Re-engaging in Immunotherapy

Many otolaryngology allergy patients have had their course of treatment interrupted by the coronavirus epidemic. Reinitiating subcutaneous immunotherapy therapy (SCIT) after a prolonged absence poses a risk of a serious systemic adverse event, and other considerations apply to other potential treatment and diagnostic modalities. Review “How to Safely Re-engage Allergy Immunotherapy Patients After Coronavirus Shutdown,” published in the June 2020 issue of ENTtoday, before you answer the question.

Which of the following is NOT in line with recent expert opinion-based guidance released by the American Academy of Otolaryngic Allergy for resuming care in such patients?

Dose must be considered when reinitiating SCIT to decrease the risk of serious complications. In determining how much to decrease the dose, time since the last injection is a major factor, with a greater time since injection requiring a greater reduction from the most recent dose.

When restarting SCIT, certain patients will need greater dose reductions based on various clinical factors that might increase the chance of a serious adverse event. Clinicians should consider lowering doses even further for factors that include allergic disease severity, degree of asthma control and severity, seasonality (in relationship to pollen allergies), medications of concern, or relevant changes in overall health status.

Short bursts of systemic corticosteroids should never be used for allergy patients in the COVID-19 era. This is because their use in patients with active COVID-19 infections has been demonstrated to worsen the infection in its early stages.

Because COVID-19 is transmitted through the aerosolization of viral particles, certain procedures should currently be omitted or replaced with alternatives. For example, corticosteroids can be given via metered-dose inhalers instead of nebulizers, and chest auscultation can be performed instead of peak flow testing.

Question by Ruth Jessen Hickman, MD