The coronavirus disease 2019 pandemic imposed multiple restrictions on health care services.
Objective
To investigate the impact of the pandemic on Allergy & Immunology (A&I) services in the United Kingdom.
Methods
A national survey of all A&I 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 & 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.
Results
A total of 99 services participated. There was a reduction in nursing, medical, administrative, and allied health professional staff during the pandemic; 86% and 92% of A&I services continued to accept nonurgent and urgent referrals, respectively, during the pandemic. There were changes in immunoglobulin dose and infusion regimen in 67% and 14% of adult and pediatric services, respectively; 30% discontinued immunoglobulin replacement in some patients. There was a significant (all variables, P ≤ .0001) reduction in the following: face-to-face consultations (increase in telephone consultations), initiation of venom immunotherapy, sublingual and subcutaneous injection immunotherapy, anesthetic allergy testing, and hospital procedures (food challenges, immunoglobulin and omalizumab administration); and a significant increase (P ≤ .0001) in home therapy for immunoglobulin and omalizumab. Adverse clinical outcomes were reported, but none were serious.
Conclusions
The pandemic had a significant impact on A&I services, leading to multiple unplanned pragmatic amendments in service delivery. There is an urgent need for prospective audits and strategic planning in the medium and long-term to achieve equitable, safe, and standardized health care.
Key words
COVID-19
Allergy
Immunology
Service
Impact
Immunodeficiency
Abbreviations used
A&I
Allergy and Immunology
BSACI
British Society for Allergy and Clinical Immunology
COVID
Coronavirus disease
COVID-19
Coronavirus disease 2019
CSU/A
Chronic spontaneous urticaria and angioedema
IgRT
Immunoglobulin replacement therapy
IQAS
Improving Quality in Allergy Services
NHS
National Health Service
RCP
Royal College of Physicians
SCIT
Subcutaneous immunotherapy
SLIT
Sublingual immunotherapy
VIT
Venom immunotherapy
Cited by (0)
Conflicts of interest: M. T. Krishna has received grants from MRC CiC, NIHR, and FSA for research unrelated to this study; received funds to attend the European Academy of Allergy and Clinical Immunology conference; and is clinical lead for the Improving Quality in Allergy Services national accreditation program. His department received funds from ALK Abello, Thermofisher, MEDA, and other pharmaceutical companies for PracticAllergy course. P. J. Turner reports grants from UK Medical Research Council, NIHR/ImperialBRC, UK Food Standards Agency, End Allergies Together, and Jon Moulton Charity Trust; personal fees and nonfinancial support from Aimmune Therapeutics, DBV Technologies, and Allergenis; personal fees and other fees from ILSI Europe and UK Food Standards Agency, outside the submitted work; and is current Chairperson of the WAO Anaphylaxis Committee, and joint-chair of the Anaphylaxis Working group of the UK Resuscitation Council. C. B. is clinical lead for the Quality in Primary Immunodeficiency Service national accreditation program. The rest of the authors declare that they have no relevant conflicts of interest.
