Thank you for your inquiry.
Unfortunately, there is no standard accepted model to follow in this situation, and the Practice Parameter information that you quoted is one way to approach it. The manufacturer of each extract does have suggestions for you to follow. For example, if you are using one manufacturer’s extract and the physician transferring the patient used another manufacturer’s extract, you can receive suggestions from the manufacturer of your extract. We will normally do this. That is, we may follow the suggestions of the manufacturer of the extract that we employ.
In addition, on occasion, I have dropped back two dilutions. Much depends on when the patient received his/her last dose, what the initial skin test reactions looked like, if they have had any previous reactions, et cetera.
All of the suggestions above (that is, to call your manufacturer, drop back two dilutions, or follow the suggestions of the Parameters) are acceptable choices.
Thank you again for your inquiry and we hope this response is helpful to you.
Phil Lieberman, M.D.