key: cord-0908348-2w4pecrv
authors: Casale, Thomas B.; Wang, Julie; Nowak-Wegrzyn, Anna
title: Acute At Home Management of Anaphylaxis During The Covid-19 Pandemic
date: 2020-04-18
journal: J Allergy Clin Immunol Pract
DOI: 10.1016/j.jaip.2020.04.022
sha: 25a77fd1e417ea69da63fd1a6a030d1f0cd0b968
doc_id: 908348
cord_uid: 2w4pecrv

nan

fatalities will likely result. Implicit in these numbers is the risk involved for uninfected COVID-19 patients 48 seeking medical care in an emergency situation. Allergists/immunologists may need to modify 49 recommendations for the acute management of anaphylaxis during these unprecedented times to 50 ensure optimal outcomes of anaphylaxis while weighing the infectious risk and health care burdens 51 associated with the COVID-19 pandemic. (1) The following recommendations reinforce and expand on 52 the recent expert opinion to assist allergists/immunologists in considering how to adjust their practice 53 under these unique circumstances. (1, 2) Decision-making will vary based on local contexts and 54 resources as rates of COVID-19 and access to healthcare differ geographically. Moreover, there will be 55 cases of severe anaphylaxis where we would not deviate from the usual plan of contacting emergency 56 services immediately after using epinephrine. (Figure 1 ) Patients should be empowered to activate 57 emergency medical services (EMS) if they feel concerns or feel urgent care is needed after epinephrine 58 use and EMS should be activated if severe symptoms do not completely resolve or if they recur. We 59 recommend utilizing telemedicine to proactively discuss the modified management of anaphylaxis and 60 communicate thresholds for activating EMS, per individual patient's profile, local COVID-19 burden and 61 careful assessment of risk to benefit ratio. 62

Patients with specific disorders that require the immediate administration of epinephrine (Table 1) Patients should inspect the epinephrine injectable devices to determine an expiration date and to 74 identify any potential issues associated with malfunction (see recent FDA communication) (8). The 75 expired and otherwise "suspicious" epinephrine devices should be replaced as soon as possible, 76 however, if a patient only has access to a recently expired autoinjector, they should be informed that 77 use of that device is preferable to non-treatment if a severe reaction were to occur. (8) Patients with underlying asthma should take prescribed asthma medications and maintain optimal asthma control. 79

Having access to a home blood pressure and pulse monitor can also be helpful. 

To be implemented based on the local risk / benefit assessment Patients with history of severe anaphylaxis such as those who have been intubated and ventilated, or had reactions treated with more than two doses of epinephrine should follow their routine anaphylaxis plan and activate emergency services immediately when anaphylaxis is recognized. 

Feeling something bad is about to happen, anxiety, confusion Itchy runny nose, sneezing and/or Itchy mouth and/or few hives, mild itch and /or mild nausea or discomfort

COVID-19: Pandemic 118 Contingency Planning for the Allergy and Immunology Clinic