A virtual management approach to infant egg allergy developed in response to pandemic‐imposed restrictions

Mahon, Jayne Mac; Hourihane, Jonathan; Byrne, Aideen

doi:10.1111/cea.13794

Cited by 17 publications

(16 citation statements)

References 12 publications

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“…Allergy services have redesigned approaches to numerous facets of care including allergy prevention, 10 tolerance promotion, 10 clinic models and training. 10 , 11 , 12 , 13 All of these changes in practice were born out of necessity. However, as the world embarks on the COVID vaccination phase, it is important to reflect on how these novel approaches inform future thinking on service planning.…”

Section: Discussionmentioning

confidence: 99%

Mass food challenges in a vacant COVID‐19 stepdown facility: Exceptional opportunity provides a model for the future

Byrne

Trujillo

Fitzsimons

et al. 2021

Pediatric Allergy Immunology

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Background Internationally, the COVID‐19 pandemic severely curtailed access to hospital facilities for those awaiting elective/semi‐elective procedures. For allergic children in Ireland, already waiting up to 4 years for an elective oral food challenge (OFC), the restrictions signified indefinite delay. At the time of the initiative, there were approx 900 children on the Children's Health Ireland (CHI) waiting list. In July 2020, a project was facilitated by short‐term (6 weeks) access to an empty COVID stepdown facility built, in a hotel conference centre, commandeered by the Health Service Executive (HSE), Ireland. The aim of this study was to achieve the rapid roll‐out of an offsite OFC service, delivering high throughput of long waiting patients, while aligning with existing hospital policies and quality standards, international allergy guidelines and national social distancing standards. Methods The working group engaged key stakeholders to rapidly develop an offsite OFC facility. Consultant paediatric allergists, consultant paediatricians, trainees and allergy clinical nurse specialists were seconded from other duties. The facility was already equipped with hospital beds, bedside monitors (BP, pulse and oxygen saturation) and bedside oxygen. All medication and supplies had to be brought from the base hospital. Daily onsite consultant anaesthetic cover was resourced and a resuscitation room equipped. Standardized food challenge protocols were created. Access to the onsite hotel chef facilitated food preparation. A risk register was established. Results After 6 weeks of planning, the remote centre became operational on 7/9/2020, with the capacity of 27 OFC/day. 474 challenges were commenced: 465 (98%) were completed and 9 (2%) were inconclusive. 135 (29%) OFCs were positive, with 25 (5%) causing anaphylaxis. No child required advanced airway intervention. 8 children were transferred to the base hospital. The CHI allergy waiting list was reduced by almost 60% in only 24 days. Conclusions Oral food challenges remain a vital tool in the care of allergic children, with their cost saving and quality‐of‐life benefits negatively affected by a delay in their delivery. This project has shown it is possible to have huge impacts on a waiting list efficiently, effectively and safely with good planning and staff buy‐in—even in a pandemic. Adoption of new, flexible and efficient models of service delivery will be important for healthcare delivery in the post–COVID‐19 era.

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Section: Discussionmentioning

confidence: 99%

Mass food challenges in a vacant COVID‐19 stepdown facility: Exceptional opportunity provides a model for the future

Byrne

Trujillo

Fitzsimons

et al. 2021

Pediatric Allergy Immunology

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“…Outreach video and telephone clinics are becoming the new norm and we have recently shown they are safe for management of egg allergy in infants and can even start before face-to-face clinic attendance and testing. 6 We consider these data show the IFAN Egg Ladder appears a safe and effective guide for treatment of most cases of egg allergy, implemented in the home environment, with remote, not in-person support from an experienced allergy clinic and with individualised, not automatic prescription of adrenaline. We have practically eliminated the use of food challenges with egg from our clinical practice by using the egg ladder on an outpatient basis.…”

mentioning

confidence: 86%

“…Outreach video and telephone clinics are becoming the new norm and we have recently shown they are safe for management of egg allergy in infants and can even start before face‐to‐face clinic attendance and testing. 6 …”

Section: Tablementioning

confidence: 99%

“…The amount of clinic time released with this supportive plan that works for most families could be used for the anxious families who cannot engage with the home egg ladder programme. As clinical practice moves to more virtual interfaces and support that appear very effective, 6 all services must adapt safe existing and novel clinical programme to this new clinical environment. The IFAN Egg Ladder is suitable for this modernisation of clinical management of egg allergy.…”

Section: Tablementioning

confidence: 99%

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Home‐based graded exposure to egg to treat egg allergy

Cotter

Lad

Byrne

et al. 2021

Clinical & Translational All

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“…58 The barriers to perform OFCs has been further exacerbated by the COVID-19 pandemic, and as a result, some have recommended the use of lowrisk home food challenges during this pandemic. [59][60][61] The application of home-based ladders during this time of significant resource limitation has obvious benefit. However, while many clinicians may feel comfortable recommending these approaches for non-IgE-mediated allergies, not all will recommend these approaches for patients with IgE-mediated allergies.…”

Section: High Previous Reaction Thresholdmentioning

confidence: 99%

Food allergen ladders: A need for standardization

Venter

Ebisawa

Athanasopoulou

et al. 2021

Pediatric Allergy Immunology

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Introduction:The process of gradually reintroducing food allergens into an individual's diet is referred to as food allergen "ladders". There remain many questions regarding the foods chosen, structure and composition of the ladder, and medical and safety considerations. The COVID-19 pandemic has propelled us into an era where medicine is increasingly practiced via online platforms, highlighting the need for standardized food allergen ladder approaches for successful and safe introduction of food allergens. Methods:We performed a search of currently published food allergen ladders and obtained published information and clinical expertise to summarize current knowledge and suggest future standardized approaches for using food allergen ladders.Results: There are currently a limited number of published milk, egg, wheat, and soy ladders. We suggest the following points should be considered when developing food ladders: (1) Food allergen: dose, time, and temperature of heating of the food allergen, simplicity of the ladder and recipes, the possible role of the wheat matrix, and testing for allergenic protein levels to standardize doses; (2) Nutritional factors: health and nutritional value of the foods in the ladder, taste, texture, and cultural appropriateness of foods should be considered; and (3) Medical aspects: consideration of which patients are safe to undergo ladders outside of the clinical setting, other safety aspects and risk factors for severe reactions, number of days suggested per steps, and availability and provision of rescue medication. Written instructions and recipes should be provided to families who wish to use food allergen ladders.Discussion: Food allergen ladders used for gradual reintroduction of food allergens into a food allergic individual's diet are increasingly being used internationally.Standardization regarding the foods included in the ladder and medical considerations are required to practice patient-centered care, best assist patients and families, and ensure safety.

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A virtual management approach to infant egg allergy developed in response to pandemic‐imposed restrictions

Cited by 17 publications

References 12 publications

Mass food challenges in a vacant COVID‐19 stepdown facility: Exceptional opportunity provides a model for the future

Mass food challenges in a vacant COVID‐19 stepdown facility: Exceptional opportunity provides a model for the future

Home‐based graded exposure to egg to treat egg allergy

Food allergen ladders: A need for standardization

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