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Background Aspirin-exacerbated respiratory disease (AERD) affects 7% of asthmatics. Usual therapies are inadequate for asthma and/or nasal polyposis, leading to decreased quality of life. Objective Our objective was to evaluate the efficacy of dupilumab in AERD patients with uncontrolled, chronic rhinosinusitis with nasal polyposis (CRSwNP). Methods Patients 18 years and older with a physician diagnosis of AERD and sino-nasal outcome test 22 (SNOT 22) score ≥19 despite standard medical therapy were eligible for the study. Patients received one month of placebo dosing, followed by 6 months of dupilumab. Patients were blinded to the order of therapy. Wilcoxon-paired rank sum test was used to compare study outcomes at baseline and the completion of the study. Results Ten patients completed the study. The median baseline SNOT 22 score improved from 46 [IQR: 34 to 64.8] to 9.5 [IQR: 2.5 to 19] after 6 months of therapy (p = 0.0050). The median baseline Lund MacKay score improved from 21.5 [IQR: 17 to 23.3] to 4 [IQR: 1.2 to 6] after 6 months of therapy (p = 0.0050). There was also improvement in the following secondary outcomes: asthma control test (ACT), mini asthma quality of life questionnaire (AQLQ), and University of Pennsylvania Smell Identification test (UPSIT). Exhaled nitric oxide (FeNO), total serum IgE, 24-hour urinary leukotriene E4, and serum thymus and activation regulated cytokine (TARC) also decreased. There were no significant study-related adverse events. Conclusion Dupilumab was highly effective as add-on therapy for CRSwNP in AERD, improving patient-reported outcomes, sinus opacification, and markers of T2 inflammation.

What is already known about this topic? There are outpatient data for electronic consultations (e-consults) in allergy/ immunology (A/I) but no data for inpatient A/I consultations. What does this article add to our knowledge? We demonstrate that A/I inpatient e-consults are feasible, potentially less costly, and maintain requesting provider satisfaction for certain conditions. How does this study impact current management guidelines? E-consults are a strategy to improve A/I access in inpatient settings and are particularly relevant during the novel coronavirus infection pandemic. BACKGROUND: Electronic consultations (e-consults) are asynchronous clinician-to-clinician exchanges within the electronic health record (EHR). OBJECTIVE: We sought to demonstrate the utility of e-consults in allergy/immunology (A/I) inpatient consultations. METHODS: Inpatients ‡18 years of age for whom an A/I consultation was requested were eligible for an e-consult. An econsult was completed if considered appropriate by the A/I physician with recommendations made in the EHR. In-person consultation was performed for inpatients if deemed necessary. Likert scale satisfaction data were collected from requesting providers after the e-consultation. Cost was calculated using time-based billing codes plus the cost of penicillin allergy evaluation, if appropriate. RESULTS: Of the 109 inpatient consults, 78 (71.6%) were completed through an e-consult and 31 (28.4%) were completed by an in-person consult. The most common indication for an inpatient consult was evaluation of penicillin allergy in 73 (67%) patients. The most common reason to complete an in-person consult was the need to complete penicillin skin testing in 17 of the 31 (55%) patients. E-consults were completed in less time than in-person consults (15 minutes, interquartile range [IQR]: 10-15 vs 60 minutes, IQR: 45-60, P < .001) and had a shorter turnaround time (1 hour, IQR: 0.5-2 vs 7 hours, IQR: 3-19, P < .001). Management recommendations were followed at a similar rate regardless of type of consult (88% of e-consults vs 96% of in-person consults, P [ .162). A total of 97% of requesting providers reported an "excellent" or "good" impression of e-consults. E-consults were less costly than in-person consults. CONCLUSIONS: E-consults have utility in providing inpatient A/I consultation and may have advantages over in-person evaluation, while adequately maintaining provider satisfaction.

Conflicts of interest: A. Ramsey has received a research grant from CSL Behring and is on speaker's bureau for Sanofi/Regeneron. S. S. Mustafa has received a research grant from CSL Behring and is on speaker's bureau for Sanofi/Regeneron, Genentech, AstraZeneca, and CSL Behring. The rest of the authors declare that they have no relevant conflicts of interest.

Background The novel coronavirus (COVID-19) pandemic necessitated a rapid transition from in-person evaluations to remote delivery of care, including both video and telephone visits, in allergy/immunology practices. Objective To evaluate patient satisfaction, patient and physician impression of encounter completeness, and reimbursement between in-person, video, and telephone encounters. This study also assessed factors influencing patient satisfaction, perception of completeness, and choice of future evaluation type. Methods This was a prospective study of all encounters at a healthcare-system owned practice. Encounter type, encounter modality, patient demographics, primary diagnoses, reimbursement data, and physician assessment of encounter completeness were tracked. Patient satisfaction was assessed via standardized questions. Results There were 447 encounters, with 303 (67.8%) in-person, 98 (21.9%) video, and 46 (10.3%) telephone. Patient satisfaction data was obtained from 251 patients. There was similar patient satisfaction among all encounter modalities. Both patients and physicians were more likely to deem an in-person encounter as complete. Physicians were more likely to report an in-person encounter to be complete for food allergy (p<0.001) and chronic rhinitis (p=0.001) as compared to video or telephone, whereas patients reported in-person encounters for food allergy to be complete as compared to other modalities (p=0.002). Patients reported that future encounter types should depend on the clinical situation. Conclusions There was similar patient satisfaction with in-person, video, and telephone encounters in an allergy/immunology practice during the COVID-19 pandemic. Chronic rhinitis and food allergy are more likely to call for an in-person evaluation. New patient visits are likely to be the most high-yield to focus on for in-person evaluations.