You must be in moderate withdrawal before you take your first dose of buprenorphine. That can be 12-36 hours after your last dose of an opiate. Your provider can explain how you can be sure that it is safe to take your first dose.
1 year or more is recommended, but every individual is unique and has different needs, you may need more or less time in treatment.
Precipitated withdrawal occurs when you take buprenorphine to soon after your last opiate use. Precipitated withdrawal is when you get your worst withdrawal symptoms all at once. Buprenorphine has an extremely strong attraction to the opiate receptors in your brain, if there are not enough available receptors, the buprenorphine pushes the other opiates off causing the precipitated withdrawal.
Precipitated withdrawal is not caused by the naloxone in the buprenorphine/naloxone product, the buprenorphine causes it.
Can I continue my allergy meds?
No prescription or over the counter oral antihistamines should be used 3 to 5 days prior to scheduled skin testing. These include cold tablets, sinus tablets, hay fever medications, or oral treatments for itchy skin, over the counter allergy medications, such as Claritin, Zyrtec, Allegra, Actifed, Dimetapp, Benadryl, and many others. Prescription antihistamines such as Clarinex and Xyzol should also be stopped at least 5 days prior to testing. If you have any questions whether or not you are using an antihistamine, please ask a member of our staff. In some instances, a longer period of time off these medications may be necessary.
You should discontinue your nasal and eye antihistamine medications, such as Patanase, Pataday, Astepro, Optivar, or Astelin at least 2 days before the testing. In some instances, a longer period of time off these medications may be necessary.
Use of these medications can block or greatly reduce the reaction by the body that will let us know that you are allergic to certain allergens.
What would prevent me from testing?
Use of a beta blocker (high blood pressure medications)
Allergy skin tests are methods of testing for allergic antibodies. A test consists of introducing small amounts of the suspected substance, or allergen, onto the skin and noting the development of a positive reaction (which consists of a wheal, swelling, or flare which is the surrounding area of redness). The results are read at 10 to 20 minutes after the application of the allergen.
What allergy test method will be done?
Percutaneous (Prick) Method: A scratcher (plastic testing device) that has been dipped in a well filled with allergens will be pressed and applied to the skin. Prick tests are usually performed on your back but may also be performed on your arms.
What will I be tested for?
You will be tested with local airborne allergens. These include, trees, grasses, weeds, molds, dust mites, and animal dander.
How long will this test take?
The skin testing generally takes 45 minutes from start to finish. After the allergens have been applied to your skin, they will sit for 10-20 minutes, then your results will be read and you will get instant results.
How long will these bumps last?
These positive reactions will gradually disappear over a period of 30 to 60 minutes, and, typically, no treatment is necessary for this itchiness. Occasionally local swelling at a test site will begin 4 to 8 hours after the skin tests are applied. These reactions are not serious and will disappear over the next week or so. They should be measured and reported to your physician at your next visit.
How do I know if I am allergic to any of the allergens tested?
If you are allergic to any of the allergens tested, you will develop a raised, red, itchy bump called a “wheal” that may look like a mosquito bite. After the test and the allergens are wiped off, you may have some mild itching, redness or swelling of the skin. These symptoms usually clear up in a few hours but may last for a few days.
What can I do to alleviate symptoms I am experiencing?
Applying an ice pack to the affected area may improve your symptoms. Over the counter medications such as hydrocortisone cream or Benadryl cream can be applied to the skin to help with the itching or swelling of the skin. You can also take an over the counter antihistamine like Benadryl, Claritin or Zyrtec.
Although rare, what do I do in case of an emergency or severe reaction?
On rare occasions, allergy tests produce an immediate allergic reaction that requires medical attention. If you develop a severe reaction after the allergy test, call 911 immediately. Severe symptoms can include swelling of the throat, difficulty breathing, worsening hives or swelling of skin, hoarse voice, nausea, vomiting, abdominal pain, dizziness, fainting, fast heartbeat, feeling of doom. If your symptoms persist or get worse, contact the office for further instruction at 480-793-1978.
What do my results mean?
A positive skin test means that you are allergic to that specific allergen. Bigger bumps or a positive result may indicate more sensitivity, and no bumps or a negative result may mean you are not allergic to that specific allergen. Many different things can play a part in your body’s reaction to the allergy testing and it is also possible to react differently to the same test performed on different occasions.
• The size of the reaction does not always correlate with the severity of your symptoms.
• A positive result does not predict the nature of your symptoms.
• The allergy test may not trigger a reaction when you do have an allergy (false negative).
You may also have a reaction on your skin but not experience any symptoms when you are exposed to it. A positive skin test indicates a true allergy but you may not have any symptoms because you are not around that allergen. The test results are used as a guideline to develop your allergy serum (see information on Immunotherapy) along with your reported symptoms.
If you know what causes an increase in your symptoms, that is considered also. When you have a negative skin test result but you know you have symptoms caused by that allergen, that allergen would still be added to the allergy serum.
What is Immunotherapy?
Immunotherapy, more commonly known as “allergy shots”, is the only disease altering treatment for allergies. Using over the counter medications like Benadryl, Claritin or Zyrtec only masks the symptoms. They do not resolve them. Immunotherapy may resolve your symptoms completely.
Immunotherapy involves two phases:
• Build-up Phase -- weekly injections
• Maintenance Phase -- biweekly or monthly injections
What happens during the build-up phase?
During the build-up phase we slowly increase the amount of allergen that the body is exposed to. The goal is to allow time for the body to recognize the allergens instead of attacking them. There are 5 dilutions in immunotherapy, 1:10,000, 1:1,000, 1:100, 1:10 and finally 1:1. The length of time you spend on each vial depends on how your body is responding to treatment. Normally each vial lasts for 6 weeks, but it can take 10 weeks or longer depending on how you are feeling. If you develop an increase in allergy symptoms that are bothersome, we can take longer on a vial. If you do not have an increase in symptoms or you can tolerate your symptoms, then the 6 weeks per vial is acceptable. You can and should continue to use over the counter medications for allergy symptom control when you are first starting immunotherapy. It can take up to 6 months before you notice symptom resolution.
What happens during the maintenance phase?
After you have finished the build-up phase, the recommended length of time to be on maintenance phase is 1-2 years. While this is a lengthy treatment, the result can be immunity to the allergens that were in your allergy serum. Sadly there is a small portion of the population that will never achieve immunity, but there is no way to know this prior to starting treatment. For those patients who do not develop immunity, there is still hope. If you continue the maintenance phase you will continue to have symptom resolution.
What side effects should I look for?
Normal side effects of immunotherapy can include itching, swelling, redness at the injection site, increase in allergy symptoms, increase in asthma symptoms. In rare circumstances, severe symptoms can develop and include swelling of the throat, difficulty breathing, worsening hives or swelling of skin, hoarse voice, nausea, vomiting, abdominal pain, dizziness, fainting, fast heartbeat, feeling of doom. If this occurs call 911 immediately.
A prescription for an EpiPen will be provided if you decide to move forward with immunotherapy. An EpiPen can be used for a severe reaction while you are waiting for the paramedics to arrive.
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