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. 2021 Mar;76(3):648-676.
doi: 10.1111/all.14453.

COVID-19 pandemic: Practical considerations on the organization of an allergy clinic-An EAACI/ARIA Position Paper

Oliver Pfaar  1 , Ludger Klimek  2 , Marek Jutel  3 , Cezmi A Akdis  4 , Jean Bousquet  5   6   7 , Heimo Breiteneder  8 , Sharon Chinthrajah  9 , Zuzana Diamant  10   11   12 , Thomas Eiwegger  13   14   15 , Wytske J Fokkens  16 , Hans-Walter Fritsch  17 , Kari C Nadeau  9 , Robyn E O'Hehir  18   19 , Liam O'Mahony  20 , Winfried Rief  21 , Vanitha Sampath  9 , Manfred Schedlowski  22 , María José Torres  23 , Claudia Traidl-Hoffmann  24   25 , De Yun Wang  26 , Luo Zhang  27   28 , Matteo Bonini  29   30 , Randolf Brehler  31 , Helen Annaruth Brough  32   33 , Tomás Chivato  34 , Stefano R Del Giacco  35 , Stephanie Dramburg  36 , Radoslaw Gawlik  37 , Aslı Gelincik  38 , Karin Hoffmann-Sommergruber  8 , Valerie Hox  39 , Edward F Knol  40 , Antti Lauerma  41 , Paolo M Matricardi  36 , Charlotte G Mortz  42 , Markus Ollert  42   43 , Oscar Palomares  44 , Carmen Riggioni  45   46 , Jürgen Schwarze  47 , Isabel Skypala  30   48 , Eva Untersmayr  8 , Jolanta Walusiak-Skorupa  49 , Ignacio J Ansotegui  50 , Claus Bachert  51   52   53 , Anna Bedbrook  7 , Sinthia Bosnic-Anticevich  54 , Luisa Brussino  55 , Giorgio Walter Canonica  56 , Victoria Cardona  57 , Pedro Carreiro-Martins  58   59 , Alvaro A Cruz  60   61 , Wienczyslawa Czarlewski  7   62 , João A Fonseca  63   64 , Maia Gotua  65   66 , Tari Haahtela  67 , Juan Carlos Ivancevich  68 , Piotr Kuna  69 , Violeta Kvedariene  70   71 , Désirée Erlinda Larenas-Linnemann  72 , Amir Hamzah Abdul Latiff  73 , Mika Mäkelä  67 , Mário Morais-Almeida  74 , Joaquim Mullol  75 , Robert Naclerio  76 , Ken Ohta  77 , Yoshitaka Okamoto  78 , Gabrielle L Onorato  7 , Nikolaos G Papadopoulos  79   80 , Vincenzo Patella  81 , Frederico S Regateiro  82   83   84 , Bolesław Samoliński  85 , Charlotte Suppli Ulrik  86   87 , Sanna Toppila-Salmi  67 , Arunas Valiulis  88 , Maria-Teresa Ventura  89 , Arzu Yorgancioglu  90 , Torsten Zuberbier  5 , Ioana Agache  91   92
Affiliations

COVID-19 pandemic: Practical considerations on the organization of an allergy clinic-An EAACI/ARIA Position Paper

Oliver Pfaar et al. Allergy. 2021 Mar.

Abstract

Background: The coronavirus disease 2019 (COVID-19) has evolved into a pandemic infectious disease transmitted by the severe acute respiratory syndrome coronavirus (SARS-CoV-2). Allergists and other healthcare providers (HCPs) in the field of allergies and associated airway diseases are on the front line, taking care of patients potentially infected with SARS-CoV-2. Hence, strategies and practices to minimize risks of infection for both HCPs and treated patients have to be developed and followed by allergy clinics.

Method: The scientific information on COVID-19 was analysed by a literature search in MEDLINE, PubMed, the National and International Guidelines from the European Academy of Allergy and Clinical Immunology (EAACI), the Cochrane Library, and the internet.

Results: Based on the diagnostic and treatment standards developed by EAACI, on international information regarding COVID-19, on guidelines of the World Health Organization (WHO) and other international organizations, and on previous experience, a panel of experts including clinicians, psychologists, IT experts, and basic scientists along with EAACI and the "Allergic Rhinitis and its Impact on Asthma (ARIA)" initiative have developed recommendations for the optimal management of allergy clinics during the current COVID-19 pandemic. These recommendations are grouped into nine sections on different relevant aspects for the care of patients with allergies.

Conclusions: This international Position Paper provides recommendations on operational plans and procedures to maintain high standards in the daily clinical care of allergic patients while ensuring the necessary safety measures in the current COVID-19 pandemic.

Keywords: COVID-19; Position Paper; SARS-CoV-2; allergen immunotherapy; allergy clinic; anaphylaxis; asthma; clinical trials; psychological impact.

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Conflict of interest statement

Dr Agache reports grants from Associate Editor Allergy. Dr Akdis reports grants from Allergopharma, Idorsia, Swiss National Science Foundation, Christine Kühne‐Center for Allergy Research and Education, European Commission's Horizon's 2020 Framework Programme, Cure, Novartis Research Institutes, AstraZeneca and Scibase, and plays advisory role in Sanofi/Regeneron, outside the submitted work. Dr Ansotegui reports personal fees from Mundipharma, ROXALL, Sanofi, MSD, Faes Farma, Hikma, UCB, AstraZeneca, Stallergenes and Abbott, outside the submitted work. Dr Bosnic Anticevich reports grants from TEVA, and personal fees from TEVA, AstraZeneca, Boehringer Ingelheim, GSK, Sanofi and Mylan, outside the submitted work. Dr Bousquet reports personal fees from Chiesi, Cipla, Hikma, Menarini, Mundipharma, Mylan, Novartis, Purina, Sanofi‐Aventis, Takeda, Teva and Uriach, and other from KYomed INNOV, outside the submitted work. Dr Brehler reports personal fees from ALK, Allergopharma, AstraZeneca, Bancard, GSK, HAL, LETI, Merck, Novartis, Stallergenes, Takeda, Thermo Fischer and Novartis, and other from ALK, Allergopharma, Novartis, Takeda, Bencard, Biotech Tools, Circassia, Genentech and LETI, outside the submitted work. Dr Brough reports speaker fees from DBV Technologies and Sanofi and research support from Thermo Fisher Scientific. Dr Canonica reports having received research grants as well as being lecturer or having received advisory board fees from A.Menarini, Alk‐Abello’, Allergy Therapeutics, AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, Genentech, Guidotti‐Malesci, Glaxo Smith Kline, Hal Allergy, Mylan, Merck, Merck Sharp & Dome, Mundipharma, Novartis, Regeneron, Roche, Sanofi‐Aventis, Sanofi‐Genzyme, Stallergenes‐Greer, UCB Pharma, Uriach Pharma, Valeas, Vibor‐Pharma. Dr Cardona reports personal fees from ALK, Allergopharma, Allergy Therapeutics, Diater, LETI, Thermo Fisher and Stallergenes, outside the submitted work. Dr Chinthrajah reports grants from NIAID, CoFAR, Aimmune, DBV Technologies, Astellas and Regeneron, other from Alladapt, Genentech and Novartis, and personal fees from Before Brands, outside the submitted work. Dr Cruz reports grants and personal fees from GSK, AstraZeneca, Boehringer Ingelheim, Novartis and MYLAN, grants from Sanofi, and nonfinancial support from CHIESI, outside the submitted work. Dr del Giacco reports personal fees from AstraZeneca, Chiesi, CSL‐Behring, Grifols and Menarini; and grants and personal fees from GSK and Novartis, outside the submitted work. Apart from academic affiliations and assignments, Dr Diamant acts as Executive and Scientific Medical Director at a phase I/II pharmacological unit (QPS‐NL), which performs clinical studies for pharmaceutical companies. In the past 3 years, she received honoraria, consultancy and speaker fees from AcuCort, AstraZeneca, ALK, Aquilon, Boehringer Ingelheim, CSL, HAL Allergy, MSD and Sanofi Genzyme. Dr Eiwegger reports other from DBV and Regeneron; and grants from Innovation fund Denmark, CIHR. He is the Co‐I or scientific lead in three investigator‐initiated oral immunotherapy trials including the usage of biologicals supported by the Allergy and Anaphylaxis Program SickKids and CIHR. He serves as an associate editor for Allergy. He is on advisory boards for ALK. Dr Hox reports personal fees from consultant work for ALK, outside the submitted work. Dr Knol reports speaker fees from Sanofi and Thermo Fisher Scientific. Dr Ivancevich reports personal fees from Faes Farma, Abbott Colombia and Eurofarma Argentina, and other from Laboratory Casasco Argentina, outside the submitted work. Dr Jutel reports personal fees from ALK‐Abello, Allergopharma, Stallergenes, Anergis, Allergy Therapeutics, Circassia, LETI, Biomay and HAL, during the conduct of the study; and from AstraZeneca, GSK, Novartis, Teva, Vectura, UCB, Takeda, Roche, Janssen, MedImmune and Chiesi, outside the submitted work. Dr Klimek reports grants and personal fees from Allergopharma, MEDA/Mylan, LETIPharma and Sanofi; and from HAL Allergie and Allergy Therapeut.; grants from ALK Abelló, AstraZeneca, GSK, Inmunotek, Stallergenes, Quintiles, ASIT Biotech and Lofarma, outside the submitted work; and is member of AeDA, DGHNO, Deutsche Akademie fürAllergologie und Klinische Immunologie, HNO‐BV, GPA, and EAACI. Dr Larenas‐Linnemann reports personal fees from Allakos, Armstrong, AstraZeneca, Boehringer Ingelheim, Chiesi, DBV Technologies, Grunenthal, GSK, MEDA, Menarini, MSD, Novartis, Pfizer, Novartis, Sanofi, Siegfried, UCB and Gossamer, and grants from Sanofi, AstraZeneca, Novartis, UCB, GSK, TEVA, Boehringer Ingelheim, Chiesi and Purina institute, outside the submitted work. Dr Mortz reports grants from Novartis, outside the submitted work. Dr Naclerio reports personal fees from Sanofi, Regeneron, GSK, AstraZeneca, American Chemistry Council, Lyra and TASC, outside the submitted work. Dr Nadeau reports grants and other from NIAID, FARE, Novartis, AnaptysBio, Adare Pharmaceuticals, Stallergenes Greer, NHLBI, NIEHS, EPA, WAO Center of Excellence, IgGenix, ProBio, Vedanta, Centocor, Seed, Immune Tolerance Network, NIH, Sanofi, Astellas, Nestle, Before Brands, Alladapt, Fortra, Genentech, Aimmune Therapeutics and DBV Technologies; personal fees and other from Regeneron; grants from EAT, AllerGenis and Ukko Pharma; and personal fees from AstraZeneca, ImmuneWorks and Cour Pharmaceuticals, outside the submitted work; in addition, Dr Nadeau has a patent inhibition of allergic reaction to peanut allergen using an IL‐33 Inhibitor pending, a patent Special Oral Formula for Decreasing Food Allergy Risk and Treatment for Food Allergy pending, a patent Basophil Activation‐Based Diagnostic Allergy Test pending, a patent Granulocyte‐based methods for detecting and monitoring immune system disorders pending, a patent Methods and Assays for Detecting and Quantifying Pure Subpopulations of White Blood Cells in Immune System Disorders pending, a patent Mixed Allergen Compositions and Methods for Using the Same pending and a patent Microfluidic Device and Diagnostic Methods for Allergy Testing Based on Detection of Basophil Activation pending. Dr O'Mahony reports personal fees from AHL, and grants from GSK, outside the submitted work. Dr Palomares received research grants from Inmunotek SL and Novartis and has received fees for giving scientific lectures from Allergy Therapeutics, Amgen, AstraZeneca, Diater, GlaxoSmithKline, S.A, Inmunotek S.L, Novartis, Sanofi Genzyme and Stallergenes and participated in advisory boards from Novartis and Sanofi Genzyme. Dr Schwarze reports speakers fees from MYLAN, personal fees from F2F events, outside the submitted work; and Industry support to educational activities of the Scottish Allergy and Respiratory Academy and of the Children's and Young people's Allergy Networtk Scotland. Industry support to EAACI, he is EAACI Secretary General 2019‐2021. Dr Papadopoulos reports personal fees from Novartis, Nutricia, HAL, Menarini/Faes Farma, Sanofi, Mylan/MEDA, Biomay, AstraZeneca, GSK, MSD, ASIT Biotech and Boehringer Ingelheim, and grants from Gerolymatos International SA, Capricare, outside the submitted work. Dr Pfaar reports grants and personal fees from ALK‐Abelló, Allergopharma, Stallergenes Greer, HAL Allergy Holding BV/HAL Allergie GmbH, Bencard Allergie GmbH/Allergy Therapeutics, Lofarma, ASIT Biotech Tools SA, Laboratorios LETI/LETIPharma, MEDA Pharma/MYLAN and Anergis SA, grants from Biomay, Circassia and GlaxoSmith Kline; personal fees from Mobile Chamber Experts (a GA2LEN Partner), Indoor Biotechnologies, Astellas Pharma Global, EUFOREA, ROXALL, Novartis, Sanofi‐Aventis, Med Update Europe GmbH, streamedup! and GmbH, outside the submitted work. Dr Regateiro reports personal fees from AstraZeneca, Novartis, Lusomedicamenta, Sanofi and GSK, outside the submitted work. Dr Toppila‐Salmi reports personal fees from Roche, personal fees from Novartis, personal fees from ERT, personal fees from Sanofi, grants from GSK, outside the submitted work. Dr Torres reports grants from the Spanish and Andalusian Ministry of Health, Horizon 2020, Diater, ALK‐Abello, Astra‐Zeneca, GSK and Leti. Dr. Torres reports grants from the Spanish and Andalusian Ministry of Health, Horizon 2020, Diater, ALK‐Abello, Astra‐Zeneca, GSK and Leti. Dr Traidl‐Hoffmann reports grants and personal fees from Töpfer GmbH and Danone Nutricia, personal fees from Sanofi, La Roche‐Posay, Lilly Pharma and Novartis, and grants from Sebapharma and Thermo Fischer, outside the submitted work. Dr Zuberbier reports grants from Organizational affiliations: Committee member: WHO‐Initiative "Allergic Rhinitis and Its Impact on Asthma" (ARIA); Member of the Board: German Society for Allergy and Clinical Immunology (DGAKI); Head: European Centre for Allergy Research Foundation (ECARF); President: Global Allergy and Asthma European Network (GA2LEN); and Member: Committee on Allergy Diagnosis and Molecular Allergology, World Allergy Organization (WAO). The remaining authors have nothing to declare.

Figures

FIGURE 1
FIGURE 1
Proposed criteria for in‐person consultation of allergic patients. These recommendations should be considered as general guidelines that always need to be adapted to suit the needs of individual patients, the capabilities of the facility itself and must comply with the relevant and current rules from the responsibility government agency. ACT, asthma control test; AD, atopic dermatitis; ARIA, Allergic Rhinitis and its Impact on Asthma; AR, allergic rhinitis; CRS, chronic rhinosinusitis; EOE, eosinophilic esophagitis; EPIT, epicutaneous immunotherapy; PEF, peak expiratory flow; OIT, oral immunotherapy; SCIT, subcutaneous AIT
FIGURE 2
FIGURE 2
Remote communication between the HCP and the patient. EHR, electronic health record
FIGURE 3
FIGURE 3
General diagnostic measures in post–COVID‐19 routine care. The decision on the diagnostic tests or additional laboratories before restarting allergy care should be based on individual patients and/or interdisciplinary consultation.
FIGURE 4
FIGURE 4
Ensuring data integrity in non‐COVID‐19–related research
See this image and copyright information in PMC

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