Web-based Infant Food Introduction (WIFI): Feasibility and satisfaction of virtual allergist-supervised food introduction

Latrous, Meriem; Zhu, Rongbo; Mack, Douglas P.; Soller, Lianne; Chan, Edmond S.; Jeimy, Samira; Hanna, Mariam; Abrams, Elissa M.; Cameron, Scott; Cook, Victoria E.; Erdle, Stephanie; Protudjer, Jennifer; Wong, Tiffany

doi:10.1016/j.jaip.2021.05.012

Cited by 6 publications

(3 citation statements)

References 8 publications

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“…This is of particular interest in a time of transition between virtual and in-person care, increased waittimes for specialist consultation, and the known psychological impact this may have on patients (21). As with many other specialties, the general uptake of telemedicine in the eld of CIA was relatively low prior to the COVID-19 pandemic (22), however, emerging data has clearly demonstrated that CIA can effectively and safely implement such a system (5,6). This is of signi cance, as the Canadian Medical Association has only 219 allergists registered as of 2019, with no practicing allergist available in Prince Edward Island, New Brunswick, or the Territories (23).…”

Section: Resultsmentioning

confidence: 99%

“…The COVID-19 pandemic has also irrevocably changed public perception regarding virtual delivery of medical care, requiring many clinicians to pivot their practice to facilitate fewer in-person visits (4). We have seen virtual care models enable allergists to supervise introduction of commonly allergenic foods at home (5), with other data showing 1-4 hours of patient time saved by attending virtual allergist care where appropriate (6). The logical corollary is how these novel models of care may be applied to concerns regarding COVID-19 vaccines.…”

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confidence: 99%

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Utility of eConsults for COVID-19 Vaccine-Related Concerns in Ontario: A Cross-Sectional Review

Walter

Jeimy

Liddy

et al. 2022

Preprint

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Background The Champlain BASE™ and Ontario eConsult services are virtual platforms that serve to facilitate contact between primary care providers and specialists across Ontario, relaying patient-specific questions to relevant specialists via a secure web-based platform. Despite ample evidence regarding the general effectiveness of these platforms, their utility as it pertains to clinical concerns regarding COVID-19 vaccines has not yet been explored. Methods We performed a cross-sectional review of COVID-19 vaccine related eConsults on Ontario patients completed by five allergy specialists between February and October of 2021. 4318 COVID-19 vaccine-related eConsults were completed in total during this time; with 1857 completed by the five allergists participating in this analysis. Question types/content were categorized using a taxonomy developed through consensus on a weighted monthly sample of 499 total cases. Data regarding whether external resources were required to answer each eConsult, impact on primary care provider referral decisions, and allergy consultant response times were collected. A 2-question survey was completed by primary care providers following eConsultation and results were collected. Results 41.08% of eConsults received involved safety concerns regarding COVID-19 vaccine administration in the setting of prior allergic disease and another 36.1% involved a potential reaction the first dose of a COVID-19 vaccine. 72.1% of eConsults were answered by specialist without needing external resources, and only 9.8% of all eConsults received resulted in a recommendation for formal in-person referral to Clinical Immunology & Allergy specialist or another subspecialty. Average time to complete eConsult was 16.4 minutes, and 79.7% of PCP eConsult queries which would have traditionally resulted in formal consultation were resolved based on advice provided in the eConsult without need for in-person assessment. Conclusions Our review demonstrates the utility of the eConsult service as it pertains to COVID-19 vaccine-related concerns. The eConsult platform proved an effective tool in diverting the need for in person assessment by an Allergist or other medical specialty. This is significant given the large volume of eConsults completed by Allergists, and demonstrates the impact of an effective electronic delivery of care model during a time of strained resources and public health efforts directed at mass vaccination.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Utility of eConsults for COVID-19 Vaccine-Related Concerns in Ontario: A Cross-Sectional Review

Walter

Jeimy

Liddy

et al. 2022

Preprint

Self Cite

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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: Ta B L Ementioning

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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Anxiety

Protudjer

2024

Encyclopedia of Food Allergy

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Web-based Infant Food Introduction (WIFI): Feasibility and satisfaction of virtual allergist-supervised food introduction

Cited by 6 publications

References 8 publications

Utility of eConsults for COVID-19 Vaccine-Related Concerns in Ontario: A Cross-Sectional Review

Utility of eConsults for COVID-19 Vaccine-Related Concerns in Ontario: A Cross-Sectional Review

Food allergen ladders: A need for standardization

Anxiety

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