Sublingual Serum Maintenance Log - 2x/Day
• Allergy drops do not need refrigeration but should not exceed room temperature
for an extended period of time.
• To ensure the correct quantity, count the drops of serum as you administer them
or count the drops onto a spoon and then take orally as directed.
• Before finishing the maintenance set, contact your provider to schedule
a follow-up appointment and order a refill.
• To achieve immune modulation, take drops every day FOR 4 YEARS.
Occasionally missing a day or two is acceptable but maintain a regular
schedule for best results — consistency is important.
Maintenance kit #________ of 15 in your four-year path to immune modulation.
M
Maintenance Phase
.......................... # of Drops
Day 1 am .......................... 3
Day 1 pm .......................... 3
Day 2 am .......................... 3
Day 2 pm .......................... 3
Day 3 am .......................... 3
Day 3 pm .......................... 3
Day 4 am .......................... 3
Day 4 pm .......................... 3
Day 5 am .......................... 3
Day 5 pm .......................... 3
Day 6 am .......................... 3
Day 6 pm .......................... 3
Day 7 am .......................... 3
Day 7 pm .......................... 3
Day 8 am .......................... 3
Day 8 pm .......................... 3
Day 9 am .......................... 3
Day 9 pm .......................... 3
Day 10 am ........................ 3
Day 10 pm ........................ 3
Day 11 am ........................ 3
Day 11 pm ........................ 3
Day 12 am ........................ 3
Day 12 pm ........................ 3
Day 13 am ........................ 3
Day 13 pm ........................ 3
Day 14 am ........................ 3
Day 14 pm ........................ 3
Day 15 am ........................ 3
Day 15 pm ........................ 3
Date
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Continue with 3 drops until finished
then proceed to new bottle.
M
Maintenance Phase
.......................... # of Drops
Day 16 am ........................ 3
Day 16 pm ........................ 3
Day 17 am ........................ 3
Day 17 pm ........................ 3
Day 18 am ........................ 3
Day 18 pm ........................ 3
Day 19 am ........................ 3
Day 19 pm ........................ 3
Day 20 am ........................ 3
Day 20 pm ........................ 3
Day 21 am ........................ 3
Day 21 pm ........................ 3
Day 22 am ........................ 3
Day 22 pm ........................ 3
Day 23 am ........................ 3
Day 23 pm ........................ 3
Day 24 am ........................ 3
Day 24 pm ........................ 3
Day 25 am ........................ 3
Day 25 pm ........................ 3
Day 26 am ........................ 3
Day 26 pm ........................ 3
Day 27 am ........................ 3
Day 27 pm ........................ 3
Day 28 am ........................ 3
Day 28 pm ........................ 3
Day 29 am ........................ 3
Day 29 pm ........................ 3
Day 30 am ........................ 3
Day 30 pm ........................ 3
Date
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Continue with 3 drops until finished then
proceed to new bottle. Call your provider
M
Maintenance Phase
............................. # of Drops
Day 31 am ........................ 3
Day 31 pm ........................ 3
Day 32 am ........................ 3
Day 32 pm ........................ 3
Day 33 am ........................ 3
Day 33 pm ........................ 3
Day 34 am ........................ 3
Day 34 pm ........................ 3
Day 35 am ........................ 3
Day 35 pm ........................ 3
Day 36 am ........................ 3
Day 36 pm ........................ 3
Day 37 am ........................ 3
Day 37 pm ........................ 3
Day 38 am ........................ 3
Day 38 pm ........................ 3
Day 39 am ........................ 3
Day 39 pm ........................ 3
Day 40 am ........................ 3
Day 40 pm ........................ 3
Day 41 am ........................ 3
Day 41 pm ........................ 3
Day 42 am ........................ 3
Day 42 pm ........................ 3
Day 43 am ........................ 3
Day 43 pm ........................ 3
Day 44 am ........................ 3
Day 44 pm ........................ 3
Day 45 am ........................ 3
Day 45 pm ........................ 3
Date
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Continue with 3 drops until finished
then proceed to new bottle.
for checkup and order your drops refill.
DMLE2X
©2011 AllerVision LLC, Scottsdale, AZ. All rights reserved.
Anaphylaxis Danger
Anaphylaxis, a severe allergic reaction, is exceedingly rare in patients treated with
sublingual immunotherapy (SLIT), but it is important that you become familiar
with the symptoms and proper response in case of emergency.
Anaphylaxis Symptoms
Anaphylaxis is a “systemic reaction,” which means that your body may be affected far
from the allergen’s entry site. Symptoms vary from mild to severe and may occur alone
or in any combination:
• SKIN: hives, swelling, itchiness, warmth, redness, rash
• BREATHING: wheezing, shortness of breath, throat tightness, cough,
hoarse voice, chest pain/tightness, nasal congestion/hay fever-like
symptoms, trouble swallowing
• STOMACH: nausea, pain/cramps, vomiting, diarrhea, itchy mouth/throat
• CIRCULATION: pale/blue color, poor pulse, passing-out, dizzy/lighheaded,
low blood pressure, shock
• OTHER: anxiety, feeling of “impending doom,” red/itchy/watery eyes,
severe headache, cramping of the uterus
Reactions may occur within minutes of exposure to an allergen, or they may be
delayed for hours. It is possible for symptoms to resolve briefly and recur or progress
hours later.
Anaphylaxis is a medical emergency that requires immediate treatment. If you
experience symptoms of anaphylaxis, use your Epinephrine Auto-Injector, and call
911 or have someone drive you to the nearest emergency room. You should review
the instructions that came with your Auto-Injector so you are prepared to use it if the
need ever arises.
When to Use Your Epinepherine Auto-Injector
Anaphylaxis Danger English and Spanish2.indd 1
4/3/11 4:40 PM