COVID-19: Pandemic Contingency Planning for the Allergy and Immunology Clinic

Marcus S Shaker¹, John Oppenheimer², Mitchell Grayson³, David Stukus³, Nicholas Hartog⁴, Elena W Y Hsieh⁵, Nicholas Rider⁶, Cullen M Dutmer⁵, Timothy K Vander Leek⁷, Harold Kim⁸, Edmond S Chan⁹, Doug Mack¹⁰, Anne K Ellis¹¹, David Lang¹², Jay Lieberman¹³, David Fleischer⁵, David B K Golden¹⁴, Dana Wallace¹⁵, Jay Portnoy¹⁶, Giselle Mosnaim¹⁷, Matthew Greenhawt¹⁸

Affiliations

¹ Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, NH; Dartmouth Geisel School of Medicine, Hanover, NH.
² UMDMJ Rutgers University School of Medicine, Newark, NJ.
³ Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio.
⁴ Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Mich.
⁵ Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
⁶ The Texas Children's Hospital, Section of Immunology, Allergy, and Retrovirology and the Baylor College of Medicine, Houston, Texas.
⁷ Pediatric Allergy and Asthma, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
⁸ Western University and McMaster University, London, ON, Canada.
⁹ BC Children's Hospital, The University of British Columbia, Vancouver, BC, Canada.
¹⁰ McMaster University, Hamilton, ON, Canada; Halton Pediatric Allergy, Burlington, ON, Canada.
¹¹ Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada.
¹² Department of Medicine, Section of Allergy and Immunology, Cleveland Clinic, Cleveland, Ohio.
¹³ Division of Allergy and Immunology, The University of Tennessee, Memphis, Tenn.
¹⁴ Division of Allergy and Clinical Immunology, John Hopkins University School of Medicine, Baltimore, Md.
¹⁵ Nova Southeastern University College of Allopathic Medicine, Fort Lauderdale, Fla.
¹⁶ Children's Mercy, University of Missouri-Kansas City School of Medicine, Kansas City, Mo.
¹⁷ Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill.
¹⁸ Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo. Electronic address: Matthew.Greenhawt@childrenscolorado.org.

PMID: 32224232
PMCID: PMC7195089
DOI: 10.1016/j.jaip.2020.03.012

Review

COVID-19: Pandemic Contingency Planning for the Allergy and Immunology Clinic

Marcus S Shaker et al. J Allergy Clin Immunol Pract. 2020 May.

. 2020 May;8(5):1477-1488.e5.

doi: 10.1016/j.jaip.2020.03.012. Epub 2020 Mar 26.

Authors

Affiliations

¹ Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, NH; Dartmouth Geisel School of Medicine, Hanover, NH.
² UMDMJ Rutgers University School of Medicine, Newark, NJ.
³ Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio.
⁴ Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Mich.
⁵ Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
⁶ The Texas Children's Hospital, Section of Immunology, Allergy, and Retrovirology and the Baylor College of Medicine, Houston, Texas.
⁷ Pediatric Allergy and Asthma, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
⁸ Western University and McMaster University, London, ON, Canada.
⁹ BC Children's Hospital, The University of British Columbia, Vancouver, BC, Canada.
¹⁰ McMaster University, Hamilton, ON, Canada; Halton Pediatric Allergy, Burlington, ON, Canada.
¹¹ Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada.
¹² Department of Medicine, Section of Allergy and Immunology, Cleveland Clinic, Cleveland, Ohio.
¹³ Division of Allergy and Immunology, The University of Tennessee, Memphis, Tenn.
¹⁴ Division of Allergy and Clinical Immunology, John Hopkins University School of Medicine, Baltimore, Md.
¹⁵ Nova Southeastern University College of Allopathic Medicine, Fort Lauderdale, Fla.
¹⁶ Children's Mercy, University of Missouri-Kansas City School of Medicine, Kansas City, Mo.
¹⁷ Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill.
¹⁸ Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo. Electronic address: Matthew.Greenhawt@childrenscolorado.org.

PMID: 32224232
PMCID: PMC7195089
DOI: 10.1016/j.jaip.2020.03.012

Abstract

In the event of a global infectious pandemic, drastic measures may be needed that limit or require adjustment of ambulatory allergy services. However, no rationale for how to prioritize service shut down and patient care exists. A consensus-based ad-hoc expert panel of allergy/immunology specialists from the United States and Canada developed a service and patient prioritization schematic to temporarily triage allergy/immunology services. Recommendations and feedback were developed iteratively, using an adapted modified Delphi methodology to achieve consensus. During the ongoing pandemic while social distancing is being encouraged, most allergy/immunology care could be postponed/delayed or handled through virtual care. With the exception of many patients with primary immunodeficiency, patients on venom immunotherapy, and patients with asthma of a certain severity, there is limited need for face-to-face visits under such conditions. These suggestions are intended to help provide a logical approach to quickly adjust service to mitigate risk to both medical staff and patients. Importantly, individual community circumstances may be unique and require contextual consideration. The decision to enact any of these measures rests with the judgment of each clinician and individual health care system. Pandemics are unanticipated, and enforced social distancing/quarantining is highly unusual. This expert panel consensus document offers a prioritization rational to help guide decision making when such situations arise and an allergist/immunologist is forced to reduce services or makes the decision on his or her own to do so.

Keywords: Allergic rhinitis; Allergy; Allergy immunotherapy; Angioedema; Asthma; Atopic dermatitis; COVID-19; Food allergy; Primary immunodeficiency; SARS-CoV-2; Urticaria; Venom allergy.

PubMed Disclaimer

Figures

**Figure 1**
Theoretic model of pandemic caseload vs health care infrastructure capacity.

**Figure 2**
Proposed paradigm of pandemic threat levels affecting normal allergy/immunology.

**Figure 3**
Triage approach to the patient with an asthma exacerbation during a pandemic. *PPE*, Personal protective equipment.

See this image and copyright information in PMC

Comment in

JACI: In Practice Response to COVID-19 Pandemic.
Angel DM, Zeiger RS, Sicherer SH, Khan DA, Schatz M. Angel DM, et al. J Allergy Clin Immunol Pract. 2020 May;8(5):1475-1476. doi: 10.1016/j.jaip.2020.03.027. Epub 2020 Apr 6. J Allergy Clin Immunol Pract. 2020. PMID: 32272283 Free PMC article. No abstract available.
Subcutaneous terbutaline as an alternative to aerosolized albuterol.
Strauss RA. Strauss RA. J Allergy Clin Immunol Pract. 2020 Jul-Aug;8(7):2450. doi: 10.1016/j.jaip.2020.04.015. Epub 2020 Apr 20. J Allergy Clin Immunol Pract. 2020. PMID: 32336646 Free PMC article. No abstract available.
Reply to "Subcutaneous terbutaline as an alternative to aerosolized albuterol".
Shaker MS, Oppenheimer J, Grayson M, Stukus D, Hartog N, Hsieh EWY, Rider N, Dutmer CM, Vander Leek TK, Kim H, Chan ES, Mack D, Ellis AK, Lang D, Lieberman J, Fleischer D, Golden DBK, Wallace D, Portnoy J, Mosnaim G, Greenhawt M. Shaker MS, et al. J Allergy Clin Immunol Pract. 2020 Jul-Aug;8(7):2450-2452. doi: 10.1016/j.jaip.2020.04.016. Epub 2020 Apr 22. J Allergy Clin Immunol Pract. 2020. PMID: 32340824 Free PMC article. No abstract available.
Debate on drugs that may aggravate COVID-19.
Giavina-Bianchi P, Aun MV, Agondi RC, Kalil J. Giavina-Bianchi P, et al. J Allergy Clin Immunol Pract. 2020 Jul-Aug;8(7):2452-2453. doi: 10.1016/j.jaip.2020.04.037. Epub 2020 Apr 25. J Allergy Clin Immunol Pract. 2020. PMID: 32344190 Free PMC article. No abstract available.
CORONAVIRUS (COVID-19) PANDEMIC: PERSONAL VIEW TO A NEW MODEL OF PAEDIATRIC PRACTICE.
Barsoum Z. Barsoum Z. J Paediatr Child Health. 2020 Jun;56(6):995. doi: 10.1111/jpc.14958. J Paediatr Child Health. 2020. PMID: 32567773 Free PMC article. No abstract available.
Real-life experience of an allergy and clinical immunology department in a Portuguese reference COVID-19 hospital.
Carneiro-Leão L, Amaral L, Coimbra A, Plácido JL. Carneiro-Leão L, et al. J Allergy Clin Immunol Pract. 2020 Nov-Dec;8(10):3671-3672. doi: 10.1016/j.jaip.2020.08.042. Epub 2020 Sep 2. J Allergy Clin Immunol Pract. 2020. PMID: 32890757 Free PMC article. No abstract available.
What a Dime Can Buy You.
Lang DM. Lang DM. J Allergy Clin Immunol Pract. 2021 Jul;9(7):2669-2671. doi: 10.1016/j.jaip.2021.04.032. Epub 2021 Apr 26. J Allergy Clin Immunol Pract. 2021. PMID: 33915309 No abstract available.

References

1. Del Rio C., Malani P.N. COVID-19—new insights on a rapidly changing epidemic. JAMA. 2020;323:1339–1340. - PubMed
1. Centers for Disease Control and Prevention Coronaviurs disease 2019 (COVID-19) situation summary. https://www.cdc.gov/coronavirus/2019-ncov/index.html Available from:
1. Novel Coronaviurs Information Center https://www.elsevier.com/connect/coronavirus-information-center Available from:
1. Coronavirus COVID-19 global cases by the Center for Systems Science and Engineering at Johns Hopkins University. https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594... Available from:
1. Bai Y., Yao L., Wei T., Tian F., Jin D.Y., Chen L., et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA. 2020;323:1406–1407. - PMC - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

LinkOut - more resources

Full Text Sources
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

COVID-19: Pandemic Contingency Planning for the Allergy and Immunology Clinic

Affiliations

COVID-19: Pandemic Contingency Planning for the Allergy and Immunology Clinic

Authors

Affiliations

Abstract

Figures

Comment in

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous