Most Care at Allergy Clinics Could Be Postponed During COVID-19

By Will Boggs MD

April 03, 2020

NEW YORK (Reuters Health) - Most allergy and immunology care could be postponed or handled virtually during the COVID-19 pandemic, according to consensus-based recommendations.

"We have to still care for our patients, but we need to be mindful of the evolving situation around us," Dr. Matthew Greenhawt of Children's Hospital Colorado, in Aurora, told Reuters Health by email. "The decision to reduce services is contextual, though many states have mandated nonessential ambulatory visits and procedures be stopped, and there are shelter-in-place orders in effect."

In an article in The Journal of Allergy and Clinical Immunology: In Practice, Dr. Greenhawt and an ad hoc expert panel of allergy/immunology specialists in the U.S. and Canada present a framework for temporarily triaging allergy/immunology services during the COVID-19 pandemic.

They note that many allergy/immunology services are elective and can be managed without face-to-face interaction or deferred outright for short periods of time.

Telehealth and other methods of virtual encounters can be useful for expanding services during the pandemic.

Face-to-face visits for evaluation and management of patients with allergic rhinitis can generally be postponed or made virtually, and, unless there is a critical acute nutritional need for introduction of a key nutrient, essentially all food challenges could be deferred. Visits for nonurgent allergic skin disorders could also be postponed or conducted via phone or telehealth.

Asthma and immunodeficiency are potential areas of service where face-to-face services may be necessary. Patients with high asthma severity risk or uncertain diagnosis may require evaluation and management in the clinic, with the potential availability of personal protective equipment when such patients present a high COVID-19 risk.

Telehealth should still be encouraged for some patients with immunodeficiency, but face-to-face care may be necessary for more serious illness and for continuation of systemic therapies.

In all cases, treatment options should consider patient values and preferences when determining the best management for a particular patient.

Practices should recognize several implications of COVID-19 reductions in service, including potential quarantines of staff and/or physicians, practice restrictions of physicians who develop COVID-19, financial losses resulting from declines in services, and staff layoffs or termination. These concerns, the experts say, are very real and valid and have no easy solutions.

"The key is to weigh the risk of the condition not being managed with the in-person service vs. their risk of potential COVID-19 exposure, illness, secondary spread, hospitalization, and fatality," Dr. Greenhawt said. "We need to be aware that our offices could be vectors of infection for our patients as we try to serve them. This is why it is important to recognize what has to continue to be seen in person, and what can perhaps be handled another way."

He added, "This article only offers suggestions for how to navigate a difficult and rapidly evolving public health crisis. Every clinician has to make their own decision. Some may feel differently about which services are more or less of a priority, and what to maintain. There is a subjective definition of 'essential,' and the decisions being made may work for one practice and may not work for another. The practicing allergist is autonomous, but also must account for local, regional, and national ordinances regarding necessary services."

SOURCE: The Journal of Allergy and Clinical Immunology: In Practice, online March 26, 2020.