Smut, Barley by is a Other medication manufactured, distributed, or labeled by Allermed Laboratories, Inc.. Drug facts, warnings, and ingredients follow.
WARNINGS
This allergenic product is intended for use by physicians who are experienced in the administration of allergenic extracts and the emergency care of anaphylaxis, or for use under the guidance of an allergy specialist.
This allergenic extract is not directly interchangeable with other allergenic extracts. The initial dose must be based on skin testing as described in the dosage and administration section of this insert. Patients being switched from other types of extracts, such as alum precipitated extracts, should be started as though they were coming under treatment for the first time. Patients should be instructed to recognize adverse reaction symptoms and cautioned to contact the physician's office if reaction symptoms occur. As with all allergenic extracts, severe systemic reactions may occur. In certain individuals these reactions may be life threatening. Patients should be observed for at least 20 minutes following treatment, and emergency measures as well as personnel trained in their use should be immediately available in the event of a life threatening reaction.
This product should not be injected intravenously (see
Dosage and Administration). Refer also to the
Warnings,
Precautions,
Adverse Reactions and
Overdosage sections below.
Serious adverse reactions to this product should be reported to MEDWATCH, Food and Drug Administration, at 1-800-FDA-1088 or www.fda.gov/medwatch
Allergenic extract contains the aqueous extractables from allergenic source material in extracting solution containing 0.25% sodium chloride, 0.125% sodium bicarbonate, and 50% glycerol. 0.4% phenol is added as a preservative. The weight by volume value shown on the label is a measurement of extract concentration, rather than extract potency.
Positive skin tests with allergenic extract are the result of histamine release from mast cells sensitized with allergen specific IgE. The exact mechanisms by which immunotherapy relieves symptoms of allergy are still under investigation. Elevations in allergen-specific IgG antibodies and an increase in the activity of T suppressor lymphocytes appear to be some of the immunologic changes that occur from hyposensitization. 1,2,3
Allergenic extract may be used as a diagnostic skin test reagent in persons suspected of being sensitive to the allergenic source material from which the extract is made. Skin tests should be used in conjunction with a thorough allergic history to establish the relevance of a given allergen in the etiology of allergic disease.
4,5,6
Immunotherapy with allergenic extract is indicated in persons suffering from allergic rhinitis, bronchitis, conjunctivitis, urticaria and asthma. The therapeutic efficacy of allergenic extract has been proven in ragweed, grass, and mountain cedar pollinosis, cat-induced asthma and hypersensitivity to hymenoptera venoms.
7-12
Immunotherapy may be used along with or exclusive of antihistamines and other medications used to control allergic symptoms.
Allergenic extract should not be administered to a non-allergic person. However, there are no absolute contraindications to the use of allergenic extract for treatment in appropriate individuals. Relative contraindications include: EXTREME SENSITIVITY TO AN ALLERGEN - Determined from the allergic history, or from previous anaphylaxis following skin testing or subcutaneous injection; AUTOIMMUNE DISEASE - Individuals with autoimmune disease may be at risk, due to the possibility of routine immunizations exacerbating symptoms of the underlying disease; PREGNANCY - In limited controlled studies of women receiving allergenic extract during conception and throughout all trimesters of pregnancy, no evidence was found that extract is harmful to the fetus or mother. However, because of the known pharmacologic action of histamine on uterine muscle, any treatment that might result in the release of significant amounts of this mediator should be avoided if possible
13. See Precaution #4; MYOCARDIAL INFARCTION - Patients who have experienced a recent myocardial infarction may not be able to tolerate immunotherapy. As in all of the above circumstances, the benefit to risk ratio must be carefully evaluated; BLEEDING DIATHESIS - Patients with a bleeding tendency should not be tested or treated with allergenic extract, unless the physician responsible believes that such procedures are safe to perform.
Allergenic extract should be temporarily withheld from patients if any of the following conditions exist: (1) severe symptoms of hay fever and/or asthma; (2) infection or flu accompanied by fever; and (3) exposure to excessive amounts of clinically relevant allergens prior to skin testing or immunotherapy.
The only approved method for determining hypersensitivity to Allermed Laboratories Allergenic Extracts is by diagnostic skin testing (See DOSAGE AND ADMINISTRATION — DIAGNOSIS).
Physicians who administer allergenic extract should have emergency medication and equipment available to treat anaphylaxis
14. See Precautions, Adverse Reactions and Overdosage below.
To reduce the risk of anaphylaxis, the following measures must be observed:
Local Reactions: The occurrence of a hive 5 to 15 minutes after the subcutaneous injection of extract does not require a reduction in dosage. However, a local reaction with edema larger than 2 cm in diameter or swelling and redness that persist for several hours or longer indicates that too much extract has been given. Treatment should be altered as follows:
Systemic Reactions: Systemic (generalized) reactions may range from a mild exacerbation of the patient's allergic symptoms to hives, anaphylactic shock, or even death from anaphylaxis. The reaction usually occurs 5 to 20 minutes after injection. As a rule, the more quickly a reaction develops, the more serious it is likely to become. Symptoms may include sneezing, coughing, itching, shortness of breath, abdominal cramps, vomiting, diarrhea, tachycardia, hypotension and respiratory failure in severe cases. The reaction is usually stopped by the subcutaneous injection of Epinephrine HCL 1:1,000 (See Overdosage below). The oral administration of antihistamines and the placement of a tourniquet proximal to the injection site are helpful adjuncts. In the event that additional measures are required, it may be necessary to treat the patient for BRONCHOSPASM with intravenous aminophylline, intravenous fluids and corticosteroids; for HYPOTENSION with vasopressors, volume repletion, isoproterenol and corticosteroids; for LARYNGEAL OBSTRUCTION with oxygen and tracheostomy; and for CARDIAC ARREST with cardiopulmonary resuscitation and other appropriate measures.
Immunotherapy after anaphylaxis should only be continued if the cause of the reaction can be identified and appropriate precautions taken to insure that a subsequent reaction does not occur.
A strong local reaction to the injection of extract may be treated with oral antihistamines and the local application of a cold compress. The dosage must be reduced and additional extract must not be given until all evidence of the reaction has disappeared.
A systemic reaction following the injection of extract must be treated immediately as follows (Ref. #4, vol. 2, p. 888):
a. Brochospasm: intravenous aminophylline 4 mg/kg up to 500 mg given over 10 to 15 minutes, aqueous hydrocortisone 5 mg/kg up to 200 mg, oxygen.
b. Laryngeal edema: oxygen, intubation, tracheostomy.
c. Hypotension: vasopressors, fluids, corticosteroids.
d. Cardiac arrest: resuscitation, sodium bicarbonate, defibrillation, antiarrhythmia medications.
Diagnosis: Concentrated extract may be used for scratch or prick testing. Provided that the patient is not extremely sensitive, concentrated extract may be used for scratch or prick testing. In the case of extreme sensitivity, the extract should be diluted 10 fold before a scratch or prick test is performed. Extract for intradermal testing must be used as follows:
a. Patients with positive scratch or prick tests: It is not advisable to perform an intradermal skin test if the patient has a positive scratch or prick test.
b. Patients with a negative scratch or prick test: Patients who do not react who do not react to a valid scratch or prick test should be tested intradermally with 0.05 mL of a 1:1000 v/v dilution of the concentrate. If the test is negative, a second test should be performed with 0.05 mL of a 1:100 v/v dilution or concentrate.
c. Patients tested only by the intradermal method: Patients suspected of being highly allergic should be tested with 0.05 mL of a 1:100,000 v/v dilution of the concentrate. A negative test should be followed by repeat tests using 10 fold stronger concentrations until the maximum dose of 0.05 mL of a 1:100 v/v dilution is reached.
Interpretation of Results
Scratch and Prick Test
A negative test shows only a slight red area at the site of scarification or prick penetration. Positive tests are scored as follows:
1+ Erythema with 5 mm wheal
2+ Erythema with a 5-10 mm wheal
3+ Erythema with a 10-15 mm wheal
4+ Erythema with a wheal 15 mm (or larger) with pseudopodia
Intradermal Test
A negative test shows no change in the appearance and size of the 5 mm wheal created by the I.D. injection of 0.05 mL of extract. Positive tests are scored as follows:
1+ Erythema 10-20 mm with a 5-10 mm wheal
2+ Erythema 20-30 mm with a 5-10 mm wheal
3+ Erythema 30-40 mm with a 10-15 mm wheal
4+ Erythema greater than 40 mm with a 15 mm wheal (or larger) with pseudopodia
Immunotherapy
Allergenic extract should be administered subcutaneously in the outer aspect of the upper arm using a sterile tuberculin syringe and needle. The skin should be cleaned with 70% alcohol and aseptic technique should be observed in removing the extract from the vial. Care must be taken to avoid injecting the extract into a blood vessel because of the risk of anaphylaxis.
Concentrated extract must be diluted before administration to new patients. A 1:100,000 v/v dilution of concentrate is usually satisfactory to start treatment. However, as a precaution against overdose, a skin test with the intended starting dose should be done to help evaluate the patient's sensitivity to the product. If the skin response is larger than 5 mm edema/15 mm erythema, the extract is too strong and must be diluted before it is given subcutaneously. The doses shown in the Suggested Dosage Schedule below are recommended unless the patient's skin test response and allergic history indicates that more dilute extract should be used.
Little is known about the required accumulated dosage of allergen that is needed to relieve symptoms. However, studies have shown that high dose immunotherapy is efficacious in the treatment of allergic rhinitis and asthma. For this reason, treatment with extract from Vial #5 is recommended, providing the patient can tolerate the extract without experiencing local or systemic reactions. Treatment with Vial #6 may be used for patients who have not had adverse reactions to extract in Vial #5 and who require more concentrated extract to control or relieve symptoms.
Patients who have received allergenic extract for maintenance therapy SHOULD NOT be given the same dose from a fresh vial of extract. IT IS ADVISABLE TO REDUCE THE DOSAGE OF FRESH EXTRACT TO ONE-FOURTH THE AMOUNT GIVEN FROM A PREVIOUS LOT OF EXTRACT MADE AT THE SAME CONCENTRATION AND BY THE SAME FORMULA.
No. | Vial #1
1:100,000 w/v frequency twice weekly mL | Vial #2
1:10,000 w/v frequency twice weekly mL | Vial #3
1:1,000 w/v frequency once weekly mL | Vial #4
1:100 w/v frequency once weekly mL | Vial #5
1:10 w/v frequency every two-four weeks mL | Vial #6
Concentrate frequency every two-four weeks mL |
---|---|---|---|---|---|---|
1 | 0.025 | 0.025 | 0.025 | 0.025 | 0.025 | 0.025 |
2 | 0.05 | 0.05 | 0.05 | 0.05 | 0.05 | 0.05 |
3 | 0.10 | 0.10 | 0.10 | 0.10 | 0.10 | 0.10 |
4 | 0.15 | 0.15 | 0.15 | 0.15 | 0.15 | 0.15 |
5 | 0.20 | 0.20 | 0.20 | 0.20 | 0.20 | 0.20 |
6 | 0.25 | 0.25 | 0.25 | 0.25 | 0.25 | 0.25 |
7 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 | 0.30 |
MUCOR PLUMBEUS
mucor plumbeus liquid |
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OAK, CALIFORNIA MIX
quercus agrifolia/quercus kelloggii liquid |
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PINE MIX
pinus echinata/pinus ponderosa/pinus strobus liquid |
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RHIZOPUS NIGRICANS
rhizopus nigricans liquid |
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SMUT, BERMUDA GRASS
ustilago cynodontis injection |
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SMUT, WHEAT
ustilago tritici liquid |
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CLADOSPORIUM CLADOSPORIOIDES
cladosporium cladosporioides liquid |
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MAPLE, CALIFORNIA MIX
acer macrophyllum/acer negundo liquid |
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SACCHAROMYCES CEREVISIAE
saccharomyces cerevisiae liquid |
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TRICHOPHYTON RUBRUM
trichophyton rubrum liquid |
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SMUT, OAT
ustilago avenae liquid |
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ALDER MIX
alnus rhombifolia/alnus rubra/alnus rugosa liquid |
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ASPERGILLUS NIDULANS
aspergillus nidulans liquid |
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STEMPHYLIUM SOLANI
stemphylium solani liquid |
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TRICHOPHYTON MENTAGROPHYTES
trichophyton mentagrophytes liquid |
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TRICHOPHYTON MIX
trichophyton mentagrophytes/trichophyton rubrum liquid |
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ASPERGILLUS NIGER
aspergillus niger injection |
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SMUT, BARLEY
ustilago nuda liquid |
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Labeler - Allermed Laboratories, Inc. (073364531) |
Registrant - Allermed Laboratories, Inc. (073364531) |
Establishment | |||
Name | Address | ID/FEI | Business Operations |
---|---|---|---|
Allermed Laboratories, Inc. | 073364531 | manufacture(49643-0161) |