Personnel who handle allergen-immunotherapy extracts are at risk for allergic reactions and even severe and potentially fatal anaphylactic reactions. This risk is highlighted in two reports, one from the United States and one from Sweden, that were recently published in the Journal of Allergy and Clinical Immunology.

In a letter to the editor, Bandino and Tankersley reported a case of anaphylaxis in a compounding technician working at the Wilford Hall Medical Center in San Antonio, Texas, who accidentally stuck herself while preparing an immunotherapy vial of timothy grass extract.

The event occurred during normal working hours, which may have saved the woman's life because physicians and support personnel were able to immediately render aid; five doses of epinephrine were required to resolve her symptoms.

The authors state that the technician had been taking a [beta]-blocker, a significant risk factor for serious anaphylaxis. In addition, she had a known allergy to timothy grass, but it's not known whether she had it before her employment as a compounding technician. This is important, they note, because although preemployment screenings can detect sensitizations, new sensitizations may arise at any time during employment.

In a response to Bandino and Tankersley's letter, Dreborg described several instances over his 50 years in practice in which nurses handling allergen extracts in Swedish facilities had become sensitized to those allergens.

Commonsense precautions, therefore, for anyone working with allergen extracts include undergoing regular screening for allergen sensitivity. In addition, compounding should be done only during normal working hours, when other personnel are available to render aid if needed. Bandino and Tankersley also suggest that personnel taking a [beta]-blocker discuss the risks with their supervising clinician.

Preventing the development of allergic sensitivity in the first place means taking precautions like those outlined by Dreborg: performing allergen tests in special rooms or boxes that provide air evacuation to remove the allergen from the environment; removing drops of allergen from surfaces and skin with tissue and discarding the tissue in a separate container; and collecting needles, syringes, and lancets used in immunotherapy in separate containers.-Laura Wallis

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