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COVID-19 pandemic and allergy and immunology services in the UK

Published online: February 1, 2021

The coronavirus disease 2019 pandemic imposed multiple restrictions and changes to health services globally.

In a study published by Krishna et al in The Journal of Allergy and Clinical Immunology: In Practice, the authors investigated the impact of coronavirus 2019 pandemic on the delivery of Allergy and Immunology services in the United Kingdom National Health Service. A national survey of all adult and pediatric allergy and immunology services registered with the Royal College of Physicians and/or the British Society for Allergy and Clinical Immunology was carried out. The survey covered staffing, facilities, personal protective equipment, appointments and patient review, investigations, treatments, and research activity. Weeks commencing February 3, 2020 (pre-coronavirus disease), April 6, 2020, and May 8, 2020, were used as reference points for the data set.

Ninety-nine services participated in this survey. Key findings are summarised as follows:

1. There was a reduction in nursing, medical, administrative, and allied health professional staff during the pandemic.
2. 86% and 92% of allergy and immunology services continued to accept nonurgent and urgent referrals, respectively, during the pandemic.
3. There was an adverse impact on patients receiving life-saving immunoglobulin replacement treatment for immunodeficiency with respect to changes to dosage and treatment regimen. A third of services also reported discontinuing immunoglobulin replacement treatment in some patients.
4. There was a significant reduction in face-to-face consultations (with an increase in telephone consultations), initiation of desensitisation treatment (immunotherapy) for bee and wasp sting anaphylaxis, desensitisation treatment for allergic rhinitis, anesthetic allergy testing for those experiencing anaphylaxis during anaesthesia, and specialist hospital procedures, including food challenges and administration of treatments such as immunoglobulin and omalizumab.
5. There was a significant increase in home treatments for immunoglobulin for primary immunodeficiency and omalizumab for chronic urticaria.
6. Adverse clinical outcomes were reported, but none were serious.

These findings suggest that the pandemic had a significant impact on allergy and immunology services in the United Kingdom leading to multiple pragmatic changes to service delivery.  Understanding of these changes will shape new guidelines regarding delivery of an equitable, safe, and standardized allergy and immunology service and a ‘fit for purpose’ governance framework in the post-pandemic recovery phase.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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