BackgroundThe COVID-19 pandemic has affected the supply, cost, and demand for certain foods, but it is not clear how these changes have affected food-allergic households.ObjectiveTo describe the changes in food-related costs that have followed COVID-19, as reported by higher- and lower-income households with a food-allergic member.MethodsBetween May 1-June 30, 2020, Canadian households, with at least one food-allergic member, completed an online survey on food shopping and preparation habits before and during the COVID-19 pandemic. The sample was divided into binary groups, either higher or lower than the sample median income. Data were analyzed using descriptive statistics and multiple regression.ResultsThe sample was comprised of 102 participants (i.e., 51/ income group). The three most common food allergies amongst both groups were peanuts, tree nuts and milk. Since the start of the pandemic, both groups reported greater monthly direct grocery costs, although costs amongst the higher-income group were twice as high as the lower-income group ($212.86 vs. $98.89, respectively). Indirect food preparation costs were similarly elevated. Higher-income households with food procurement difficulties reported increased indirect shopping costs following the outbreak of COVID-19, whereas those without such difficulties reported decreased costs. Lower-income households with allergies to milk, wheat, or eggs (i.e., staple allergy) experienced a larger change in indirect food preparation costs following the outbreak of COVID-19 relative to those with other food allergies ($244.58 vs. –$20.28, respectively; p = 0.03).ConclusionBoth higher and lower income households with food allergy reported greater direct food costs and indirect food preparation costs following the COVID-19. Households with staple allergy and those with difficulties finding their typical food items were particularly affected.

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As clinical immunologists, we are experts in immune dysregulation as we regularly treat patients with combined immune deficiency and autoimmunity. This places us in a unique position to understand the nuances of COVID-19 immune disturbances, including cytokine release syndrome, and make recommendations regarding treatment. METHODS: At our institution, Allergy and Immunology faculty and fellows participated on a multidisciplinary COVID-19 treatment team whose role was to develop and revise a treatment algorithm for admitted patients and review patient charts under a stewardship module in the EMR. Outcome data for patients admitted with SARS-CoV-2 infection from March 10 to 31, 2020 was analyzed. Severe disease was defined as requiring at least 3L of oxygen to maintain SpO2 >93%. RESULTS: A treatment algorithm with recommendation for tocilizumab for patients requiring 3L/min of oxygen or greater to maintain SpO2 >93% was developed. The treatment algorithm included consideration of Allergy and Immunology consultation if there was need for repeat or alternative biologic agents. A total of 239 patients with PCR-confirmed SARS-CoV-2 infection were included. 153 of 239 patients received tocilizumab. Of all patients, 25 of 239 died, for an overall mortality rate of 10.5%. Among tocilizumab-treated patients requiring mechanical ventilation, survival was 75% (95% CI, 64-89). CONCLUSIONS: The presence of a multidisciplinary treatment team, treatment algorithm, and stewardship module involving Allergy and Immunology was associated with favorable mortality outcomes for patients affected by COVID-19. Involvement of Allergy fellows on the multidisciplinary team supported learning opportunities for fellows via collaboration with other specialists.