Reopening Allergy/Immunology Services Based on a Phased Approach

In response to the coronavirus disease 2019 (COVID-19) pandemic, a phased approach for resuming suspended allergy/immunology clinical services is advised, according to consensus recommendations published in the Journal of Allergy and Clinical Immunology.

In March 2020, as the COVID-19 pandemic was increasing in North America, shelter-in-place orders were instituted and nonessential ambulatory care was significantly curtailed including allergy/immunology services. However, with rates of new infections and fatalities reaching a plateau and/or declining, the restrictions on provision of routine ambulatory care are lifting, and there is a need to help guide the allergy/immunology clinician on how to reinitiate services.

A diverse group of academic and private practice allergy/immunology specialists conducted an organized discussion of the issues and potential approaches to reopening a clinical allergy/immunology practice and developed guidance in the form of consensus-based, best-practice recommendations.

First, when deciding to reinitiate services, it is essential to have certain key information to assess infrastructure capacity and safety concurrently. The authors recommended that services roll out based on the following 4 phases: 1) community infection risk remains high; 2) community infection risk is declining or stable; 3) community risk is declining; and 4) postpandemic “normal” operations. For example, in phases 1 and 2, routine spirometry is contraindicated in most situations because of the risk for aerosolization, except when treatment decisions cannot be made without such information and if it can performed with the appropriate precautions. In phase 3, however, spirometry and office-based rhinolaryngoscopy can be reintroduced.

Rolling out services in this manner will allow for time to monitor demand for in-person services, changes to the rate of community exposure to COVID-19, recommendations for and access to personal protective equipment, and to address staffing issues. The authors also provided special considerations for patients with primary and secondary immunodeficiency, including conducting visits via telehealth whenever possible, as these patients may be at a higher risk for severe COVID-19.

“The decisions on what services to offer and how fast to proceed are left to the discretion of the individual clinician and practice, operating in accordance with state and local ordinances with respect to the level of nonessential ambulatory care that can be provided, and to some extent where appropriate, patient preferences if a preference-sensitive context may exist within a particular risk tier,” the authors concluded.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Searing DA, Dutmer CM, Fleischer DM, et al. A phased approach to resuming suspended allergy/immunology clinical services. J Allergy Clin Immunol Pract. 2020;8(7):2125-2134.