95180 Rapid desensitization procedure, each hour (eg, insulin, penicillin, equine serum)

Name of the Procedure:

Rapid Desensitization Procedure
Common name(s): Desensitization therapy
Technical/medical terms: Rapid drug desensitization, Rush desensitization

Summary

The rapid desensitization procedure is a medical technique used to temporarily modify a patient's immune response to a medication they are allergic to, such as insulin, penicillin, or equine serum. The process involves administering gradually increasing doses of the allergen over a period of hours to allow the patient to tolerate the medication without severe allergic reactions.

Purpose

The procedure addresses hypersensitivity to specific medications, especially when those medications are essential for treating a patient's condition. The goal is to enable patients to safely receive necessary drugs without experiencing serious allergic reactions.

Indications

• Known hypersensitivity to a critical medication (e.g., insulin, penicillin, equine serum)
• Patients requiring immediate treatment with a medication they are allergic to
• No suitable alternative medication available

Preparation

• Patients may be advised to fast for a few hours before the procedure.
• Review of the patient's medical history, current medications, and allergy testing results.
• Baseline assessments, including vital signs and, if necessary, skin testing.

Procedure Description

1. Initial intravenous line placement for drug administration.
2. The patient receives minute amounts of the allergen at gradually increasing concentrations over roughly one-hour intervals.
3. Monitoring of vital signs and allergic reaction symptoms between doses.
4. Incremental dose escalation continues until the target therapeutic dose is achieved or the patient exhibits significant intolerance.

• Tools and equipment: Intravenous access setup, infusion pumps, emergency resuscitation equipment.
• Anesthesia/Sedation: Typically not required.

Duration

Approximately 4 to 8 hours, depending on the patient's reaction and the specific protocol.

Setting

Typically performed in a hospital setting, under close medical supervision such as an inpatient unit or specialized outpatient clinic.

Personnel

• Allergist or immunologist overseeing the procedure
• Registered nurses for administration and monitoring
• Emergency personnel available for critical care if needed

Risks and Complications

• Mild to moderate allergic reactions (e.g., rash, itching, mild shortness of breath)
• Severe reactions including anaphylaxis, necessitating immediate intervention
• Temporary discomfort, flu-like symptoms, or localized pain at the infusion site

Benefits

• Allows the patient to receive essential medication despite an allergy
• Potential for immediate therapeutic effects, enabling proper management of the underlying condition
• Typically, tolerance to the medication lasts for the duration of the treatment course.

Recovery

• Patients are monitored for a few hours post-procedure to manage any delayed reactions.
• Discharge instructions include signs of allergic reactions to watch for.
• Possible follow-up appointments for continued desensitization or monitoring.

Alternatives

• Switching to an alternative medication if available and effective
• Pre-treatment with corticosteroids and antihistamines to manage mild allergic reactions
• Avoidance of the allergenic medication and alternative treatment strategies

Patient Experience

During the procedure, patients might feel mild discomfort from the IV placement and potential localized reactions at the infusion site. Anxiety or nervousness is common and can be alleviated with supportive care and reassurance. Post-procedure, they may experience mild to moderate symptoms typical of mild allergic reactions, managed with antihistamines or other symptom-specific treatments. Pain is usually minimal and well-managed with standard care protocols.