The technique I prefer to teach is to grasp the skin with the thumb and middle finger and slightly lift the skin (Figure 4). Then place the index finger between the thumb and middle finger (Figure 5) to indent the fold of skin being held up so that it forms a Y or V shape (Figures 6 & 7). The needle should be inserted parallel or at up to a 30-degree angle from the plane of the back or neck (Figure 8). Insert the needle rapidly, and then press the plunger. Caution owners about not putting pressure on the plunger as they
insert the needle; instead they should wait to put a finger on and press the plunger until the needle is located subcutaneously.
To avoid plunger pressure, have clients hold the syringe like a dart and touch the plunger only after inserting the needle
through the skin (Figure 9). Also, they need to point directly to the center of the pocket because an angled direction may place the needle through
the fold, resulting in the solution being injected outside the skin.
Figure 4. Preparing to grasp the dog's skin with the thumb and middle finger.
Many clients are initially concerned about administering the injections and should practice this technique with a technician
or veterinarian present. To alleviate a pet's reluctance to allow the injections at home, the client should draw the solution
into the syringe and let the solution come to room temperature before giving the injection as well as train the pet that receiving
the injection is good. This training is especially helpful when owners are nervous about giving the injections, as the dogs
will often sense this apprehension. Training is accomplished by taking the vial from the refrigerator every day, acting as
if the allergen solution is being drawn up, positioning the dog and making a skin fold, touching the fold with a covered needle,
and then giving a reward. The client should give a real injection only every other day during the induction and less often
after that. Rewards should be given after the real injections as well. Many dogs can be trained to happily anticipate receiving
their injections instead of hiding when the refrigerator is opened. For some dogs it is best to only give treats or rewards
after the dog has sat still for a practice injection once or even several times a day. They are not given rewards at other
times on those days.
Figure 5. Slightly lift the skin, and then place the index finger between the thumb and middle finger.
MONITORING FOR REACTIONS
You must educate clients about what types of reactions they need to watch for. Clients should be able to observe their dogs
for the first 30 minutes and preferably one hour after each injection. Any reactions should be noted and communicated to the
Figure 6. Indent the fold of lifted skin so that it forms a Y or V shape.
Reactions that require contacting the veterinarian immediately include hives, facial swelling, vomiting, diarrhea, weakness,
or collapse. These last three problems may indicate anaphylaxis, a potentially life-threatening situation. In one study, anaphylaxis
was seen in only one of 185 dogs receiving allergen-specific immunotherapy.11 Usually dogs will exhibit less severe reactions with the injections preceding the development of anaphylaxis. One study
reported adverse reactions as early as Day 6 of therapy or as late as Day 142.12