The Impact of COVID-19 Pandemic on Adult and Pediatric Allergy & Immunology Services in the UK National Health Service

Abstract

Background The COVID-19 pandemic imposed multiple restrictions on healthcare services. Objective To investigate the impact of the pandemic on Allergy & Immunology (A&I) services in the UK. Methods National survey of all A&I services registered with the Royal College of Physicians and/or British Society for Allergy and Clinical Immunology. The survey covered staffing, facilities, personal protective equipment, appointments & patient review, investigations, treatments and research activity. Weeks commencing 03 Feb’20 (pre-COVID), 06 April’20 and 08’May’20 were used as reference points for the dataset. Results 99 services participated. There was a reduction in nursing, medical, administrative and allied health professional staff during pandemic; 86% and 92% of A&I services continued to accept non-urgent and urgent referrals respectively during the pandemic. There were changes in immunoglobulin (Ig) dose and infusion regimen in 67% and 14% of adult and pediatric services respectively; 30% discontinued immunoglobulin replacement in some patients. There was a significant (all variables, p≤0.0001) reduction in the following: face-to-face consultations (increase in telephone consultations), initiation of venom immunotherapy, sublingual and subcutaneous injection immunotherapy, anesthetic allergy testing and hospital procedures (food challenges, immunoglobulin and omalizumab, administration); and a significant increase (p≤0.0001) in home therapy for immunoglobulin and omalizumab. Adverse clinical outcomes were reported, but none were serious. Conclusion The pandemic had significant impact on A&I services leading to multiple unplanned pragmatic amendments in service delivery. There is an urgent need for prospective audits and strategic planning in the medium and long term to achieve equitable, safe and standardised healthcare.

Safety Evaluation of an Expedited Omalizumab Home Self-Administration Pathway

“…Previously strict guidelines were loosened to allow extra-license usage of home self-administration in patients with a history of anaphylaxis which had a clear trigger unrelated to omalizumab or in shortening the pathway [ 3 ]. The effects of the pandemic and these guidelines in the real world were investigated by Krishna et al [ 17 ]. It was found that 86-92% of immunology services continued routine appointments including new referrals but most of these consultations were telehealth or virtual, as there was a significant reduction in face-to-face consultations amongst the 99 immunology and allergy services participating in the study.…”

“…The vast majority of services changed immunoglobulin administration regimens and reduced sublingual and subcutaneous injection immunotherapy among other therapeutic procedures. Adverse outcomes relating to these changes primarily centred around the immunoglobulin replacement therapy, although some centres reported exacerbations of CSU relating to missed omalizumab doses [ 17 ]. One flaw of these reports is inconsistent coding of anaphylaxis and urticarial symptoms; it is possible that the incidents of urticaria may have been misdiagnosed as anaphylaxis, falsely raising the rate of this complication.…”

Progress of Home-Based Food Allergy Treatment during the Coronavirus Disease Pandemic in Japan: A Cross-Sectional Multicenter Survey

“…Ozturk et al reported that only 21% of the respondents were continuing subcutaneous immunotherapy as usual during the COVID-19 pandemic [18]. Krishna et al reported that there was a highly significant decrease in subcutaneous immunotherapy up dosing and maintenance during the pandemic [19]. We predicted that many parents would temporarily suspend the home-based OIT for children with FA to avoid the risk of emergency visits and ambulatory care for adverse reactions.…”

“…Primary Investigators Akagawa Shohei MD, PhD 1 , Anzai Kaori, MD 2 , Bandou Kenji, MD 3 , Ikeda Akiko, MD 4 , Doi Masaaki, MD, PhD 5 , Enomoto Masahiro, MD, PhD 6 , Fujikawa Shiori, MD 7 , Nagai Megumi MD, PhD 8 , Nishiyama Atsuko, MD 9 , Otsuka Keita, MD 10 , Shimizu Satoko, MD 11,12 , Sugimoto Yukiko, MD 13 , Sumimoto Shinichi, MD, PhD 2 , Tanaka Yukiko, MD 14 , Tanaka Yuko, MD 15 , Tanaka Yuya, MD 16 , Wakahara Ryohei, MD, PhD 17 , Yamasaki Koji, MD, PhD 18 Co-Investigators Arima Tomoyuki, MD 8 , Imaide Aya, MD 6 , Fukasawa Yohei, MD 21 , Hashimoto Naoki, MD 19 , Masumi Hiroki MD 8 , Matsutani Eri, MD 3 , Kim Jong Soo, MD 20 , Nakai Yoko, MD 1 , Nakamichi Erina, MD 2 , Natsuki Momo MD 16 , Onaka Masayuki, MD 9 , Shingaki Tomoya, MD 20 , Sunaga Ayana, MD 3 , Tsurinaga Yuki, MD 21 , Yamada Saki, MD 20 , Yamagishi Mitsuru, MD 1…”

“…The relationship between the COVID-19 pandemic and FA treatments has been explored previously [10][11][12][13][14][15][16][17][18], although these reports were review articles (not surveys) [11][12][13][14][15][16][17] or small-scale surveys that included patients and their parents [10,18,19]. However, no large-scale study comprising more than 1000 subjects has evaluated the relationship between the COVID-19 pandemic and FA treatment.…”