Tammi Hinds

Information comes from ACAAI. The original article can be found here.

As COVID-19 continues to spread throughout the United States and the world, allergists are hearing from their patients – those with allergies and especially those suffering from asthma. They are worried that having asthma means they’re at increased risk for developing symptoms from COVID-19 if they are exposed. They also wonder if their symptoms will be more dangerous if they have the virus. In addition, a recent announcement regarding a shortage of albuterol has increased anxiety throughout the country.  

It is important if you have been diagnosed with COVID-19 or suspect you may have COVID-19 and are using a nebulizer at home, that you know the virus may persist in droplets in the air for 1-2 hours. Therefore, you should administer nebulized albuterol in a location that minimizes exposure to members of your household who aren’t infected. Choose a location for your treatment where air is not recirculated into the home – places like a porch or patio, or in a garage – areas where surfaces can be cleaned more easily or may not need cleaning.

The allergists of the American College of Allergy, Asthma and Immunology have information and tips to share. We are making every effort to keep our information updated and will be linking to the most current news on the virus to keep you in the loop.

The U.S. Centers for Disease Control and Prevention has listed asthma as one of the chronic illnesses that may increase the chance of a severe case of COVID-19. So, what do you need to know if you or a family member suffers from asthma? Read the points below for more information.

• Respiratory viruses are the most common trigger for asthma exacerbations (severe worsening typically requiring oral steroids to relieve symptoms).
• Not all viruses affect asthma patients equally. Some viruses such as influenza and rhinovirus are more likely to trigger asthma flares than others.
• Right now, we don’t know if COVID-19 is one of those viruses that tends to trigger asthma exacerbation.
• There is no clear evidence that patients with asthma are at any higher risk of contracting COVID-19.
• Asthma is an “underlying medical condition” that may be associated with more severe disease if you are infected with COVID-19.
• There is no evidence that asthma medications used to prevent symptoms (inhaled steroids, oral steroids, montelukast, biologics), etc. increase your risk of contracting COVID-19.

The American College of Allergy, Asthma and Immunology recommends:

• Continuing or resuming your asthma routine that helps you control your symptoms.
• Using short acting rescue medications as needed for symptoms.
• Following your asthma action plan if you have one.
• Following CDC guidelines regarding infection control, hygiene, social distancing, etc.
• If you have an upcoming appointment with your allergist, please call to confirm. Many allergists are using telemedicine for return appointments.
• Contacting your allergist if you have questions about your medications or if your symptoms seem to be worsening or not under control.

The American College of Allergy, Asthma, and Immunology (ACAAI)’s Guidance on Risk of Allergic Reactions to the Pfizer-BioNTech COVID-19 Vaccine:

December 14, 2020
Allergic reactions to vaccines, in general, are rare with the incidence of anaphylaxis estimated at 1.31 in 1 million doses given. With the emergency use authorization of the Pfizer-BioNTech COVID-19 vaccine by the FDA on December 11, 2020, the ACAAI COVID-19 Vaccine Task Force recommends the following guidance for physicians and other providers related to risk of an allergic reaction on vaccination. These recommendations are based on best knowledge to date but could change at any time, pending new information and further guidance from the FDA or CDC. 

1. The Pfizer-BioNTech COVID-19 vaccine should be administered in a health care setting where anaphylaxis can be treated. All individuals must be observed for at least 20-30 minutes after injection to monitor for any adverse reaction. All anaphylactic reactions should be managed immediately with IM epinephrine as the first line treatment.

2. The Pfizer-BioNTech COVID-19 vaccine should not be administered to individuals with a known history of a severe allergic reaction to polyethylene glycol as it is a component of this vaccine known to cause anaphylaxis.

3. Data related to risk in individuals with a history of allergic reactions to previous vaccinations and/or mast cell activation syndrome/idiopathic anaphylaxis is very limited and evolving. A clinical decision to administer the Pfizer-BioNTech COVID-19 vaccine should be undertaken by the physician or other provider administering the vaccine using their professional judgment and in consultation with the patient, balancing the benefits and risks associated with taking the vaccine.

4. Individuals with common allergies to medications, foods, inhalants, insects and latex are no more likely than the general public to have an allergic reaction to the Pfizer-BioNTech COVID-19 vaccine. Those patients should be informed of the benefits of the vaccine versus its risks.

5. The Pfizer-BioNTech COVID-19 vaccine is not a live vaccine and can be administered to immunocompromised patients. Physicians and other providers should inform such immunocompromised patients of the possibility of a diminished immune response to the vaccine.

6. Anyone with questions related to the risk of an allergic reaction to the Pfizer-BioNTech COVID-19 vaccine should contact their local board-certified allergist/immunologist.

Links

Frequently Asked Patient Questions About the COVID-19 Vaccine (Updated 01/11/2022)

Important information about COVID-19 for those with asthma (Posted 3/12/2020)

A message to asthma sufferers about a shortage of albuterol metered-dose inhalers (Updated 04/09/2020)

Asthma-specific information and recommendations from the CDC (Updated 04/07/2022)

COVID-19 resources from the American College of Allergy, Asthma and Immunology

We are not equipped to test or treat COVID-19.

Please click here to be directed to the Colorado Department of Public Health and Environment’s website for information on testing criteria and locations.

As allergists, we are advising all of our patients, especially those with asthma, to remain on their medications. Specifically, asthma patients taking inhaled corticosteroids (ICS) should be advised to continue these medications as they have been shown to prevent or reduce asthma exacerbations. To date 80% of cases are mild and self-limited, manifesting as fever, cough and shortness of breath. 

For now, we remain calm and prudent on how we advise our patients. For patients with severe asthma currently on a biologic therapy, there is no information at this time that these treatments should be stopped. Optimal control of this chronic condition is of the utmost importance.

We are implementing intensive phone prescreening of acute visits to determine if patients have had fever for the past several weeks, potential exposure to COVID-19, or new onset cough. This way, patients can be effectively triaged before arriving at our office or even referred to an acute care clinic, emergency room or your local facility set up to handle potential COVID-19 exposed patients as we feel that our office is not prepared to safely treat COVID patients; while protecting other patients and staff in the office from the virus.

Reasonable health care recommendations for our asthma patients are:

1. Avoid close contact (6 feet) with people who are sick.
2. Avoid touching your eyes, nose, and mouth.
3. Wash your hands often with soap and water for at least 20 seconds.
4. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.
5. Use tissues to cover coughs and sneezes, then discard tissue in the trash.
6. Clean/disinfect frequently touched objects and surfaces.
7. Continue your regular controller/maintenance therapies
8. IF YOU ARE SICK, STAY AT HOME! 

This is an excerpt from https://acaai.org/news/important-information-about-covid-19-those-asthma

Our office is not equipped to test or treat patients with COVID-19.

For the safety of our staff and other patients, many of whom have compromised immune systems or severe respiratory problems, we ask that you call us before coming to the office if you are experiencing symptoms of the flu or other respiratory infection including: fever, cough, runny nose, etc. or if you suspect you have been exposed to the coronavirus through close personal contact with a confirmed case or travel.

For information on the virus and how to protect yourself, we recommend the CDC website, which can be found by clicking here.

We recommend using standard flu precautions: hand-washing for at least 20 seconds with water, avoid sick people, stay home if sick, and clean frequently touched surfaces often.

For information specific to Colorado, the Denver Post is doing a good job tracking coronavirus in Denver and around the state.

What is it? 

Palforzia is the first of its kind treatment for patients age 4 to 17 who have a history of confirmed allergy to peanuts.  Palforzia comes as a powder that is made from peanuts.  It will come in a capsule form.  The capsule is emptied and mixed with a small amount of applesauce, yogurt, or pudding that is swallowed.

What does it do?

Though there is no “cure” for food allergies, Palforzia can be prescribed to help reduce the likelihood of a severe allergic reaction to peanuts with accidental exposure, including anaphylaxis.  It is NOT an emergency treatment for anaphylaxis.

How does it work?

The exact mechanism of how Palforzia works is not known.  However, just like other types of oral immunotherapy, exposing peanut allergic patients to small amounts of peanut protein over time can potentially reduce the likelihood of a severe reaction.  The amount of peanut protein from Palforzia is increased gradually over the course of several months.

When will I see benefits?

Scientific studies showed a reduction in allergic symptoms after patients were on a maintenance dose of Palforzia for 6 months when challenged with a dose of 600 mg of peanut protein (about 2 peanuts).

What are the side effects?

The most common side effects reported included abdominal pain, vomiting, nausea, itching, cough, runny nose, throat irritation, hives, asthma symptoms, and anaphylaxis.  No fatal reactions occurred in the clinical trials.

How much does it cost?

The annual cost of Palforzia falls in the middle of the $3,000 to $20,000 range.  It is not known at this time whether insurance companies will cover a part or all of this cost.

What do I do?

Palforzia is a very new treatment option.  It is not appropriate for all patients.  Please talk to your doctor at BVAAC/DAA to get more information.  Remember, Palforzia is not a cure for peanut allergy.  Peanut avoidance and having injectable epinephrine available for treatment of an allergic reaction remains the mainstay of management.

The Physicians and Staff of BVAAC/DAA

For the full FDA Press Release, click here.