213-740-9355 (WELL) One number. 24/7. Serving students on two campuses. Including all services:
Patient Guide to
Treating Allergies
COUNSELING AND MENTAL HEALTH SERVICES, a division of the Department of Psychiatry and Behavioral Sciences, Keck School of Medicine of USC MEDICAL SERVICES, with providers on clinical faculty of the Departments of Family Medicine, Obstetrics and Gynecology, Dermatology, Orthopaedic Surgery, Keck School of Medicine of USC; and professional affiliations with the USC Chan Division of Occupational Science and Occupational Therapy, the USC School of Pharmacy, and the Division of Physical Therapy and Biokinesiology. RELATIONSHIP AND SEXUAL VIOLENCE PREVENTION AND SERVICES, with counselors who are clinical faculty of the Department of Psychiatry and Behavioral Sciences, Keck School of Medicine of USC A NURSE (for medical concerns) or licensed counselor (for mental health concerns) is available 24 hours a day, even when the student health centers are closed and during university closures.
Did You Know?
About accessing care: • Students in crisis may walk-in for urgent mental health services at the health centers (Engemann Student Health Center on UPC or Eric Cohen Student Health Center at HSC) during operational hours without an appointment; this may include urgent matters involving a death in the family, suicide concern, crime/sexual assault survivor counseling, or other high-risk matters. • Urgent “sick” appointments for medical care are available “same-day” for students needing care during operational hours. • The evening operators of the 24/7 phone service line can connect to USC Student Health services when an urgent matter presents itself. • Sexual assault survivors requiring transportation to a SART center can ask RSVP to call a Lyft ride (24/7 “on-call” staff advocates can accompany survivors). • MySHR (the student health record portal) shows all available regular appointment times; many appointments can be made within 24-48 hours. • Campus incident post-ventions are regularly provided by Counseling and Mental Health Services on campus for students; departments are encouraged to contact us to learn more or to make arrangements.
Sept 2019
SH_allergy_cover_r2.indd 1
2/3/20 1:15 PM
Overview Asthma and allergies affect millions of people and some don’t even know it. If you sometimes have trouble taking a good deep breath, cough at night or have a stuffy or runny nose and itchy eyes, you may be affected by environmental allergies to Allergy symptoms occur when your immune system overreacts to an allergen—something that usually is harmless, such as plant pollen, dust mites, molds, insect stings or food. Effective treatment of allergic asthma includes identifying and avoiding allergens that trigger symptoms, using drug therapies and developing an emergency action plan for severe attacks. If you think you might have allergies, make an appointment to see a health care provider.
Allergy Treatment at USC Student Health
New patient evaluation/treatment: If you would like to be evaluated by an allergist at USC Student Health, first schedule a primary care appointment to obtain a referral to see an allergy specialist. Once the referral is obtained, schedule an appointment visit with the allergist. During the initial consultation, the allergist will evaluate you and provide you with a personalized allergy management program. This treatment plan may include allergy skin testing and patch testing (lab/test fees may apply).
Transferring a Treatment Protocol
Continuing care from your private health care provider: If you already have an existing treatment plan supervised by an allergist, you can continue that series of treatments while attending USC, under the supervision of USC Student Health in the immunization office. The USC Student Health allergy clinic program is managed under the supervision of our consulting allergist. Our goal is to maintain a desensitization program for students who have been in a continuing program through their private health care provider. Whenever possible, and in accordance with our policies, all students will be admitted and maintained in our program. You must have an initial consultation with the allergist at USC Student Health prior to continuing your treatment.
Next Steps
1. Request that your private health care provider complete the form titled “Allergy Desensitization Injection Program; Onset of Immunotherapy” (both pages) and submit it to the health center immunizations office. Mail/fax/hand-deliver to immunizations office. 2. Have your allergy serum(s) sent to the health center (Engemann at UPC) immunizations office. Shipped or hand-delivered to the immunizations office. 1031 West 34th St. Immunizations, Room 145 Los Angeles, CA 90089 Clinic Fax #: 213-821-2740 3. Call USC Student Health at (213) 740-9355 (WELL) to ensure that your “Onset of Immunotherapy Form” and serum(s) were received. 4. Complete the “Allergy Desensitization Program Criteria Information Sheet.” 5. Upon confirmation that your form and serum(s) were received, schedule an appointment with a health center allergist. After your consultation with the allergist, regular follow-up appointments will need to be scheduled.
Notes for Patients
• Patients are required to remain at the health center for 30 minutes after receiving allergy injection(s) to monitor reactions. • Medical services provided are covered by the USC Student Health Fee; separate lab/test fees may apply for individual treatment plans. Current fee list is available in the footer of the USC Student Health website.
See next section for instructions on completing required forms, and making arrangements for serums.
Make an appointment through MySHR at studenthealth.usc.edu Call 213-740-9355 (WELL) for 24/7 assistance
SH_allergy_cover_r2.indd 2
Make an appointment through MySHR at studenthealth.usc.edu Call 213-740-9355 (WELL) for 24/7 assistance
2/3/20 1:15 PM
213-740-9355 (WELL) • studenthealth.usc.edu
Allergy/Immunization Clinic
Allergy Desensitization Injection Program Dear Health Care Provider, Your patient is requesting transfer and continuation of his/her allergy desensitization injection program to the Engemann Student Health Center while he/she attends the University of Southern California (USC). The program is managed under the supervision of our Consulting Allergist. Our goal is to maintain an allergy desensitization program for students who are in a continuing program through their private allergist. Our intent is to follow the prescribing physician’s orders and schedule to the extent that they fall within our guidelines. These guidelines will take precedence if any aspect of the student’s desensitization program is ambiguous or in conflict with our procedures and policies. Please submit: □ 1. A Full Build Schedule showing Starting Dose through Maintenance Dose □ 2. Missed Dose Adjustment Protocol for both Building and Maintenance Schedules □ 3. Injection Record over past 3-6 months □ 4. Completed “Onset of Immunotherapy” form on the reverse Note: Any missing information may lead to a delay in injection administration. All antigen vials must have the following information printed legibly on their labels: 1. Patient’s name & DOB 2. Expiration date 3. Dilution or concentration (e.g., 1:1000, 500 BAU, etc.) 4. Contents (i.e., tree mix, environmentals, etc.) After receiving the above information, an appointment will be made for the student to be evaluated by our Consulting Allergist. Thank you for assisting us in providing continuity of care to our mutual patient.
to be completed by student’s physician
SH_allergy_forms_r2.indd 1
2/3/20 1:16 PM
Patient Label 213-740-9355 (WELL) • studenthealth.usc.edu
Allergy/Immunization Clinic
Onset of Immunotherapy Name: USC ID #:
Date of Birth: (MM/DD/YY)
PATIENT INFORMATION Has your patient exhibited systemic reactions on the present treatment program? □ Yes □ No If yes, please describe:
Is patient on a beta-blocker? □ Yes □ No Please list all medications:
Additional Information and/or special instructions:
OFFICE CONTACT Name:
Best time to be reached:
Telephone #:
Physician Telephone:
Physician’s Name: (please print)
Physician Fax:
Office Address: Physician Signature:
Date: (MM/DD/YY)
Note: We will not be able to administer allergy shots to your patient unless all of the above information is completed in full and signed by the physician. Thank you. to be completed by student’s physician
SH_allergy_forms_r2.indd 2
2/3/20 1:16 PM
Patient Label 213-740-9355 (WELL) • studenthealth.usc.edu
Allergy/Immunization Clinic
Allergy Desensitization Program Criteria Agreement Name:
USC ID #:
1. The “Student Health Fee” must be paid prior to receiving allergy treatment. An additional fee will be assessed for allergy injections. 2. Patients requesting to continue on their established injection program at USC must have their private physician complete the enclosed USC Student Health Services Allergy History and Therapy Form and submit it to the USC Allergy Clinic Nurse prior to their first scheduled appointment. 3. Student agrees and signs the Criteria Information Sheet which will be provided at their first visit. 4. Patient agrees to see the consulting Allergist for a review and discussion of their records prior to receiving injections from the Allergy Clinic Nurse. 5. The patient will assume full responsibility for contacting their private allergist and making appropriate arrangements for shipment of antigens. All extracts MUST be labeled with the following information: • Name of the Patient • Contents • Concentration • Expiration Date 6. The patient assumes responsibility for picking up antigens when leaving for vacation and or at the end of the school year. If patient receives injections elsewhere during their vacation, the patient agrees to bring a copy of those records to the USC Allergy Clinic Nurse, upon their return. 7. If antigens are abandoned (not picked-up) after their expiration date, the USC Allergy Clinic Nurse may discard them without contacting the patient. 8. The administration of allergy injections is dependent on the discretion of the consulting Allergist and the Allergy Clinic Nurse. Allergy injections MAY NOT be given if the following occurs: • Antigen has expired • Antigens are improperly labeled • Patient has had a systemic or large local reaction. (Patient must see the consulting Allergist prior to resuming injections.) • Illness (discuss with the Allergy Clinic Nurse) • Time lapse has occurred in the injection schedule (3 or more occurrences) • Breach of the ESHC’s policies and procedures • Patient has not been initially reviewed by the consulting Allergist. 9. Patient agrees to the following procedures when receiving an allergy injection: • Patient agrees to adhere to the designated office hours for the Allergy/Immunization Clinic. • Patient agrees to wait 30 minutes upon receiving their allergy injection, and to have the site checked prior to leaving the clinic. • Patient will notify the Allergy Clinic Nurse if there is any concern of a reaction (e.g., trouble breathing, dizziness). • Patient agrees that if late for routine shots for 2 months or greater the USC Allergy Clinic may not be able to continue allergy shots. • Patient agrees to receive epinephrine or other indicated treatment in the event of an allergic reaction 10.Patient will notify Allergy Clinic Nurse if placed on Beta Blocker medications (medication for high blood pressure, heart conditions or eye problems). 11. Female Patients: If you are pregnant, suspect you might be pregnant or are trying to become pregnant, please notify the Allergy Clinic Nurse. Signature:
Date: to be completed by student