Description:
The dock and sorrel mix is a sterile diagnostic extract derived from pure pollen extracted from the Rumex acetosella plant. This allergenic extract is standardized to contain a specific quantity of抗原E, a measure of the allergenicity of the extract. The extract is prepared from short ragweed and mixed tall and short ragweed pollen, as well as from individual molds and yeast particles. The mold and yeast are extracted from pure powdered inactivated mold source material. The purpose of the extract is to be used for diagnostic purposes in skin testing for the accurate determination of an individual's sensitivity to specific allergens.
Indications and Usage:
This extract is intended for use by allergists experienced in the administration of allergenic extracts and the emergency care of anaphylaxis, or under the guidance of an allergy specialist. It is not for therapeutic use. The extract is designed for use in skin testing to establish the clinical relevance of specific allergens to which the patient has been exposed. By measuring skin test response, the physician can assess the degree of sensitivity patients have to the allergens.
Contra-Indications:
People with unstable asthma or who are steroid-dependent should avoid using this product due to a higher risk of a fatal allergic reaction. The product should not be injected intravenously, and beta-blockers may diminish the response to epinephrine or inhaled bronchodilators. It is crucial that emergency procedures and appropriately trained personnel are readily available in case of a life-threatening reaction.
Warnings:
There are serious warnings associated with this product. Severe allergic reactions can occur, including skin reactions that may progress to anaphylaxis. After skin testing, patients should be observed for at least 20-30 minutes. In the event of a systemic reaction, such as urticaria, angioedema, wheezing, dyspnea, respiratory obstruction, hypotension, coma, or death, epinephrine should be administered immediately according to the recommended dose. Additionally, volume expanders and vasopressor agents may be required to manage hypotension, and bronchodilators and parenteral aminophylline may be necessary to reverse bronchospasm. A tourniquet above the injection site and epinephrine injection are recommended in marked systemic reactions.
Precautions:
Special care should be taken when performing skin testing due to the risk of anaphylactic shock. The extract should be stored between 2-8°C to maintain stability. It is important to avoid causing pain by drawing blood and to be aware that blood observation is necessary for intradermal testing. Anaphylactic reactions have been reported in the post-marketing diagnostic use of some food allergenic extracts, and healthcare providers should consider confirming negative skin testing with serologic testing by measuring specific serum IgE or with a medically-supervised oral food challenge.
Adverse Reactions:
fatalities from skin testing in the United States have been extensively reviewed by Lockey, et al. (1987). Six deaths were associated with intradermal testing without percutaneous testing and one was associated with a combination of percutaneous and intradermal skin testing. Although fatal reactions are rare, it is mandatory that physicians administering allergenic extracts for skin testing understand and be prepared to treat a severe reaction. Local reactions such as immediate wheal and erythema can occur, and in cases of severe Systemic Reactions, epinephrine and other emergency interventions may be necessary.
Overdose:
Signs and symptoms of overdose can be large local and systemic reactions. For management of overdose reactions, refer to the Adverse Reactions section above.
Dosage and Administration:
Parenteral drug products should be inspected visually before administration, whenever solution and container permit. For percutaneous and intracutaneous testing, follow the specific device manufacturer's or distributor's instructions for preparation and use.
Storage:
To maintain stability of allergenic extracts, proper storage conditions are essential. The extract should be stored at 2-8°C even during use.
Information for Patients:
Patients should be instructed to describe any active allergic symptoms, such as rhinitis, wheezing, dyspnea, etc., before testing. Always observe patients for at least 20-30 minutes after testing.
References:
Lockey, R.F., et al. Fatalities from immunotherapy (IT) and skin testing (ST). Journal of Allergy and Clinical Immunology, 1987; 79: 660.
Reid, M.J., et al. Survey of fatalities from skin testing and immunotherapy. 1985-1989. Journal of Allergy and Clinical Immunology, 1993; 92: 6.
Bousquet, J. In vivo methods for the study of allergy: skin test, techniques and interpretation. In: Middleton, D.I., ed. Allergy Principles and Practice. St. Louis, MO: CV Mosby, 1988: 167.
Freedman, S.O. Asthma and Allergic Rhinitis II: Clinical Aspects. In: Freedman, S.O. and Gold, J.G., eds. Clinical Immunology, 2nd ed. New York, NY: Harper & Row, 1976:131.
Revised February 2023
