What is the usual volume of the next dose of allergy shot if a patient received 1ml last week and 0.7ml the week before?

Allergy Immunotherapy Dosing Protocol

The next dose of allergy immunotherapy should be 1.2 ml, following the standard incremental increase pattern from the previous doses of 0.7 ml and 1.0 ml. 1, 2

Rationale for Dose Progression

Allergen immunotherapy follows a build-up phase where doses are gradually increased until reaching maintenance levels. The standard approach involves:

• Conventional build-up schedules typically increase doses by approximately 0.2-0.3 ml per injection when progressing through higher concentrations 1
• The pattern observed (0.7 ml → 1.0 ml → next dose) shows a 0.3 ml increase in the previous step
• Continuing this pattern, the next logical dose would be 1.2 ml 2

Key Considerations for Dose Progression

Standard Build-up Protocol

• During the build-up phase, injections are typically administered 1-2 times per week 1
• The volume generally increases at a rate that depends on:
  • Patient's sensitivity to the extract
  • History of prior reactions
  • Concentration being delivered (smaller percentage increments at higher concentrations) 1

Safety Factors

• The progression from 0.7 ml to 1.0 ml (a 0.3 ml increase) was well tolerated as evidenced by the patient returning for subsequent dosing
• Maintaining consistent incremental increases helps minimize risk of systemic reactions 1
• Smaller percentage increases are recommended at higher concentrations 2

Potential Adjustments to Consider

While 1.2 ml is the recommended next dose, certain circumstances might warrant dose adjustments:

• Prolonged interval between injections: If more than 1-2 weeks have elapsed since the last injection, dose reduction might be necessary 1
• Recent systemic reactions: Would require dose reduction to previously tolerated levels 1
• High allergen exposure periods: During peak allergen seasons for highly sensitive patients, consider not increasing or even reducing the dose 1, 2

Practical Implementation

1. Administer 1.2 ml of the same concentration as the previous injection
2. Observe patient for at least 30 minutes after injection to monitor for any adverse reactions
3. Document the dose, patient's response, and any local or systemic reactions
4. Plan subsequent dose increases based on tolerance to the current dose

Common Pitfalls to Avoid

• Inconsistent increments: Erratic dose increases can increase risk of adverse reactions
• Failure to adjust for missed appointments: If the interval between injections is prolonged, dose reduction is typically necessary 1
• Ignoring seasonal factors: High allergen exposure periods may require more conservative dosing 2
• Overlooking patient-specific factors: Individual sensitivity and previous reaction history should inform dosing decisions 1

Following this systematic approach to allergen immunotherapy dosing helps maximize efficacy while maintaining patient safety.