95130 Professional services for allergen immunotherapy in the office or institution of the prescribing physician or other qualified health care professional, including provision of allergenic extract; single stinging insect venom

Name of the Procedure:

Allergen Immunotherapy (AIT) for Single Stinging Insect Venom

Summary

Allergen Immunotherapy (AIT) for single stinging insect venom is a treatment designed to reduce the allergic reaction to insect stings. This is achieved by gradually exposing the patient to small amounts of the venom to build up their tolerance.

Purpose

Allergen immunotherapy aims to decrease the severity of allergic reactions to insect stings, which can be life-threatening. The goal is to reduce sensitivity to the venom and potentially provide long-term protection against severe allergic reactions.

Indications

• History of severe allergic reactions (anaphylaxis) to stinging insects such as bees, wasps, hornets, or yellow jackets.
• Positive skin test or blood test confirming venom allergy.
• Patients in high-risk occupations or environments where exposure to stinging insects is likely.

Preparation

• Patients should inform their physician of any current medications and medical conditions.
• Certain medications, such as beta-blockers, may need to be adjusted or paused before treatment.
• An initial evaluation with allergy testing to confirm the specific insect venom allergy.

Procedure Description

1. Initial Consultation: Evaluation and testing to confirm venom allergy.
2. Treatment Plan: A series of injections containing small amounts of the insect venom are administered.
3. Incremental Dosing: Initial doses are very low and gradually increase over time, typically over several months.
4. Maintenance Phase: Once the effective dose is reached, injections are spaced out, usually every 4 weeks.
5. Observation: Patients are observed for 30 minutes post-injection to monitor for any adverse reactions.

Tools and Equipment:

• Syringes and allergenic extracts specific to the insect venom.
• Emergency equipment for managing allergic reactions.

Anesthesia/Sedation:

• None typically required; local discomfort may be managed with topical anesthetics.

Duration

• Each injection visit lasts about 30 minutes.
• The entire course of therapy may last 3-5 years.

Setting

• Outpatient clinic or the office of a prescribing physician or qualified healthcare professional.

Personnel

• Allergist or immunologist.
• Registered nurse.
• Medical assistant.

Risks and Complications

• Local reactions: Redness, swelling, itching at the injection site.
• Systemic reactions: Mild symptoms (e.g., hives, itching) or severe reactions (e.g., anaphylaxis).
• Emergency management includes immediate administration of epinephrine and supportive care.

Benefits

• Reduction or complete elimination of severe allergic reactions to insect stings.
• Improved quality of life and decreased anxiety regarding insect stings.
• Benefits may be seen within the first year but often require 3-5 years of treatment for long-term protection.

Recovery

• Patients can usually resume normal activities immediately after each visit.
• Avoid strenuous activity for several hours post-injection.
• Regular follow-up appointments for assessment and continuation of therapy.

Alternatives

• Avoidance measures: Wearing protective clothing, avoiding known insect habitats.
• Emergency self-injection epinephrine (EpiPen) for immediate treatment of stings.
• Pros and Cons: While avoidance and emergency epinephrine provide immediate measures, they do not offer long-term protection like AIT.

Patient Experience

• During Procedure: Mild discomfort or a sting-like sensation at the injection site.
• Post-Procedure: Possible mild local reactions; systemic reactions are monitored and treated immediately.
• Pain Management: Over-the-counter pain relievers or antihistamines may be used for post-injection site reactions.

This comprehensive overview provides a clear understanding of the process, benefits, and expectations associated with allergen immunotherapy for single stinging insect venom.