue in the stomach as he was feeling stomach cramps
along with an itchy throat.
On the basis of the observations r\taken, it has been analysed that the blood pressure rate
of Jim was lower enough. Also, the respiratory rate was higher than the normal range as well. It
means that the injections were making very less use on the condition of Jim. According to the
manufacturers and practitioners, it is said to increase the dose of the injections slowly. After the
grass injection being given to Jim, again the vital signs have been observed. The blood pressure
rate was evaluated as 130/75 which also comes within the normal range and the respiratory rate
was analysed within normal rate as well. For excluding any delayed symptoms of the injections,
the doctor prescribed him another medicine, prednisone for next three days along with Cetrizine.
Then there was a probability of the things getting better and efficient enough.
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Health management
Health management is considered as a very important aspect that needs to be ensured
while treating an allergic patient. As in this case, Jim was having allergic rhinitis, so he has been
undergoing treatment for the same. He was undergoing a therapy in which he was given an
injection consisting of two components. So, this can be considered as an effective way of
managing the health because taking an appropriate dose of the medication that has been
prescribed by the doctor is a very necessary step (Dong, Huang and Zhu, 2016). So, factors like
eating a managed and balanced diet, taking proper rest and medications etc. are considered as
some steps that are important enough for maintaining the health and the lifestyle in an
appropriate way. It was also observed that after taking the observations, some vital signs have
been observed which involves a higher rate of blood pressure along with a higher rate of
respiratory rate as well. After the injection provided to Jim, the condition seemed to be better
enough and the respiratory rate along with the blood pressure came within the normal range.
Patient education
Patient education is considered as an important aspect because the patient should know
that they are taking which medicines and why. It is very important. Also, it is the right of the
patient to ask that why the specified medicines are recommended to them. If patients will be
aware of the medications or therapies that are provided to them, it can help them to stay away
from any sort of blunder etc. As in case of Jim, he took anti histamines just 15 minutes before
taking the injections, without knowing the consequences. So, it is very important that the clients
should know that they are taking what medication and why. Sometimes, there are allergic
reactions as well when some particular medicine does not get well with some other medicine. So,
this is important that the patient should know that the difference between the medicines they are
taking. This helps them to stay away from any sort of blunder etc. It is because sometimes the
patient is not aware of the side effects of some medicine, so combination of a few medicines
together can also act as a cause for causing allergies and other major complications as well. As
on taking both the injections, the outputs were quite different.
While giving the HDM injection, Jim observed a huge lump on the night of the injection.
Also, after that lump as well, Jim did not consult the doctor. It was another blunder. This also
reflects lack of patient education. It is because as Jim did not tell or consulted any of the medical
authority. This can turn into major complications. Although the situation was controlled till his
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next injection, but this can actually throw a negative impact on the health of the person. Also, it
can cause major further complications as well because it is obvious that the lump as in case of
Jim as well may impact negative on the internal processing of the body and thus, it can act risky
as well. So, in such cases, immediate consultation is required so that the person may not have to
face any major complication, thus the situation can get controlled. Therefore, these means can be
considered for ensuring the need for education of the patients.
Patient and staff safety
Maintaining the safety and security of the patients along with that of the staff and
employees is important enough. It is because this is one of the essential concerns to be taken care
of. This is the responsibility of the health care to manage the operations and functions in a way
that the safety of the patients can be maintained. As in case of Jim, nurse asked him that before
how much time, he had taken anti histamines, so he said 15 minutes before without analysing the
actual timing. The nurse also provided him another injection without even evaluating. So, these
factors needs to be ensured. This can prove more harmful for the patient sometimes. So, rather
than trusting completely the patient, it is better if the nurses can be able to evaluate the same on
its own. This will help them in preventing a wide range of issues and complications that may
occur because of the negligence (Aasbjerg, Backer and Würtzen, 2014). If at that time, the nurse
would have checked and analysed it, she might not have given the injection to Jim. So, there
would be the possibility that Jim may not had faced stomach cramps and itchy nose. Therefore, it
is very important to ensure that a proper amount of safety is being provided to the patients along
with the staff members so that there can be maintain an efficiency in the environment of the
health care centre, thus making the surroundings there more healthier and happier. The higher
authorities should also ensure the fact that the nurses that are working in the health care centre
are following every single policy and rules so that there is no chance of any sort of blunder etc.
Therefore, it is very important to maintain and manage all the measures associated with the
safety and security of the patients.
Role and professional responsibilities of the allergy nurse
An allergy nurse has to ensure various factors in order to ensure providing an efficient set
of care and support to Jim. Accessing past medical history is very important because by the
same, nurse can be able to understand the factors to which the person is allergic to. It is because
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if these factors will be considered before only, then the analysis can be made in an efficient way.
The professional responsibility of an allergy nurse is that they should note all the past and the
current details very clearly. It is because these factors are very important for continuing the
treatment procedure. Also, in the analysis process, all the ingredients etc. are being evaluated that
from what ingredients etc., the person is allergic to. It is important to be accessed because while
the treatment procedure, the nurse ensures that the medications that are provided to the person
does not contain any of the ingredient. It is considered as one of the basic responsibility of the
nurse while considering the professional aspects of a nurse clinically.
A nurse is also considered as a care giver. So, taking care of every aspect that the patient
does not have to undergo any major complication or issue is the major responsibility of a nurse.
Along with providing an efficient range of care and treatment, monitoring the patient is equally
important (Bahceciler and Barlan, 2015). It is because after providing the treatment and
medications, it is very important to check that the medications are throwing a positive impact or
not. Also, treating the patient with care is another factor which needs to be ensured. It is another
important factor of professionalism. It is because any sort of discrimination or racism with
patient can actually throw an impact on the mental ability of the patient. So, the nurse should
ensure giving equal respect to the patient. Also, if in case the patient has issues like allergies etc.,
then the nurse should not behave in a way that can hurt the patient as for touching etc. It is
because this can throw a very bad impact on the mental ability of the patient. Also, no sort of
discrimination is allowed in the health care.
As per the Equality law 2010, it considers the fact that there must be no sort of racism or
discrimination with the patients. If anyone found guilty in such actions, they may have to pay
huge amount of penalty and along with that, the punishment can also lead to the imprisonment of
the person. So, an allergy nurse can ensure that they deal with the patient with due respect and
does not act in any way that can hurt the sentiments of the person. Also, they should modify the
past history of the person so that if in the future, the person faces any sort of complication, then
through the help of the reports and medical records, it can be easy enough to analyse the range of
ingredients that are must not to be used for the patient. These can be considered as the basic roles
and responsibilities of an allergy nurse.
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Scope of practice and decision making related to allergy nurse
The scope of practice is wide enough because in case for allergy nurse, various people
can come who must be suffering from allergies, so in every single case, the nurse has to
investigate that from what range of products, the person is allergic to. It is because the allergic
products can vary from one person to another. So, it is very important to consider the same in
every single case. Therefore, it makes the scope wider enough. Also, in the decision making
process of an allergy nurse, it is very important that they involve in an appropriate decision
making. So, the nurse should ensure that the room in which the patient is staying should be germ
free and also restricts the entry of everyone. It is important because these are considered as
effective measures that are need to be ensured for an effective decision making process. Also, it
involves the fact that the nurse should focus on using hand gloves etc. while providing treatment
to the patient because if in case, the doctor also gets attacked by the allergy, involving the
existence of some other doctor on an urgent basis can act tough (A Patient's guide to SCIT,
2017). Therefore, it is very important to make sure that all these factors have been covered while
the decision making process of the plan of providing treatment to the patient. If all the factors
ensuring a better decision making will be involved, then it can help in ensuring that the
requirements that are required and are essential will help in increasing the scope of the practice.
Other concepts related to the case study
One of the essential concept is that Jim was dealing with allergic rhinitis and due to this,
he must have to undergo a variety of symptoms such as itchy nose, headache etc. So, for coping
with the symptoms of the same, he has been undergoing Subcutaneous immunotherapy treatment
(SCIT). He has to take anti histamines before that. As there can be some sort of reaction between
two medications. Thus, providing an efficient range of patient education is must. This helps in
providing the patients a wide knowledge about the factors that are essential such as the
difference between taking any two medications together etc. (Aasbjerg, Backer and Würtzen,
2014). It helps in reducing the rate of blunders. Also, along with the nurse, the patient is also
responsible for taking care of their own needs. AS in this case, Jim told the nurse that he has
taken anti histamines before 15 minutes, he was not accurate enough with that and the nurse also
acted casual and injected him the injection. After a while, he started feeling stomach cramps etc.
So, it is very important to stay accurate enough between taking two medications because this can
actually increase the overall rate of complications etc. Therefore, such factors need to be ensured
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properly. So, proper preventive measures can be considered in order to access various ways that
can be used and prove helpful enough for providing a sort of help and support to the people
dealing with allergic rhinitis. The involvement of these measures can actually prove beneficial
enough in making modifications and improvements in the overall processing of the operations.
CONCLUSION
It has been concluded that Jim was suffering from allergic rhinitis and because of that
only, he has been undergoing the therapy. Although it has been analysed that the impact of the
therapy was not much enough on the condition of Jim, so for that proper preventive measures
have been included in the essay. All the basic aspects that are required for making a sort of
effectiveness in the whole process of providing operations and services to the patients in order to
provide a better rate of treatment and care have also been included in the essay. Some well-
known examples of the aspects that have been included in order to clear the understanding of the
roles and procedures of the treatment process for allergic rhinitis have also been discussed such
as management of health, safety of patients and staff etc.
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REFERENCES
Books and Journals
Aasbjerg, K., Backer, V., and Würtzen, P.A., 2014. Immunological comparison of allergen
immunotherapy tablet treatment and subcutaneous immunotherapy against grass
allergy. Clinical & Experimental Allergy. 44(3). pp.417-428.
Bahceciler, N. and Barlan, I., 2015. Long-term effect of sublingual and subcutaneous
immunotherapy in dust mite–allergic children with asthma/rhinitis: a 3-year prospective
randomized controlled trial. J Investig Allergol Clin Immunol. 25(5). pp.334-42.
Dong, X., Huang, N., and Zhu, R., 2016. Systemic reactions to dust mite subcutaneous
immunotherapy: a 3-year follow-up study. Allergy, asthma & immunology research. 8(5).
pp.421-427.
Dranitsaris, G. and Ellis, A. K., 2014. Sublingual or subcutaneous immunotherapy for seasonal
allergic rhinitis: an indirect analysis of efficacy, safety and cost. Journal of evaluation in
clinical practice. 20(3). pp.225-238.
Durham, S. R. and Penagos, M., 2016. Sublingual or subcutaneous immunotherapy for allergic
rhinitis?. Journal of Allergy and Clinical Immunology. 137(2). pp.339-349.
Ozdemir, C., Kucuksezer, U. C., and Akdis, C. A., 2016. Mechanisms of aeroallergen
immunotherapy: subcutaneous immunotherapy and sublingual
immunotherapy. Immunology and Allergy Clinics. 36(1). pp.71-86.
Schmid, J. M., Würtzen, P. A. and Hoffmann, H. J., 2016. Pretreatment IgE sensitization patterns
determine the molecular profile of the IgG4 response during updosing of subcutaneous
immunotherapy with timothy grass pollen extract. Journal of Allergy and Clinical
Immunology. 137(2). pp.562-570.
Tabatabaian, F. and Casale, T. B., 2015, March. Selection of patients for sublingual
immunotherapy (SLIT) versus subcutaneous immunotherapy (SCIT). In Allergy &
Asthma Proceedings (Vol. 36, No. 2).
Online
A Patient's guide to SCIT. 2017. [Online]. Available through:
<http://quantumallergycanada.com/a-patients-guide-to-scit-subcutaneous-
immunotherapy/>.
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