Novel Approaches to Food Allergy Management During COVID-19 Inspire Long-Term Change

Abstract

The SARS-CoV2 pandemic has prompted a re-evaluation of our current practice of medicine. The seemingly abrupt worldwide spread of this disease resulted in immediate changes and a reduction in many allergy-focussed services and procedures. The reality of the long-term circulation of this virus in our communities requires us to evolve as a specialty. In this article, we outline current and future challenges in the management of food allergy in light of coronavirus disease 2019 (COVID-19). We focus on infant food allergy prevention, management of anaphylaxis, accurate diagnosis with oral food challenges, and active management of food allergy with oral immunotherapy. This article identifies the challenges of conflicting guidelines, shortcomings of acute management approaches, and inherent system deficiencies. We offer perspectives and strategies that can be implemented now, including an evaluation of virtual care and telemedicine for the management of food allergy. The use of a shared decision-making model results in novel approaches that can benefit our patients and our specialty for years to come. COVID-19 has forced us to re-evaluate our current way of thinking about food allergy management to better treat our patients.

Practical challenges in oral immunotherapy resolved through patient-centered care

“…Moreover, if a reaction occurs at home following up-dosing, they must be prepared to go the emergency department. In the context of the pandemic, it can be argued that the safest option would be to hold current build-up dose for an extended period until able to return for up-dosing at the allergy clinic [ 89 ].…”

Challenges in Diagnosis of Food Allergies via Oral Food Challenges: A Qualitative Analysis of the Caregiver Perspective

“…The British Society for Allergy and Clinical Immunology (BSACI) permits home challenges or reintroductions without challenges for children with milk and egg allergies under certain circumstances and provides instructions for parents on how to do so (26,27). The SARS-CoV-2 pandemic has generated increasing interest in the use of telemedicine to conduct home-based virtual OFCs in low-risk scenarios (28). Given the importance of OFC setting for parents, parental discomfort with home OFCs and the risks associated with performing OFCs in healthcare settings during the SARS-CoV-2 pandemic, future studies could explore the utility and safety of home-based virtual OFCs.…”

Management of Allergic Diseases During COVID-19 Outbreak

“…General recommendations for food allergy patients during COVID-19 outbreak [16,27] careful risk-benefit assessment in cases of urgent need, such as chemotherapy in cancer patients, radiocontrast media in subjects needing urgent procedures, and DA reaction during the perioperative time. Given that DAs are causes of catastrophic events occurring in the perioperative period, they are of major concern to anesthesiologists [29].…”

“…General recommendations for food allergy patients during COVID-19 outbreak [ 16 , 27 ]: Promote telehealth and incorporating more allowances for parents to facilitate FA management are strategies that can improve outcomes while balancing risk. Follow local recommendations, and prioritize when possible a face-to-face consultation in patients with a high risk of severe reaction and multiple FA.…”