COVID-19: Pandemic Contingency Planning for the Allergy and Immunology Clinic

Abstract

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Risk Communication During COVID-19

“…[4][5][6] Multiple guidelines have emerged from international societies on the management of care during COVID-19, including a North American guideline on contingency planning for allergy and immunology clinics during a pandemic and a Canadian Pediatric Society statement on asthma management during COVID-19. 7,8 In such unequaled and unstable times, circumstances are changing and information rapidly evolving. A focus must not be just on the transmission of reliable and up-to-date information but also on the role of proper and effective risk communication.…”

Reply to “Subcutaneous terbutaline as an alternative to aerosolized albuterol”

“…We appreciate the comments and perspective expressed by Dr. Strauss regarding our recent pandemic contingency guidance, 1 and we agree that in the setting of acute severe asthma or impending respiratory failure, both nebulized albuterol and subcutaneous terbutaline are important clinical considerations. Although evidence suggests that inhaled albuterol through a metered dose inhaler can be as effective as nebulized albuterol, alternative bronchodilator delivery may be needed in some situations.…”

“…In this context, for a patient with potential SARS-CoV-2 infection, it would be appropriate to consider administering nebulized therapy in a negative pressure room with appropriate airborne precautions-complete personal protective equipment (PPE) including an N95 respirator. 1 In the setting of acute severe asthma, it is important to ensure availability of emergency medical services and/or additional intensive care resources that may be required for patient management, including supplemental oxygen, aggressive bronchodilator therapies (both intramuscular and intravenous beta-agonists, anticholinergics, and other smooth muscle inhibitors including magnesium sulfate), anti-inflammatory medications including early administration of corticosteroids, and supportive measures such as noninvasive positive pressure ventilation and helium-oxygen gas mixtures. 4 Terbutaline is a beta-agonist that preferentially stimulates beta-2 receptors in the bronchi to a greater degree than beta-1 receptors in the heart.…”

“…6 In the context of supplemental oxygen therapy, recommendations for PPE for patients with suspected SARS-CoV-2 infection would also apply. 1 During the COVID-19 pandemic, each clinician must treat the patient in front of him or her, managing each unique situation in its appropriate context. Although subcutaneous beta-agonists may have a role in managing some asthma exacerbations during the pandemic, COVID-19 is not an absolute contraindication to any medication or management strategy urgently needed in delivering optimal care.…”

Acute At Home Management of Anaphylaxis During the Covid-19 Pandemic

“…Allergists/immunologists may need to modify 49 recommendations for the acute management of anaphylaxis during these unprecedented times to 50 ensure optimal outcomes of anaphylaxis while weighing the infectious risk and health care burdens 51 associated with the COVID-19 pandemic. (1) The following recommendations reinforce and expand on 52 the recent expert opinion to assist allergists/immunologists in considering how to adjust their practice 53 under these unique circumstances. (1, 2) Decision-making will vary based on local contexts and 54 resources as rates of COVID-19 and access to healthcare differ geographically.…”