Guest guest Posted July 18, 2008 Report Share Posted July 18, 2008 At 07:14 PM 7/17/2008, you wrote: >I am taking my previously vaccinated infant in for allergy testing (he >had severe reactions to his 2, 4, & 6 mo vaccines) - yes, I know that >the vaccines caused the food allergies. However, when I called to >schedule the appt, I was told that she does not require the AAP Vaccine >Refusal Form....I wasn't even considering going back to her, but I have >no choice because every other doc requires it. I would like to think >that my " education " letter that I sent her in recent months about >vaccines had something to do with it. I will keep everyone posted on >the outcome. Glad to hear your good news, BUT...................from one of my colleagues........ Lots of info on this there is phenol even in the kind the DAN docs use, but not all of them contain it. The standard allergy shots do contain thimerosal. This is from the book ImmunoFacts Vaccines and Immunologic Drugs 2004 Solvent: Allergen extract may be manufactured in either aqueous or glycerinated form. Lyophilized and glycerinated extracts are the most stable forms. Stock containers of water-based allergen extracts typically contain constituents of diluting fluid. Sodium chloride, sodium bicarbonate, and are usually preserved with phenol. Diluent: Dilute Aquinas extracts with a solution containing 0.03% human serum albumin (HSA) as a protein stabilizer, 0.9% sodium chloride for tonicity, and 0.4% phenol as an antimicrobial agent. Extracts in a solution with 50% glycerin offer a higher degree of protein preservation, but glycerin injections may cause local irritation or sterile abscesses. Glycerin is often used in the diluent for prick skin test dilutions, because its viscosity retard the flow of 1 prick-test reagent int neighboring reagents. However, glycerin may also increase the incidence of false-positive skin-test reactions, especially in the higher dose associated with ID injections. Label all vials with concentration of their contents. Suboptimal fluids for compounding dilutions of aqueous allergen extracts include phenol-saline, 0.9% sodium chloride with 0.4% phenol, phosphate-buffered saline, sodium chloride with 0.08% to 0.11% sodium phosphate, 0.036% to 0.04% potassium phosphate, and 0.4% phenol, bicarbonate-saline. Coca's solution: 0.5% sodium chloride, 0.275% sodium bicarbonate 0.4% phenol, and various glycero-saline solutions. 10% glycerin with 0.5% sodium chloride and 0.4% phenol, 25% glycerin with 0.5% sodium chloride, sodium phosphate, potassium phosphate, and 0.4% phenol. Undiluted sterile parenteral glycerin, with a glycerin content of 95% or more, is available from several manufacturers. Preservative: Usually 0..4% or 0.5% phenol; 0.01% thimerosal is used if the allergen may darken or precipitate in the presence of phenol. Extracts of privet pollen, mushroom, grain mill dust, white potato, avocado. Food extracts of corn, barley, oat, rye and wheat. Allergens: Allergens extracts are allergenic by definition and intent. HSA, used in many diluents, does not sensitize recipients. Excipients: Mannitol in some lyophilized products. Extracts may contain varying amounts of sodium chloride, sodium bicarbonate, sodium carbonate, calcium carbonate, sodium phosphate, potassium phosphate, magnesium phosphate, potassium citrate, or glycerin. Shelf Life: Products containing 50% or more glycerin expire within 36 montsh, less than 50% glycerin within 18 m,onths. Short-ragweek extracts expire within 12 months. Lyophilized products expire within 30 to 48 months. From an old post! Someone on another list I'm on asked about immunotherapy treatment. My son received these treatments six years ago, and I haven't thought very much about it until this question. I decided to do a little digging, and do not like what I found. http://neuro-www.mgh.harvard.edu/forum/CreutzfeldtJakobsF/Albumininallergyextrac\ t.html Albumin in allergy extract This response submitted by Zambenini , RN on 2/7/98. Email Address: lzambeni@i... Ask any allergist what the " diluents " are. They are either a combination of HSA (human serum albumin),normal saline, and phenol OR glycerol, normal saline and phenol. The glycerol based solution is almost always used for skin testing since it has higher viscosity and thus tends not to " bleed " into adjacent test sites and obscure results. From my experience working in an Immunization/Travel clinic it seems most extracts are HSA based, not glycerol. Glycerol is not used as often because it tends to cause more reactivity and sterile abcesses especially at larger doses. All this info can be found in the " Immunofacts " book which we have at our office -it is an excellent resource book on vaccines and immunobiologicals. I can get you the publisher and ISBN # if you want it. Also, patients who are RAST tested for allergies (blood test) instead of skin tested have their allergy extracts ordered from and produced by large pharmaceutical companies who deal in immunobiologicals, rather than having the allergist formulate them in the office. Bayer and Allermed are a couple of the companies that come to mind. When we get these vials of allergy extract to administer to a patient they come with extensive package inserts (you practically need a microscope to read) just like any other prescription drug. They all use different formulations - some mix cat pelt allergen using the HSA mixture, others use this for their dust mites etc... I have read this on the ingredient list on the package inserts. HSA is used as a protein stabilizer (as is glycerol) to extend shelf life. Without HSA or glycerol (ie: just normal saline and phenol} the allergy extract is only good a short time- I beleive just a few hours or days. Maybe you could get a package insert from an allergist that employs RAST testing, or from Bayer if you are interested. Allergy extract formulated in the allergist's office almost never list the diluents used - just the allergens (cat,dust, mold, ragweed, pollens, cockroach,dog etc...). I learned about allergy extract diluents accidently about 2 weeks ago when I was flipping through our " Immunofacts " book looking for some info about a vaccine. There was a single page dedicated to allergenic diluents - I was quite surprised to learn that HSA was used. I always thought they were formulated with saline or glycerol and phenol. I also get allergy shots and contacted my allergist. Sure enough my dust mites vial was diluted with the HSA diluent. I asked my allergist to reformulate it and told him my concerns. He has agreed to do this but made a point of saying it is FDA approved , which it is. However, I choose to have control over what goes in my body till more is known. I do not beleive non-essential products (like allergy extracts) should contain HSA; till more is known these should be reformulated , which is possible, to eliminate any risk. http://www.greerlabs.com/47.aspx WARNINGS Concentrated extracts must be diluted with a sterile diluent (such as normal saline, buffered saline, saline with human serum albumin, or saline with 10% glycerin) prior to use in a patient for intradermal testing. Concentrates of Allergenic Extracts are manufactured to assure high potency and have the ability to cause serious local and systemic reactions including death in sensitive patients. Most reactions occur within 20 minutes after injection, but may occur later. To minimize the potential for local or systemic reactions, the relative sensitivity of the patient must be assessed from the allergic history and from clinical observations. Patients should be informed of the possibility of these reactions and the precautions should be discussed prior to testing http://www.wramc.amedd.army.mil/departments/allergy/CAEL/product.htm 1. Aqueous Extract Solutions Sterile aqueous stock solutions comprise the vast majority of allergen extracts on the shelves of the USACAEL. A typical aqueous extract solution as prepared by our contract manufacturer, Bayer Laboratories, will contain the active ingredients or allergens as noted on the label (pollen, dander, molds, dust etc.). The preservative is 50% V/V glycerin, 0.4% phenol or in a few instances where phenol cannot be used 0.1% thimerosal. Additional ingredients include 0.5% sodium chloride and 0.275% sodium bicarbonate. These solutions should be clear and free from any particulate matter. The supplied concentration of these solutions is usually expressed as Protein Nitrogen Units per ml (ie. 10,000 or 20,000 PNU/ml) or Weight per Volume (ie. 1:10 or 1:20 W/V) concentrations from the manufacturer. The large part of our inventory (attached) are stocked at PNU/ml and W/V concentrations. The FDA is working hard to better standardize allergen extract products. The continued utilization of these products and scientific advances have aided in the gradual refinement of earlier allergen extract products. The perfect allergenic extract as been defined as one that contains all the potential allergens in their native form, in the proper ratio and with all irrelevant material removed. Currently, however, only a few relevant " allergens " have been isolated in only a small number of extract products (Fel d 1 or Cat Allergen 1 in Cat extracts and Antigen E in Short ragweed extract for example). Diluents and Preservatives Dilutions of concentrated extracts prepared for diagnostic testing materials and treatment sets retain potency longer when diluted with Human Serum Albumin saline diluent (HSA) than with plain buffered or phenol saline alone. Glycerin is a superb stabilizer and extracts in 50% solution retain their potency for considerable periods of time. It must be noted, however, that when extracts containing more than 10% glycerin are injected, a burning sensation occurs at the site of injection which is not well tolerated by patients. Thus, intradermal testing materials (ID) are diluted with HSA diluent rather than a 50% glycerin solution. Prick or scratch testing materials, on the other hand, may be diluted and stabilized with glycerin. This is due to the fact that glycerin is not irritating on the surface of the skin. Thus, prick or scratch testing materials are in 50% glycerin. Immunotherapy treatment sets for patients are diluted down with HSA diluent except where Center- Al or Allpyral extracts are being used. In instances where these alum- precipitated extracts are being used the preferred diluent is phenol saline diluent (0.9% sodium chloride and 0.4% phenol). http://www.hollister-stier.com/download_pdfs/385407-H02.pdf OVERDOSAGE: See ADVERSE REACTIONS Section. DOSAGE AND ADMINISTRATION: 1. General Sterile aqueous diluent containing albumin (human) [Albumin Saline with Phenol (0.4%)] or diluent of 50% glycerin may be used when preparing dilutions of the concentrate for immunotherapy. For intradermal testing dilutions, Albumin Saline with Phenol (0.4%) is recommended. Dilutions should be made accurately and aseptically, using sterile diluent, vials, syringes, etc. Mix thoroughly and gently by rocking or swirling. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever solution and container permit. Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.