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

  • Thomas B. Casale
    Correspondence
    Corresponding author: Thomas B. Casale, MD, University of South Florida, 12901 Bruce B Downs Blvd, MDC19, Tampa, FL 33612.
    Affiliations
    Food Allergy Research & Education (FARE), McLean, Va

    Department of Medicine, Division of Allergy and Immunology, University of South Florida, Tampa, Fla
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  • Julie Wang
    Affiliations
    Jaffe Food Allergy Institute, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
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  • Anna Nowak-Wegrzyn
    Affiliations
    Allergy and Immunology, Department of Pediatrics, Hassenfeld Children's Hospital, New York University School of Medicine, New York, NY

    Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
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Published:April 18, 2020DOI:https://doi.org/10.1016/j.jaip.2020.04.022
      Recent estimates indicate that several million Americans are at risk of contracting COVID-19 and many fatalities will likely result. Implicit in these numbers is the risk involved for uninfected patients with COVID-19 seeking medical care in an emergency situation. Allergists/immunologists may need to modify recommendations for the acute management of anaphylaxis during these unprecedented times to ensure optimal outcomes of anaphylaxis while weighing the infectious risk and health care burdens associated with the COVID-19 pandemic.
      • Shaker M.S.
      • Oppenheimer J.
      • Grayson M.
      • Stukus D.
      • Hartog N.
      • Hsieh E.W.Y.
      • et al.
      COVID-19: pandemic contingency planning for the allergy and immunology clinic.
      The following recommendations reinforce and expand on the recent expert opinion to assist allergists/immunologists in considering how to adjust their practice under these unique circumstances.
      • Shaker M.S.
      • Oppenheimer J.
      • Grayson M.
      • Stukus D.
      • Hartog N.
      • Hsieh E.W.Y.
      • et al.
      COVID-19: pandemic contingency planning for the allergy and immunology clinic.
      ,
      • Shaker M.
      • Karaoke T.
      • Feenan L.
      • Greenhawt M.
      An economic evaluation of immediate vs non-immediate activation of emergency medical services after epinephrine use for peanut-induced anaphylaxis.
      Decision-making will vary based on local contexts and resources as rates of COVID-19 and access to health care differ geographically. Moreover, there will be cases of severe anaphylaxis where we would not deviate from the usual plan of contacting emergency services immediately after using epinephrine (Figure 1). Patients should be empowered to activate emergency medical services (EMS) if they feel concerns or feel urgent care is needed after epinephrine use, and EMS should be activated if severe symptoms do not completely resolve or if they recur. We recommend using telemedicine to proactively discuss the modified management of anaphylaxis and communicate thresholds for activating EMS, per individual patient's profile, local COVID-19 burden, and careful assessment of the risk-to-benefit ratio.
      Figure thumbnail gr1
      Figure 1Revised anaphylaxis algorithm replacing the standard management protocol during the COVID-19 pandemic.
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