Allergy Services Research Articles

Global assessment of the knowledge and confidence in managing allergic disorders among primary care pediatricians across Europe: An EAACI task force report.

Pediatricians are often the first point of contact for children in Primary Care (PC), but still perceive gaps in their allergy knowledge. We investigated self-perceived knowledge gaps and educational needs in pediatricians across healthcare systems in Europe so that future educational initiatives may better support the delivery of allergy services in PC. A multinational survey was circulated to pediatricians who care for children and adolescents with allergy problems in PC by the EAACI Allergy Educational Needs in Primary Care Pediatricians Task Force from February to March 2023. A 5-point Likert scale was used to assess the level of agreement with questionnaire statements. Thirty surveys per country were the cut-off for inclusion and statistical analysis. In this study, 1991 respondents were obtained from 56 countries across Europe and 210 responses were from countries with a cut-off below 30 participants per country. Primary care pediatricians (PCPs) comprised 74.4% of the respondents. The majority (65.3%) were contracted to state or district health services. 61.7% had awareness of guidelines for onward allergy referral in their countries but only 22.3% were aware of the EAACI competencies document for allied health professionals for allergy. Total sample respondents versus PCPs showed 52% and 47% of them have access to allergy investigations in their PC facility (mainly specific IgE and skin prick tests); 67.6% and 58.9% have access to immunotherapy, respectively. The main barrier to referral to a specialist was a consideration that the patient's condition could be diagnosed and treated in this PC facility, (57.8% and 63.6% respectively). The main reasons for referral were the need for hospital assessment, and partial response to first-line treatment (55.4% and 59.2%, 47% and 50.7%, respectively). Learning and assessment methods preference was fairly equally divided between Traditional methods (45.7% and 50.1% respectively) and e-learning 45.5% and 44.9%, respectively. Generalist physicians (GPs) have the poorest access to allergy investigations (32.7%, p = .000). The majority of the total sample (91.9%) assess patients with allergic pathology. 868 (43.6%) and 1117 (46.1%), received allergy training as undergraduates and postgraduates respectively [these proportions in PCPs were higher (45% and 59%), respectively]. PCPs with a special interest in allergology experienced greater exposure to allergy teaching as postgraduates. GPs received the largest amount of allergy teaching as undergraduates. Identifying allergic disease based on clinical presentation, respondents felt most confident in the management of eczema/atopic dermatitis (87.4%) and rhinitis/asthma (86.2%), and least confident in allergen immunotherapy (36.9%) and latex allergy (30.8%). This study exploring the confidence of PCPs to diagnose, manage, and refer patients with allergies, demonstrated knowledge gaps and educational needs for allergy clinical practice. It detects areas in need of urgent improvement especially in latex and allergen immunotherapy. It is important to ensure the dissemination of allergy guidelines and supporting EAACI documents since the majority of PCPs lack awareness of them. This survey has enabled us to identify what the educational priorities of PCPs are and how they would like to have them met.

Ockham’s Razor: The Application of Parsimonious Medicine in Allergy/Immunology

The spectacular advances of modern medicine have distracted clinicians from applying the age-old principles of thorough history and examination followed by only ordering tests relevant to the patient’s presentation. The most obvious diagnosis is the most likely and should be addressed first. Ockham’s razor, or parsimonious medicine, should be applied because plurality of diagnoses is less likely than a single explanation.Component resolved diagnostics and highly effective biological therapies for allergy/immune mediated diseases have been highly effective when used by specialist allergy services. However, they are accessed too easily and frequently, either before diagnostically appropriate allergy skin testing and challenge have been employed or before the reasons for poor disease control have been investigated. The current fashion to test for vitamin D insufficiency in patients with poorly controlled allergic diseases has rarely achieved benefit but significantly increased costs.There are considerable health/economic benefits from following the proven value of a thorough clinical history, examination, focused allergy/immunology testing and the judicious use of Ockham’s razor.

APAAACI clinical pathway on direct provocation testing for penicillin allergy delabeling

Background: Allergy to penicillin is commonly reported in many countries and is an overwhelming global public health concern. Penicillin allergy labels can lead to the use of less effective antibiotics and can be associated with antimicrobial resistance. Appropriate assessment of suspected penicillin allergy (often including skin testing, followed by drug provocation testing [DPT] performed by allergists) can prevent the unnecessary restriction of penicillin or delabelling. Many countries in the Asia Pacific (AP) have very limited access to allergy services, and there are significant disparities in the methods of evaluating penicillin allergy. Therefore, a clinical pathway for the management of penicillin allergy is essential. Objectives: To develop a risk-stratified clinical pathway for delabeling penicillin allergy, taking into account the distinct epidemiology, patient/sensitization profiles, and disparities of allergy services or facilities within the AP. Methods: A risk-stratified penicillin allergy delabeling clinical pathway was formulated by the Drug Allergy Committee of the Asia Pacific Association of Allergy, Asthma and Clinical Immunology. and members of the Penicillin Allergy Disparities survey in AP each representing one country/region of the AP. The clinical pathway was tested based on a database of anonymized patients who were sequentially referred for and completed penicillin allergy evaluation in Hong Kong. Results: The clinical pathway was piloted employing a “hub-and-spoke” approach to foster multidisciplinary collaboration between allergists and nonallergists. A simulation run of the algorithm on a retrospective Hong Kong cohort of 439 patients was performed. Overall, 367 (84%) of patients were suitable for direct DPT and reduced the need for skin testing or specialist’s care for 357 (97%) skin test-negative individuals. Out of the skin test-negative patients, 345 (94%) patients had a negative DPT. Conclusions: This risk-stratification strategy for direct oral DPT can reduce the need for unnecessary skin testing in patients with low-risk penicillin allergy histories. The hub and spoke model of care may be considered for further piloting and validation in other AP populations that lack adequately trained allergists.

Provision of Food Allergy Care in the United Kingdom and United States: Current Issues and Future Directions.

Food allergy (FA) is a growing issue worldwide. The United Kingdom (UK) and United States (US) are high-income, industrialized countries with reported increases in FA prevalence over the past few decades. This review compares delivery of FA care in the UK and US and each country's response to the heightened demand and disparities for FA services. In the UK, allergy specialists are scarce and general practitioners (GPs) provide most allergy care. While the US has more allergists per capita than the UK, there is still a shortage of allergy services owing to the greater reliance on specialist care for FA in America and wide geographic variation in access to allergist services. At this time, generalists in these countries lack the specialty training and equipment to optimally diagnose and manage FA. Moving forward, the UK aims to enhance training for GPs so they may provide better quality frontline allergy care. In addition, the UK is implementing a new tier of semi-specialized GPs and increasing cross-center collaboration through clinical networks. The UK and US aim to increase the number of FA specialists, which is critical at a time of rapidly expanding management options for allergic and immunologic diseases requiring clinical expertise and shared decision-making to select appropriate therapies. While these countries aim to actively grow their supply of quality FA services, further efforts to build clinical networks, and perhaps, recruit international medical graduates and expand telehealth services, are necessary to reduce disparities in access to care. For the UK in particular, this will require additional support from the leadership of the centralized National Health Service, which remains challenging.

The Quality and Management of Penicillin Allergy Labels in Pediatric Primary Care.

Penicillin allergy labels are the most common drug allergy label. The objective of this study was to describe the quality and management of penicillin allergy labels in the pediatric primary care setting. Retrospective chart review of 500 of 18 015 children with penicillin allergy labels born from January 1, 2010 to June 30, 2020 randomly selected from an outpatient birth cohort from Texas Children's Pediatrics and Children's Hospital of Philadelphia networks. Penicillin allergy risk classification ("not allergy," "low risk," "moderate or high risk," "severe risk," "unable to classify") was determined based on documentation within (1) the allergy tab and (2) electronic healthcare notes. Outcomes of allergy referrals and penicillin re-exposure were noted. Half of penicillin allergy labels were "unable to classify" based on allergy tab documentation. Risk classification agreement between allergy tabs and healthcare notes was fair (Cohen's ĸ = 0.35 ± 0.02). Primary care physicians referred 84 of 500 (16.8%) children to an allergist, but only 54 (10.8%) were seen in allergy clinic. All children who were challenged (25 of 25) passed skin testing. Removal of allergy labels was uncommon (69 of 500, 13.8%) but occurred more often following allergy appointments (26 of 54, 48%) than not (43 of 446, 9.6%, P < .001). Children delabeled by primary care physicians were as likely to tolerate subsequent penicillin-class antibiotics as those delabeled by an allergist (94% vs 93%, P = .87). Penicillin allergy documentation within the allergy tab was uninformative, and children were infrequently referred to allergists. Future quality improvement studies should improve penicillin allergy documentation and expand access to allergy services.

COVID-19 Vaccine Allergy Safety Track (VAS-Track) pathway: real-world outcomes on vaccination rates and antibody protection.

Misdiagnosed vaccine-related "allergies" lead to unnecessary vaccine deferrals and incomplete vaccinations, leaving patients unprotected against COVID-19. To overcome limitations and queues for Allergist assessment, the "VAS-Track" pathway was developed to evaluate patients via a multi-disciplinary triage model including nurses, non-specialists, and Allergists. We assessed the effectiveness and safety of VAS-Track and evaluate its real-world impact in terms of vaccination rates and COVID-19 protection. Patients referred to VAS-Track between September 2021 and March 2022 were recruited. Subgroup analysis was performed with prospective pre- and post-clinic antibody levels. Nurse-assisted screening identified 10,412 (76%) referrals as inappropriate. 369 patients were assessed by VAS-Track. Overall, 100% of patients were recommended to complete vaccination and 332 (90%) completed their primary series. No patients reported any significant allergic reactions following subsequent vaccination. Vaccination completion rates between patients seen by non-specialists and additional Allergist review were similar (90% vs. 89%, p = 0.617). Vaccination rates were higher among patients with prior history of immediate-type reactions (odds ratio: 2.43, p = 0.025). Subgroup analysis revealed that only 20% (56/284) of patients had seropositive COVID-19 neutralizing antibody levels (≥ 15 AU/mL) prior to VAS-Track, which increased to 92% after vaccine completion (pre-clinic antibody level 6.0 ± 13.5 AU/mL vs. post-clinic antibody level 778.8 ± 337.4 AU/mL, p > 0.001). A multi-disciplinary allergy team was able to streamline our COVID-19 VAS services, enabling almost all patients to complete their primary series, significantly boosting antibody levels and real-world COVID-19 protection. We propose similar multidisciplinary models to be further utilized, especially in the settings with limited allergy services.

567. The Quality &amp; Management of Penicillin Allergy Labels in a Pediatric Birth Cohort

Abstract Background Penicillin allergy labels (PALs) influence antibiotic prescribing, yet little is known about the quality and management of PALs placed in the pediatric outpatient setting. Methods We performed a retrospective chart review of 500 randomly selected children with PALs from a ten-year birth cohort (n=18,015) from Texas Children’s Pediatrics and Children’s Hospital of Philadelphia Primary Care Networks. PALs were classified as “not allergy” (family history, isolated diarrhea), “low risk” (maculopapular rash &amp;gt;24 hours into antibiotic course, no hives or pruritis), “moderate or high risk” (hives or pruritis, maculopapular rash &amp;lt; 24 hours into antibiotic course, anaphylaxis, swelling, or respiratory symptoms), “severe cutaneous reaction” (erythema multiforme, serum sickness), or “unable to classify” (information not available or unspecified rash characteristics or timing) based on 1) information in the allergy tab and 2) encounter notes. We used kappa-statistic measure-of-agreement to determine allergy classification agreement between the allergy tab and notes. Results The median age of PAL placement was 1.4 years (IQR 0.9, 2.2). Most (n=303, 63%) PALs were placed by physicians. Half of PALs were categorized as “unable to classify; physicians were just as likely to place ambiguous PALs as other providers (48 vs 53%, p=0.31). Most (80%) children were evaluated at a primary care office within 1 week of their reaction. There was fair agreement between the allergy tab and encounter note documentation (Table 1). Of 54 (11%) children evaluated by an allergist, 25/25 passed an oral amoxicillin challenge. Only 69 (14%) children were de-labeled during the study period, more by an allergist (48%) than in the community (9.6%, p&amp;lt; 0.001). Table 1.Risk stratification by penicillin allergy label and notes. Conclusion PAL classification was ambiguous in half of labeled children; there was fair risk classification agreement between the allergy tab and notes. Children with PALs were rarely referred to allergists or de-labeled in the community. Future quality improvement efforts should seek to improve PAL documentation and access to allergy services. Disclosures Debra Palazzi, MD, MEd, AAP: Board Member|AHRQ: Grant/Research Support|AMA: Board Member|Elsevier: Honoraria.

National Survey of United Kingdom Paediatric Allergy Services.

Comprehensive national assessments of paediatric allergy services are rarely undertaken, and have never been undertaken in the United Kingdom. A 2006 survey estimated national capacity at 30,000 adult or paediatric new allergy appointments per year and identified 58 hospital clinics offering a paediatric allergy service. The UK Paediatric Allergy Services Survey was the first comprehensive assessment of UK paediatric allergy service provision. All 450 UK hospitals responded to a survey. Paediatric allergy services are provided in 154 lead hospitals with 75 further linked hospitals. All 154 lead paediatric allergy services completed a detailed questionnaire between February 2019 and May 2020. The 154 paediatric allergy services self-define as secondary (126/154, 82%) or tertiary (28/154, 18%) level services. The annual capacity is 85,600 new and 111,400 follow-up appointments. Fifty-eight percent (85/146) of services offer ≤10 new appointments per week (no data provided from 8 services-2 no response, 6 unknown) and 50% (70/139) of the services undertaking challenges undertake ≤2 food or drug challenges per week (no data from 3 challenge services). Intramuscular adrenaline is rarely used during challenges-median annual frequency 0 in secondary services and 2 in tertiary services. Allergen-specific immunotherapy is offered in 39% (60/154) of services, with 71% (41/58) of these centres treating ≤10 patients per annum (no data from 2 immunotherapy services). The 12 largest services see 31% of all new paediatric allergy appointments, undertake 51% of new immunotherapy patient provision and 33% of food or drug challenges. Seventy percent (97/126) of secondary and all tertiary services are part of a regional paediatric allergy network. Only nine services offer immunotherapy for any food (3 for peanut), 10 drug desensitization and 18 insect venom immunotherapy. There has been a fourfold increase in paediatric allergy clinics and an approximately sevenfold increase in new patient appointment numbers in the United Kingdom over the past 15 years. Most services are small, with significant regional variation in availability of specific services such as allergen immunotherapy. Our findings emphasize the need for national standards, local networks and simulation training to ensure consistent and safe service provision.

Self-completed online dietary recalls as an alternative method of dietary assessment for dietetic outpatient appointments: A feasibility study.

Integrating digital dietary assessment within dietetic care could save time and reduce costs, at the same time as increasing patient engagement. The present study explores the feasibility of implementing a web-based dietary assessment tool, myfood24 (https://www.myfood24.org), into routine healthcare. This mixed methods feasibility study recruited dietitians and patients from a National Health Service (NHS) hospital outpatient setting. Patients completed and shared three online 24-h dietary recalls in advance, which were used as a dietary assessment by dietitians. Recruitment data were collected and questionnaires on technology, usability, and acceptability were completed. Patient interviews and focus groups with dietitians were conducted. Eleven dietitians working in allergy, bariatrics, diabetes, oncology, general, renal, infectious diseases, and coeliac services took part with 39 patients. Recruitment rates were highest in bariatrics and lowest in renal and oncology. Compared to other studies, completion rates were good, with 29 (74.4%) completing three recalls despite lower technology readiness and software usability scores than in similar studies. Illness and difficulty with technology were reasons for non-completion. Opportunity to receive nutritional feedback from the tool and share this with a dietitian motivated patients to complete the record accurately. Consultation times were shortened in approximately one-third of appointments and a higher proportion of time was spent on nutritional education compared to usual practice. However, mean preparation time increased by 13 min per appointment because dietitians found nutritional analysis reports difficult to interpret. It is feasible to introduce a digital dietary assessment tool into NHS dietetic practice. However, further development is needed to ensure that the tool is suitable for healthcare.

Telehealth and Allergy Services in Rural and Regional Locations That Lack Specialty Services

Secondary to the coronavirus disease 2019 pandemic, telehealth quickly peaked as the dominant health care modality and its use still remains high. Although allergists and health care systems adapted quickly to adopt telehealth, its increased use has both highlighted its benefits for patients and allergists and demonstrated known concerns with delivering allergy specialty care to rural and regional patient populations. With increased concentration of both patients and allergists in urban areas, the ability to provide allergy specialty care to the rural and remote population continues to remain a challenge despite the advantages leveraged through telehealth. Herein, we review aspects specific to the rural patient population, tele-allergy outcomes with these patient cohorts, and efforts, both past and present, taken at different levels within the allergy community to promote our specialty through specific telehealth modalities to address and engage the rural and regional patient.

Allergy and Immunotherapy During the Pandemic.

Purpose of ReviewTo summarize and review recent literature on the role of allergen immunotherapy in the setting of a worldwide pandemic.Recent FindingsAt the start of the SARS-CoV-2 pandemic, most elective ambulatory patient care services, including allergen immunotherapy, were suspended. Now with medical practices reopening, allergists must establish plans and protocols for resuming care of allergy patients, including strategies for restarting allergen immunotherapy. While there are no published evidence-based protocols for resuming allergen immunotherapy, limited scientific data and expert opinion suggest that the major factor in dose adjustment is the time elapsed from the last dose.SummaryResuming outpatient allergy services in the setting of the COVID-19 pandemic poses many challenges to the practitioner. Allergy specialists are now faced with developing prudent and evidence-based strategies for safely resuming allergen immunotherapy, while also maintaining a safe environment for staff and patients.

Safe Handling of Antineoplastic Drugs During Allergy Diagnostic Workup and Desensitization: A Single Experience of the Allergy Department in a Tertiary Hospital

The increased use of antineoplastic drugs has been associated with a rising number of hypersensitivity reactions to these drugs, which has led to a growth in the demand for assistance from allergy services. The involvement of an allergist is essential to ensure that these patients with hypersensitivity reactions continue to be able to receive appropriate first-line treatment. Chemotherapy and biological agents have specific handling requirements and all the allergy departments involved in the diagnosis and therapeutic management of patients reacting to these drugs should find the means to guarantee safety. There are currently several guidelines on the safe handling of hazardous drugs for healthcare workers. However, specific recommendations are lacking for reducing occupational exposure in staff working in the allergy departments and managing these drugs for the diagnosis and management of hypersensitivity reactions. This review article focuses on the safe handling strategy of the allergy department in the Ramón y Cajal University Hospital and provides details of its implementation and experience over 10 years. This protocol could improve the knowledge of safe handling of antineoplastic drugs in allergy procedures.

Observational Study: Sublingual Immunotherapy Compliance In The Paediatric Population

Background: Sublingual Immunotherapy (SLIT) is becoming an increasingly popular choice of treatment for allergic rhinitis. Cork University Hospital (CUH) is the regional paediatric allergy centre in the Munster Region (Ireland). This study looked in detail at the paediatric Population commenced on SLIT within 2011 to 2020 inclusive, assessing demographic characteristics and compliance in this cohort. Methods: A retrospective chart review was conducted focusing on the population who were commenced on SLIT in the paediatric allergy and pulmonology services in CUH. This study was carried out in conjunction with INFANT Research Centre. Results: A sample of 72 patients were commenced on Immunotherapy in CUH between the defined timeframe, with information gathered on a total sample of 67 patients. Compliance rate within the total sample who underwent SLIT was 79.1% (53 patients completed), with 20.8% (14 patients) failing to complete the treatment. Children over 10-years old had a statistically significant higher proportion of completion in contrast to those under 10-year (P-value=0.041). Conclusion: CUH population have a good compliance with SLIT comparable with other cohorts. Decreased compliance is associated with the number of SLIT treatments, age of patient, co-morbid asthma, and antihistamine use.

Management of penicillin allergy in primary care: a qualitative study with patients and primary care physicians

BackgroundSix percent of patients are allergic to penicillin according to their medical records. While this designation protects a small number of truly allergic patients from serious reactions, those who are incorrectly labelled may be denied access to recommended first line treatment for many infections. Removal of incorrect penicillin allergy may have positive health consequences for the individual and the general population.We aimed to explore primary care physicians’ (PCPs) and patients’ views and understanding of penicillin allergy with a focus on clinical management of infections in the face of a penicillin allergy record.MethodsWe conducted an interview study with 31 patients with a penicillin allergy record, and 19 PCPs in the North of England. Data were analysed thematically.ResultsPatients made sense of their allergy status by considering the timing and severity of symptoms. Diagnosis of penicillin allergy was reported to be ‘imperfect’ with PCPs relying on patient reports and incomplete medical records. PCPs and patients often suspected that an allergy record was incorrect, but PCPs were reluctant to change records. PCPs had limited knowledge of allergy services. PCPs often prescribed alternative antibiotics which were easy to identify. Both patients and PCPs differed in the extent to which they were aware of the negative consequences of incorrect penicillin allergy records, their relevance and importance to their lives, and management of penicillin allergy.ConclusionsPCPs and patients appear insufficiently aware of potential harms associated with incorrect penicillin allergy records. Some of the problems experienced by PCPs could be reduced by ensuring the details of newly diagnosed reactions to antibiotics are clearly documented. In order for PCPs to overturn more incorrect penicillin records through appropriate use of allergy services, more information and training about these services will be needed.

P30 Can non-allergy health workers safely delabel reported penicillin allergies using an antibiotic allergy assessment tool? - A multicentre study

BackgroundFalse penicillin allergy labels can be potentially hazardous to patients. Most penicillin allergy labels can be safely removed following risk stratification and formal drug challenge. These de-labelling strategies have been limited to specialist allergy and infectious disease services.AimsTo determine whether non-allergy specialist health-care workers can use an antibiotic allergy assessment tool (AAAT) to correctly phenotype and manage reported penicillin allergy.MethodNon-allergy health-care workers in three UK hospital were emailed online questionnaires and asked to assign the allergy phenotype and management recommendation for eight vignettes of real cases reporting a penicillin allergy using the AAAT. In one hospital participants were randomised into two groups: one group was directed to use the AAAT whilst the second group had no decision tool. Participants were assigned an average score for correct allergy phenotype, management and a major error rate.ResultsUse of the AAAT across the eight vignettes significantly improved the average score for assigning correct phenotype (6.7 vs 5.2 p < 0.001), management choice (7.1 vs 5.7 p < 0.001), and major error rate (0.6 vs 1.6 p < 0.001). Participant performance with the AAAT was generalizable across all three hospitals. Despite use of the AAAT 35-40% of participants made at least one major error.ConclusionThe AAAT significantly improved health worker performance in phenotyping and choosing correct management for reported penicillin. However, even with the AAAT, there remains a risk of potentially hazardous management choices highlighting the need for formal allergy training to expand penicillin allergy assessment services.

Food protein-induced enterocolitis syndrome to nuts: An increasing phenomenon

Food protein-induced enterocolitis syndrome (FPIES) is a non–immunoglobulin E (IgE)-mediated food allergy which typically presents in infancy. Although rice is a rare cause of IgE-mediated food allergy, it is one of the most common triggers of FPIES in Australia and the United States. 1 Mehr S. Frith K. Barnes E.H. Campbell D.E. FPIES Study GroupFood protein-induced enterocolitis syndrome in Australia: a population-based study, 2012-2014. J Allergy Clin Immunol. 2017; 140: 1323-1330 Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar ,2 Ruffner M.A. Ruyman K. Bami S. Cianferoni A. Brown-Whitehorn T. Spergel J.M. Food protein-induced enterocolitis syndrome: insights from review of a large referral population. J Allergy Clin Immunol Pract. 2013; 1: 343-349 Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar Conversely, peanut and tree nuts are rarely described to cause FPIES, but are common triggers of IgE-mediated food reactions. Ruffner et al 2 Ruffner M.A. Ruyman K. Bami S. Cianferoni A. Brown-Whitehorn T. Spergel J.M. Food protein-induced enterocolitis syndrome: insights from review of a large referral population. J Allergy Clin Immunol Pract. 2013; 1: 343-349 Abstract Full Text Full Text PDF PubMed Scopus (135) Google Scholar reported peanut and tree nut FPIES in only 2% and less than 1% of children, respectively, in a retrospective cohort of 462 children from a single institution. Mehr et al 1 Mehr S. Frith K. Barnes E.H. Campbell D.E. FPIES Study GroupFood protein-induced enterocolitis syndrome in Australia: a population-based study, 2012-2014. J Allergy Clin Immunol. 2017; 140: 1323-1330 Abstract Full Text Full Text PDF PubMed Scopus (75) Google Scholar reported a single case (0.5%) of peanut FPIES in a prospective population-based study of 230 children. Case reports of peanut FPIES have been published, 3 Mansi J. Anvari S. Anagnostou A. Development of peanut allergy despite early introduction: a real-world case series in the United States. Pediatr Allergy Immunol. 2020; 31: 589-592 Crossref PubMed Scopus (2) Google Scholar , 4 Robbins K.A. Ackermann O.R. Carter C.A. Uygungil B. Sprunger A. Sharma H.P. Food protein-induced enterocolitis syndrome to peanut with early introduction: a clinical dilemma. J Allergy Clin Immunol Pract. 2018; 6: 664-666 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar and 1 case of peanut FPIES was noted as a reason for discontinuation in the Learning Early About Peanut (LEAP) allergy trial. 5 Du Toit G. Roberts G. Sayre P.H. et al. Randomised trial of peanut consumption in infants at rick of peanut allergy. N Engl J Med. 2015; 372: 803-813 Crossref PubMed Scopus (1129) Google Scholar We recently noted an increase in the number of children being referred with peanut FPIES to our private allergy services, in Melbourne, Australia.

Intensive Infection Control at a Canadian Tertiary Allergy and Clinical Immunology Clinic during COVID-19 to Provide Crucial Services

Several groups have made recommendations for adjustments during COVID-19 to facilitate the care of urgent/high-risk patients. Here we describe our Canadian multi-allergist tertiary allergy & clinical immunology clinic’s observational data with intensive infection control measures to provide crucial services. After instituting an intensive infection control protocol, we measured the daily number of patients seen (virtually and in-person), skin tests, target biologic therapy (TBT), venom (VIT) and allergy immunotherapy (AIT) administered as well as adverse safety events (allergy related and viral transmission related). Our protocol consisted of scheduling in-person visits by appointment-only, health screening during the reminder call (ensuring no COVID-19 symptoms, exposures, and recent high-risk travel history) and before clinic entry, providing obligatory hand sanitizer and mask at the door, scanning body temperature, disinfecting rooms in-between patients, daily deep cleaning after-hours, donning full personal protective equipment for any direct patient care, and performing spirometry in outdoor tents with plexiglass. AIT patients waited in their own vehicle, if possible, to be directly monitored by staff for 30 minutes to maximize physical distancing. For any concerns, patients immediately called over front door staff or honked their car horn. Since the pandemic, we provided virtual care and accommodated over 18,000 patients. On average per day, there were 25 new teleconsults, 12 skin tests, 40 TBT, 30 VIT, and 80 AIT patients. There have been no adverse safety events. By adopting intensive infection control measures, we can optimize reduction of viral transmission and maintain crucial allergy services to keep high-risk allergic conditions under control.

The Impact of COVID-19 Pandemic on Adult and Pediatric Allergy & Immunology Services in the UK National Health Service

BackgroundThe coronavirus disease 2019 pandemic imposed multiple restrictions on health care services.ObjectiveTo investigate the impact of the pandemic on Allergy & Immunology (A&I) services in the United Kingdom.MethodsA national survey of all A&I services registered with the Royal College of Physicians and/or the British Society for Allergy and Clinical Immunology was carried out. The survey covered staffing, facilities, personal protective equipment, appointments & patient review, investigations, treatments, and research activity. Weeks commencing February 3, 2020 (pre–coronavirus disease), April 6, 2020, and May 8, 2020, were used as reference points for the data set.ResultsA total of 99 services participated. There was a reduction in nursing, medical, administrative, and allied health professional staff during the pandemic; 86% and 92% of A&I services continued to accept nonurgent and urgent referrals, respectively, during the pandemic. There were changes in immunoglobulin dose and infusion regimen in 67% and 14% of adult and pediatric services, respectively; 30% discontinued immunoglobulin replacement in some patients. There was a significant (all variables, P ≤ .0001) reduction in the following: face-to-face consultations (increase in telephone consultations), initiation of venom immunotherapy, sublingual and subcutaneous injection immunotherapy, anesthetic allergy testing, and hospital procedures (food challenges, immunoglobulin and omalizumab administration); and a significant increase (P ≤ .0001) in home therapy for immunoglobulin and omalizumab. Adverse clinical outcomes were reported, but none were serious.ConclusionsThe pandemic had a significant impact on A&I services, leading to multiple unplanned pragmatic amendments in service delivery. There is an urgent need for prospective audits and strategic planning in the medium and long-term to achieve equitable, safe, and standardized health care.

UK allergy and immunology in a post‐COVID‐19 era

UK allergy and immunology in a post‐COVID‐19 era

Achieving equitable management of allergic disorders and primary immunodeficiency in a Black, Asian and Minority Ethnic population

Achieving equitable management of allergic disorders and primary immunodeficiency in a Black, Asian and Minority Ethnic population