Q:

7/2/2014
From a medico-legal perspective can paramedics at their own facility administer allergy shots?

A:

Thank you for your inquiry.

I cannot speak directly to the issue of emergency medical technicians administering allergy injections because, to my knowledge, there is no consensus on this issue, and our Guidelines (1) do not specifically speak to it. The closest we can come to giving you guidance in this regard is the statement taken from this document regarding the personnel who are qualified to administer allergen injections. Please note that according to these Guidelines state "A physician or qualified physician extender (nurse practitioner or physician's assistant) should be present and immediately available and be prepared to treat anaphylaxis when immunotherapy injections are administered." This would imply of course that if an emergency medical technician was administering allergy injections, it is suggested that one of the above personnel be immediately available.

Thank you again for your inquiry and we hope this response is helpful to you.

LOCATION OF ALLERGEN IMMUNOTHERAPY ADMINISTRATION
Supervising medical personnel:
Summary Statement 62:
Regardless of the location, allergen immunotherapy should be administered under the direct supervision of an appropriately trained physician, qualified physician extender (nurse practitioner or physician assistant), or both in a facility with the appropriate equipment, medications, and personnel to treat anaphylaxis.

Prescribing physician’s office
Summary Statement 63: The preferred location for administration of allergen immunotherapy is in the office of the physician who prepared the patient’s allergen immunotherapy extract.

The preferred location of allergen immunotherapy administration is in the office of the physician who prepared the patient’s allergen immunotherapy extract. The physician’s office should have the expertise, personnel, and procedures in place for the safe and effective administration of immunotherapy. However, in many cases it might be necessary to administer the allergen immunotherapy extract in another physician’s office.

Allergen immunotherapy should be administered with the same care wherever it is administered. A physician or qualified physician extender (nurse practitioner or physician’s assistant) should be present and immediately available and be prepared to treat anaphylaxis when immunotherapy injections are administered.

Regular practice drills with the office staff for handling systemic reactions to immunotherapy reactions should be considered.

Reference:
1. Cox L, Nelson H, Lockey R, et al. Allergen immunotherapy: a practice parameter, third update. Journal of Allergy and Clinical Immunology, January 2011; Volume 127 (1), Supplement, page S1-S55.

Sincerely,
Phil Lieberman, M.D.

AAAAI - American Academy of Allergy Asthma & Immunology