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Smolinska S, Popescu FD, Izquierdo E, Antolín-Amérigo D, Price OJ, Alvarez-Perea A, Eguíluz Gracia I, Papadopoulos NG, Pfaar O, Fassio F, Hoffmann-Sommergruber K, Dramburg S, Agache I, Jutel M, Brough HA, Fonseca JA, Angier E, Boccabella C, Bonini M, Dunn Galvin A, Gibson PG, Gawlik R, Hannachi F, Kalayci Ö, Klimek L, Knibb R, Matricardi P, Chivato T. Telemedicine with special focus on allergic diseases and asthma-Status 2022: An EAACI position paper. Allergy 2024; 79:777-792. [PMID: 38041429 DOI: 10.1111/all.15964] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
Efficacious, effective and efficient communication between healthcare professionals (HCP) and patients is essential to achieve a successful therapeutic alliance. Telemedicine (TM) has been used for decades but during the COVID-19 pandemic its use has become widespread. This position paper aims to describe the terminology and most important forms of TM among HCP and patients and review the existing studies on the uses of TM for asthma and allergy. Besides, the advantages and risks of TM are discussed, concluding that TM application reduces costs and time for both, HCP and patients, but cannot completely replace face-to-face visits for physical examinations and certain tests that are critical in asthma and allergy. From an ethical point of view, it is important to identify those involved in the TM process, ensure confidentiality and use communication channels that fully guarantee the security of the information. Unmet needs and directions for the future regarding implementation, data protection, privacy regulations, methodology and efficacy are described.
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Affiliation(s)
- Sylwia Smolinska
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
| | - Florin-Dan Popescu
- Department of Allergology, Nicolae Malaxa Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Elena Izquierdo
- Department of Basic Medical Sciences, Facultad de Medicina, Institute of Applied Molecular Medicine Instituto de Medicina Molecular Aplicada Nemesio Díez (IMMA), Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Madrid, Spain
| | - Darío Antolín-Amérigo
- Servicio de Alergia, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Oliver J Price
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Alberto Alvarez-Perea
- Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Ibon Eguíluz Gracia
- Allergy Department, Hospital Regional Universitario de Malaga and Allergy Research Group, Instituto de Investigacion Biomedica de Malaga (IBIMA-Plataforma BIONAND). RICORS "Inflammatory Diseases", Malaga, Spain
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National Kapodistrian University of Athens, Athens, Greece
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | | | | | - Stephanie Dramburg
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - Ioana Agache
- Allergy and Clinical Immunology at Transylvania University, Brasov, Romania
| | - Marek Jutel
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
- "ALL-MED" Medical Research Institute, Wroclaw, Poland
| | - Helen A Brough
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital, London, UK
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - João A Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Elizabeth Angier
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Cristina Boccabella
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Bonini
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Clinical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | | | - Peter G Gibson
- John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Radoslaw Gawlik
- Department of Internal Medicine, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland
| | - Farah Hannachi
- Immuno-Allergology Unit, Hospital Centre of Luxembourg, Luxembourg City, Luxembourg
| | - Ömer Kalayci
- Hacettepe University School of Medicine, Ankara, Turkey
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Rebecca Knibb
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Paolo Matricardi
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - Tomás Chivato
- Department of Clinical Medical Sciences, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Madrid, Spain
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Kvedarienė V, Burzdikaitė P, Česnavičiūtė I. mHealth and telemedicine utility in the monitoring of allergic diseases. FRONTIERS IN ALLERGY 2022; 3:919746. [PMID: 36118170 PMCID: PMC9478181 DOI: 10.3389/falgy.2022.919746] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/15/2022] [Indexed: 11/21/2022] Open
Abstract
This literature review discusses the use of mHealth technologies and telemedicine for monitoring various allergic diseases both in everyday life and in the context of COVID-19. Telemedicine, whose popularity, and demand has skyrocketed during the pandemic, rely on mHealth technologies, video calls and websites as a resource-saving and safe way of consulting patients. The incorporation of new mHealth technologies into telemedicine practice may not only be relevant in the context of pandemic restrictions but can also be applied in everyday medical practice as an effective method of patient counseling. The mobile healthcare applications include a wide range of mobile apps for patients' education, monitoring, and disease management. However, applications for the people with food allergies lack relevant information about allergies and, like most other applications, are developed without the contribution of healthcare specialists. During the COVID-19 pandemic, low-risk food-allergic patients were able to rely on telemedicine services where they could get the help, they needed without increasing risk of contracting COVID-19 while saving time. Meanwhile, some applications for allergic rhinitis and asthma patients are showing practical benefits in clinical trials by allowing an efficient assessment of treatment regimens and efficacy. The use of digital symptom diaries further facilitates the implementation of real-life studies. However, for respiratory allergic diseases, the often insufficient quality of pollen prediction needs to be taken into account. Even though studies have shown that asthma is better controlled with mHealth technologies, the quality of mobile apps for asthma patients varies widely, as many products provide information that has not been scientifically proven. Inhaler sensors - have been shown to improve the course of asthma and its monitoring, while push notifications prompting people to take their medication double the likelihood of treatment adherence. Teledermatology has a high level of patient satisfaction - as it is perceived as a more time-saving method of consultation. However, the diagnostic accuracy of contact consultations remains higher. mHealth technologies provide a patient's health data from his/her daily life, which enables insights into behavioral patterns. This closer look at the daily routine can have a significant impact on developing individualized treatment and care guidelines.
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Affiliation(s)
- Violeta Kvedarienė
- Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Hagemann J, Zuberbier T, Walter Canonica G, Blain H, Bousquet J, Klimek L. Reply to correspondence to 'Differentiation of COVID-19 signs and symptoms from allergic rhinitis and common cold: An ARIA-EAACI-GA2LEN consensus'. Allergy 2022; 77:2574-2575. [PMID: 35932252 PMCID: PMC9538534 DOI: 10.1111/all.15330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/19/2022] [Indexed: 01/08/2023]
Affiliation(s)
- Jan Hagemann
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany
| | - Torsten Zuberbier
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Hubert Blain
- University Hospital Montpellier, Montpellier, France
| | - Jean Bousquet
- Institute of Allergology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Allergology and Immunology, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Berlin, Germany.,University Hospital Montpellier, Montpellier, France
| | - Ludger Klimek
- Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany.,Center for Rhinology and Allergology, Wiesbaden, Germany
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The Role of Access and Cost-Effectiveness in Managing Asthma: A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:2109-2116. [PMID: 35525532 PMCID: PMC9353043 DOI: 10.1016/j.jaip.2022.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 03/25/2022] [Accepted: 04/12/2022] [Indexed: 12/21/2022]
Abstract
Background Inconsistent and unequal access to medical care is an issue that predates the COVID19 pandemic, which only worsened the problem. Limited access to care from asthma specialists and other specialists treating comorbid diseases may adversely affect asthma. Objective The purpose of this review is to identify health disparities associated with access to care for asthma, and cost-effectiveness of therapies and interventions addressing this health disparity. Methods A narrative systematic review was undertaken using MeSH searches of English language articles published in CINAHL, Scopus, or PubMed. Results A total of 725 articles were identified. Barriers recognized from the literature included access to diagnostic spirometry, access to specialists, medication formulary restrictions, and issues leading to medical nonadherence. Telemedicine, school-based health care interventions, digital applications, and non–office-based digital spirometry could be used to address these gaps in access to asthma care while potentially being cost-effective. Conclusion With the widespread adoption of telemedicine because of the pandemic, and adoption of other mobile services, we now have potential tools that can increase access to asthma care, which can help address this health care inequity. Evidence is limited, but favorable, that some of these tools may be cost-effective.
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Barbosa MT, Sousa CS, Morais-Almeida M. Telemedicine in the Management of Chronic Obstructive Respiratory Diseases: An Overview. Digit Health 2022. [DOI: 10.36255/exon-publications-digital-health-respiratory-diseases] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Teledermatology and Inflammatory Skin Conditions during COVID-19 Era: New Perspectives and Applications. J Clin Med 2022; 11:jcm11061511. [PMID: 35329838 PMCID: PMC8950226 DOI: 10.3390/jcm11061511] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The most frequent inflammatory skin diseases are psoriasis, atopic dermatitis, hidradenitis suppurativa, and acne. Their management is challenging for dermatologists since their relapsing chronic clinical course is associated with a great impact on quality of life. Nevertheless, the recent introduction of novel therapies, such as biological drugs and small molecules has been changing the history of these diseases. Methods: A systematic review of the scientific literature of case reports, case series, epidemiological studies, reviews, and systematic reviews regarding teledermatology and inflammatory skin disease. Studies were identified, screened, and extracted for relevant data following the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. Results: A total of 69 cases articles were included in the review. Conclusions: As we have shown in the review, several experiences of teledermatology for patients affected by inflammatory skin diseases have been demonstrated to increase due to clinical access to hospital and specialized health care services, allowing better access to specialized dermatology care for people living in remote areas, and saving costs and money with health care.
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El Shahawy AA, Oladimeji KE, Hamdallah A, Saidani A, Abd-Rabu R, Dahman NBH. Prognosis of COVID-19 in respiratory allergy: a systematic review and meta-analysis. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022. [PMCID: PMC8894551 DOI: 10.1186/s43168-022-00110-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Do underlying allergic respiratory diseases such as asthma and rhinitis predispose to a severe coronavirus (COVID-19) infection? We conducted this systematic review to map out and synthesize evidence of published literature. Main body of the abstract We searched five bibliographic databases for articles published between 1 January and 15 November 2020 using keywords: “COVID” AND “Allergic disease,” “Prognosis and COVID-19,” “SARS-CoV-2,” “Asthma,” “Allergic rhinitis.” We synthesized 32 eligible articles from a total of 11,376 articles retrieved from the search process. The profile of allergic respiratory conditions was identified, and only seven studies reported on the treatment administered. No significant difference was observed concerning the prevalence of COVID-19 in individuals with allergic asthma and those with non-allergic asthma (RR = 0.61, p = 0.08). The mortality rate significantly decreased in COVID-19-infected patients with asthma than patients without asthma (RR = 0.63, p = 0.04). Short conclusion There is little evidence available on the role of asthma medications and risk factors influencing the prognostic outcomes for COVID-19 individuals with respiratory allergies, which invites further research.
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Allergic Diseases: A Comprehensive Review on Risk Factors, Immunological Mechanisms, Link with COVID-19, Potential Treatments, and Role of Allergen Bioinformatics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212105. [PMID: 34831860 PMCID: PMC8622387 DOI: 10.3390/ijerph182212105] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/02/2021] [Accepted: 11/16/2021] [Indexed: 12/24/2022]
Abstract
The prevalence of allergic diseases is regarded as one of the key challenges in health worldwide. Although the precise mechanisms underlying this rapid increase in prevalence are unknown, emerging evidence suggests that genetic and environmental factors play a significant role. The immune system, microbiota, viruses, and bacteria have all been linked to the onset of allergy disorders in recent years. Avoiding allergen exposure is the best treatment option; however, steroids, antihistamines, and other symptom-relieving drugs are also used. Allergen bioinformatics encompasses both computational tools/methods and allergen-related data resources for managing, archiving, and analyzing allergological data. This study highlights allergy-promoting mechanisms, algorithms, and concepts in allergen bioinformatics, as well as major areas for future research in the field of allergology.
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Alvarez-Perea A, Dimov V, Popescu FD, Zubeldia JM. The applications of eHealth technologies in the management of asthma and allergic diseases. Clin Transl Allergy 2021; 11:e12061. [PMID: 34504682 PMCID: PMC8420996 DOI: 10.1002/clt2.12061] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 01/14/2023] Open
Abstract
Portable devices, such as smartphones and mobile Internet access have become ubiquitous in the last decades. The term 'eHealth' stands for electronic health. The tools included in the eHealth concept utilize phones, computers and the Internet and related applications to improve the health care industry. Implementation of eHealth technologies has been documented for the management of different chronic diseases, including asthma and allergic conditions. Clinicians and patients have gained opportunity to communicate in new ways, which could be used cost-effectively to improve disease control and quality of life of those affected. Additionally, these innovations bring new opportunities to academic researchers. For example, eHealth has allowed researchers to compile data points that were previously unavailable or difficult to access, and analyse them using novel tools, collectively described as 'big data'. The role of eHealth become more important since early 2020, due to the physical distancing rules and the restrictions on mobility that have been applied worldwide as a response to the coronavirus disease 2019 pandemic. In this review, we summarize the most recent developments in various eHealth platforms and their relevance to the speciality of allergy and immunology, from the point of view of three major stakeholders: clinicians, patients and researchers.
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Affiliation(s)
- Alberto Alvarez-Perea
- Allergy Service Hospital General Universitario Gregorio Marañón Madrid Spain.,Gregorio Marañón Health Research Institute Madrid Spain
| | - Ves Dimov
- Cleveland Clinic Florida FAU Charles E. Schmidt College of Medicine Weston Florida USA
| | - Florin-Dan Popescu
- Department of Allergology 'Nicolae Malaxa' Clinical Hospital 'Carol Davila' University of Medicine and Pharmacy Bucharest Romania
| | - José Manuel Zubeldia
- Allergy Service Hospital General Universitario Gregorio Marañón Madrid Spain.,Gregorio Marañón Health Research Institute Madrid Spain.,Biomedical Research Network on Rare Diseases (CIBERER)-U761 Madrid Spain
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10
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Paoletti G, Di Bona D, Chu DK, Firinu D, Heffler E, Agache I, Jutel M, Klimek L, Pfaar O, Mösges R, DunnGalvin A, Genuneit J, Hoffmann HJ, Canonica GW. Allergen immunotherapy: The growing role of observational and randomized trial "Real-World Evidence". Allergy 2021; 76:2663-2672. [PMID: 33583050 DOI: 10.1111/all.14773] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although there is a considerable body of knowledge about allergen immunotherapy (AIT), there is a lack of data on the reliability of real-world evidence (RWE) in AIT, and consequently, a lack of information on how AIT effectively works in real life. METHODS To address the current unmet need for an appraisal of the quality of RWE in AIT, the European Academy of Allergy and Clinical Immunology Methodology Committee recently initiated a systematic review of observational studies of AIT, which will use the RELEVANT tool and the Grading of Recommendations Assessment, Development and Evaluation approach (GRADE) to rate the quality of the evidence base as a whole. The next step will be to develop a broadly applicable, pragmatic "real-world" database using systematic data collection. Based on the current RWE base, and perspectives and recommendations of authorities and scientific societies, a hierarchy of RWE in AIT is proposed, which places pragmatic trials and registry data at the positions of highest level of evidence. KEY RESULTS There is a need to establish more AIT registries that collect data in a cohesive way, using standardized protocols. CONCLUSIONS This will provide an essential source of real-world data that can be easily shared, promoting evidence-based research and quality improvement in study design and clinical decision-making.
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Affiliation(s)
- Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy Humanitas Clinical and Research Center IRCCS and Department of Biomedical Sciences Humanitas University Milan Italy
| | - Danilo Di Bona
- Department of Emergency and Organ Transplantation School and Chair of Allergology and Clinical Immunology University of Bari – Aldo Moro Bari Italy
| | - Derek K. Chu
- Division of Immunology and Allergy Department of Health Research Methods, Evidence and Impact Department of Medicine McMaster University Hamilton ON Canada
- The Research Institute of St. Joe's Hamilton Hamilton ON Canada
| | - Davide Firinu
- Department of Clinical Sciences and Public Health University of Cagliari Cagliari Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy Humanitas Clinical and Research Center IRCCS and Department of Biomedical Sciences Humanitas University Milan Italy
| | - Ioana Agache
- Department of Allergy and Clinical Immunology Faculty of Medicine Transylvania University of Brasov Brasov Romania
| | - Marek Jutel
- Department of Clinical Immunology Wroclaw Medical University and “ALLMED”Medical Research Institute Wroclaw Poland
| | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Oliver Pfaar
- Section of Rhinology and Allergy Department of Otorhinolaryngology, Head and Neck Surgery University Hospital MarburgPhilipps‐Universität Marburg Marburg Germany
| | - Ralph Mösges
- Faculty of Medicine Institute of Medical Statistics and Computational Biology (IMSB) University of Cologne and CRI – Clinical Research International Limited Cologne Germany
| | - Audrey DunnGalvin
- School of Applied Psychology and Department of Paediatrics & Child Health University College Cork Cork Ireland
| | - Jon Genuneit
- Institute of Epidemiology and Medical Biometry Ulm University Ulm Germany
- Pediatric Epidemiology, Department of Pediatrics, Medical Faculty Leipzig University Leipzig Germany
| | - Hans Jürgen Hoffmann
- Department of Clinical Medicine Aarhus University and Department of Respiratory Diseases and AllergyAarhus University Hospital Aarhus Denmark
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy Humanitas Clinical and Research Center IRCCS and Department of Biomedical Sciences Humanitas University Milan Italy
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Abstract
PURPOSE OF REVIEW Drug allergy management has previously not been emphasized in the elderly. However, the geriatric population poses several unique characteristics, challenges for drug allergy testing and considerations in the management. Especially in the era of COVID-19, the elderly population is a vulnerable cohort and reviewing the management during this unprecedented time is both timely and relevant. RECENT FINDINGS In recent years, larger scale studies focusing on the epidemiology and prevalence trends of drug allergies among older adults has been summarized in this review. Emphasis on anaphylaxis in the older adults has been studied. SUMMARY There are many implications of these findings. Epidemiological studies are useful in realizing the burden and spectrum of drug allergies on our healthcare system. It has allowed us to identify certain barriers in drug allergy management and develop ways to overcome these challenges through. Lastly, we have proposed an approach to drug allergy management based on previous studies as well as from our perspective and local experience.
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Affiliation(s)
- Jane C Y Wong
- Division of Rheumatology & Clinical Immunology, Department of Medicine, Queen Mary Hospital, Pok Fu Lam, Hong Kong
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12
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Paoletti G, Racca F, Piona A, Melone G, Merigo M, Puggioni F, Ferri S, Azzolini E, Lagioia M, Lamacchia D, Cataldo G, Cecconi M, Canonica GW, Heffler E. Successful SARS-CoV-2 vaccine allergy risk-management: The experience of a large Italian University Hospital. World Allergy Organ J 2021; 14:100541. [PMID: 33850601 PMCID: PMC8030995 DOI: 10.1016/j.waojou.2021.100541] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/29/2021] [Accepted: 04/01/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccines have been approved recently, and public concern regarding the risk of anaphylactic reactions arose after a few cases during the first days of mass vaccination. Polyethylene glycol (PEG) has been suggested as the most probable culprit agent for allergic reactions. OBJECTIVE We describe the allergy work-up protocol implemented for the vaccination campaign in our Center, aiming to allow the greatest number of people to be vaccinated safely. METHODS The protocol included the self-report of a history of suspected drug or vaccine allergies, and subsequent teleconsultation and allergometric tests for PEG and Polysorbate 80 (PS80). A desensitizing protocol of vaccine administration was applied to patients sensitized only to PS80, and to those with a suspect allergic reaction after the first vaccine dose. RESULTS 10.2% (414 out of 4042) of the entire vaccine population have been screened: only one patient resulted allergic to PEG and therefore excluded from the vaccination. Another patient was sensitized to PS80 only and safely vaccinated applying the desensitizing protocol. Seven subjects without a previous history of allergic disease experienced suspect hypersensitivity reactions to the first administered dose: one of them resulted allergic to PEG and was excluded from the second dose, while the others safely completed the vaccination with the desensitizing protocol. CONCLUSION A careful allergological risk-assessment protocol significantly reduces the number of patients who would have avoided SARS-CoV-2 vaccination for their allergies and to effectively identify and manage those rare patients with sensitization to PEGs and/or PS80.
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Affiliation(s)
- Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy – IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
- Department of Biomedical Sciences – Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - Francesca Racca
- Personalized Medicine, Asthma and Allergy – IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Alessandra Piona
- Allergy Service – Humanitas San Pio X Hospital, Via Francesco Nava 31, 20159, Milano, Italy
| | - Giulio Melone
- Personalized Medicine, Asthma and Allergy – IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Morena Merigo
- Personalized Medicine, Asthma and Allergy – IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy – IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
- Department of Biomedical Sciences – Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - Sebastian Ferri
- Personalized Medicine, Asthma and Allergy – IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
- Department of Biomedical Sciences – Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - Elena Azzolini
- Clinical Quality Department - IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Michele Lagioia
- Clinical Quality Department - IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Donatella Lamacchia
- Personalized Medicine, Asthma and Allergy – IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Giuseppe Cataldo
- Personalized Medicine, Asthma and Allergy – IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences – Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Department of Anesthesiology and Intensive Care - IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy – IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
- Department of Biomedical Sciences – Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy – IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
- Department of Biomedical Sciences – Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
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Mustafa SS, Shaker MS, Munblit D, Greenhawt M. Paediatric allergy practice in the era of coronavirus disease 2019. Curr Opin Allergy Clin Immunol 2021; 21:159-165. [PMID: 33534416 DOI: 10.1097/aci.0000000000000727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW To summarize the impact of the COVID-19 pandemic on the practice of paediatric allergy. RECENT FINDINGS Given significant overlap in symptoms, care must be taken to differentiate routine allergic conditions from COVID-19 infection but it appears that most allergic diseases are not risk factors for a severe COVID-19 course. The full impact of restricted allergy/immunology ambulatory services will take months to years to fully understand. One benefit of having to adapt practice style is greater awareness and acceptance of shared decision-making and recognition of preference-sensitive care options in food allergy, in particular for approaches towards allergy prevention, treatment, and anaphylaxis care. Social distancing and masks have helped reduce spread of common respiratory viruses, which may be helping to lower the incidence of viral-associated wheezing episodes, enhancing evidence of the effects of preventing exposure of young children to respiratory viruses on asthma pathogenesis, as well as on allergic rhinitis. There has been a revolution in the rise of telemedicine to increase access to high-quality allergy/immunology specialty care. SUMMARY Although the field has adapted to remain operational in the face of a significant challenge, it is important to apply lessons learned to evolve patient care and optimize treatment in the aftermath of the pandemic.
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Affiliation(s)
- S Shahzad Mustafa
- Department of Allergy, Immunology, & Rheumatology, Rochester Regional Health, University of Rochester School of Medicine and Dentistry
| | - Marcus S Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Daniel Munblit
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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Kulhas Celik I, Metbulut AP, Uneri OS, Senses Dinc G, Dibek Misirlioglu E. Effect of patient and parental anxiety on adherence to subcutaneous allergen immunotherapy during the coronavirus disease 2019 pandemic. Ann Allergy Asthma Immunol 2021; 126:595-597. [PMID: 33493638 PMCID: PMC7825879 DOI: 10.1016/j.anai.2021.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/29/2020] [Accepted: 01/19/2021] [Indexed: 01/16/2023]
Affiliation(s)
- Ilknur Kulhas Celik
- Division of Pediatric Allergy and Immunology, Ankara City Hospital, Ankara, Turkey.
| | - Azize Pinar Metbulut
- Division of Pediatric Allergy and Immunology, Ankara City Hospital, Ankara, Turkey
| | - Ozden Sukran Uneri
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Gulser Senses Dinc
- Department of Child and Adolescent Psychiatry, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Emine Dibek Misirlioglu
- Division of Pediatric Allergy and Immunology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
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The Impact of COVID-19 Pandemic on Adult and Pediatric Allergy & Immunology Services in the UK National Health Service. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:709-722.e2. [PMID: 33271350 PMCID: PMC7703386 DOI: 10.1016/j.jaip.2020.11.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/28/2020] [Accepted: 11/14/2020] [Indexed: 01/18/2023]
Abstract
Background The coronavirus disease 2019 pandemic imposed multiple restrictions on health care services. Objective To investigate the impact of the pandemic on Allergy & Immunology (A&I) services in the United Kingdom. Methods A 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. Results A 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. Conclusions The 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.
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Bellanti JA. The role of the allergist/immunologist in the COVID-19 pandemic: A Janus-faced presentation. Allergy Asthma Proc 2020; 41:397-412. [PMID: 32797762 DOI: 10.2500/aap.2020.41.200072] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Following its initial description in December 2019 in Wuhan, China, coronavirus-2 (COVID-19) has rapidly progressed into a worldwide pandemic, affecting millions of lives. Although every specialty of medicine has been affected, the field of allergy/immunology holds a special place in the battle against this modern-day plague. Because of the specialized training in allergy and clinical immunology, and the familiarity with comorbid contributing conditions, the allergist/immunologist is uniquely poised to play a major role both in the delivery of specialized therapeutic procedures and practices that can improve the health of patients with COVID-19 as well as in the use of forthcoming vaccines for the prevention of its spread. Objective: The purpose of this report is to examine the current body of evidence supporting the two phases of infection and inflammation that influence the pathogenesis of COVID-19 and to provide a classification of COVID-19 disease presentations and potential therapeutic targets with which the allergist/immunologist has particular expertise. Methods: This article was based on a literature review of articles published in PubMed related to COVID-19 and the immune response, and the author's own research and clinical experiences in the field of immunology. Results: Currently, the management of COVID-19 disease is being directed by a preventive strategy based on social distancing, quarantine, and facemasks to reduce the spread of the virus. Numerous clinical trials are being initiated to identify effective treatments for COVID-19 and are directed toward treatment of the two phases of infection and inflammation that influence the pathogenesis of COVID-19. An important resource for the allergist/immunologist is the COVID-19 Treatment Guidelines Panel (COVID-19 TGP), a National Institutes of Health sponsored panel of U.S. physicians, statisticians, and other experts, which has developed a set of continuously updated treatment guidelines intended for clinicians caring for patients during the rapidly evolving COVID-19 pandemic. Conclusion: COVID-19 is unique among other infectious diseases because, in many cases, the host immune inflammatory response can cause greater harm to the individual who is infected than the pathogen itself. In this report, the pathogenesis of COVID-19 and the influence it has on COVID-19 presentations is reviewed, together with recommended potential therapeutic targets and treatment recommendations.
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Affiliation(s)
- Joseph A. Bellanti
- From the Department of Pediatrics and Microbiology-Immunology; and International Center for Interdisciplinary Studies of Immunology, Georgetown University Medical Center, Washington, D.C
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Lin SY. Sublingual immunotherapy in the United States: history and current relevance in the time of COVID‐19. Int Forum Allergy Rhinol 2020; 10:1125-1126. [DOI: 10.1002/alr.22670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 11/08/2022]
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Benfante A, Scichilone N. Prioritizing care for severe asthma during SARS-CoV-2 pandemic. Pulmonology 2020; 27:189-190. [PMID: 33208299 PMCID: PMC7444931 DOI: 10.1016/j.pulmoe.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 08/14/2020] [Accepted: 08/14/2020] [Indexed: 12/21/2022] Open
Affiliation(s)
- A Benfante
- Dipartimento Universitario di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo, Palermo, Italy
| | - N Scichilone
- Dipartimento Universitario di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza "G. D'Alessandro" (PROMISE), Division of Respiratory Medicine, "Paolo Giaccone" University Hospital, University of Palermo, Palermo, Italy.
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