Allergen specifik immunterapi

Formål
Allergen specifik immunterapi er et kernekompetenceområde indenfor allergologien.
Formålet med denne vejledning er at
- Skabe en gennembearbejdet og kvalitetssikret arbejdsrutine for allergen-specifik immunterapi, som sikrer en høj professionel standard og effektiv ressourceudnyttelse.
- Sikre at patienter og personale føler sikkerhed og tryghed ved start af og under behandlingen ved at beskrive sikkerhedsrutiner og praktiske fremgangsmåder så der opnås en minimal patientrisiko, høj patienttilfredshed og helhed i patientforløbet.
- Angive retningslinjer for dokumentation og opfølgning af behandlingsresultatet.
Der henvises til:
Overordnet politik vedrørende immunterapi: bilag: kliniske-retningslininier AIT-allergiklinik-###TELEFON###

Målgrupper og anvendelsesområde
Læger, sygeplejersker og bioanalytikere, som arbejder med immunterapi.

Definitioner
Der henvises til:
Overordnet politik vedrørende immunterapi: bilag: kliniske-retningslininier AIT-allergiklinik-###TELEFON###

Fremgangsmåde
Der henvises til:
Overordnet politik vedrørende immunterapi: bilag: kliniske-retningslininier AIT-allergiklinik-240419

Ansvar og organisering
Det overordnede ansvar for udførelse af allergen specifik immunterapi påhviler overlæge ###NAVN###. Klinikkens immunterapi team (overlæge ###NAVN### og udpegede sygeplejersker) har ansvar for uddannelse, instrukser, kvalitetskontrol og administrative funktioner vedr. immunterapifunktionen. Den daglige drift er uddelegeret til IT klinikkens personale (sygeplejersker og den vagthavende læge). Personalet arbejder på eget ansvar inden for den kompetenceramme, deres viden og erfaring tillader. Dette betyder, at kendskab til eget erfaringsgrundlag og beslutningskompetence er kritisk nødvendigt for at kunne afgrænse i hvilke situationer de kan træffe beslutninger, og hvornår en mere erfaren kollega skal rådføres. Sygeplejersken træffer selvstændigt beslutninger om dosering inden for egen kompetenceramme i forhold til denne instruks. Overskrider sygeplejersken sin kompetence er denne personligt ansvarlig jvf. almindelige sygeplejeretslige regler.
Delegeringen til sygeplejersker omfatter intramuskulær injektion af adrenalin-autoinjekter til patienter med anafylaktiske symptomer, hvis patientens tilstand ikke tillader at afvente lægens behandling. Anden antiallergisk medicin kan ligeledes administreres af sygeplejersker. Den ansvarshavende læge skal altid orienteres om patienter, der i forbindelse med reaktioner på behandlingen modtager farmakologisk behandling ud over peroral antihistamin.

Referencer, lovgivning og faglig evidens samt links hertil
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- Abramson MJ, Puy RM, Weiner JM. Allergen immunotherapy for asthma. [update in: Cochrane Database Syst Rev 2010;(8):CD001186] Cochrane Database Syst Rev (2003), p. CD001186
- Wilson DR, Torres LI, Durham SR. Sublingual immunotherapy for allergic rhinitis. [update in: Cochrane Database Syst Rev 2010;(12):CD002893] Cochrane Database Syst Rev (2) (2003), p. CD002893
- Penagos M, Compalati E, Tarantini F, Baena-Cagnani R, Huerta J, Passalacqua G et al. Efficacy of sublingual immunotherapy in the treatment of allergic rhinitis in pediatric patients 3 to 18 years of age: a meta-analysis of randomized, placebo-controlled, double-blind trials. Ann Allergy Asthma Immunol, 97 (2006), pp. 141–148
- S. Radulovic S, M.A. Calderon MA, D. Wilson S, S. Durham S. Sublingual immunotherapy for allergic rhinitis. Cochrane Database Syst Rev (12) (2010), p. CD002893
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- Penagos M, Passalacqua G, Compalati E, Baena-Cagnani CE, Orozco S, Pedroza A et al. Metaanalysis of the efficacy of sublingual immunotherapy in the treatment of allergic asthma in pediatric patients, 3 to 18 years of age. Chest, 133 (2008), pp. 599–609.
- Calderon MA, Penagos M, Sheikh A, Canonica GW, Durham S. Sublingual immunotherapy for treating allergic conjunctivitis. Cochrane Database Syst Rev (7) (2011), p. CD007685
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- Nielsen L, Johnsen CR, Mosbech H, Poulsen LK, Malling H-J. Antihistamine premedication in specific cluster immunotherapy: A double-blind, placebo-controlled study. J Allergy Clin Immunol 1996; 97: 1207-1213.
- Müller UR, Jutel M, Reimers A et al. Clinical and immunologic effects of H1 antihistamine preventive medication during honeybee venom immunotherapy. J Allergy Clin Immunol 2008;122:1001-7
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En kort oversigt over immunterapi findes på
https://www.sundhed.dk/sundhedsfaglig/laegehaandbogen/allergi/tilstande-og-sygdomme/behandling/allergen-specifik-immunterapi/

Akkrediteringsstandarder
Ingen.

Bilag
Overordnet politik:
Kliniske-retningslinier AIT-allergiklinik-240419.docx