Allergen immunotherapy administration form

v/v: volume/volume.
* Health screen refers to either a written or verbal interview of the patient prior to the administration of the allergy injection regarding the presence of increased asthma symptoms or symptoms of respiratory tract infection, beta-blocker use, change in health status (including pregnancy), or adverse reaction to previous infection. A "yes" answer to this health screen may require further evaluation.
¶ Antihistamine use: To improve consistency in interpretation of reactions, it should be noted if the patient has taken an antihistamine on injection days. Clinician may also request that antihistamines be taken consistently on injection days (recommended? Y N ).
Δ Reaction: Refers to either immediate or delayed systemic or local reactions. Local reactions (noted as LR) can be reported in millimeters as the longest diameter of wheal and erythema. The details of the symptoms and treatment of a systemic reaction (noted as SR) would be recorded elsewhere in the medical record.