Image of physician writing on clipboard

 

 

The AAAAI has compiled the following resources so that you have the latest information to inform you as you continue to treat your allergy/immunology patients during the ongoing pandemic. This includes a section specific to pediatric patients due to the increase of COVID-19 cases in children.

 

 

Treating Your A/I Patients

Caring for Pregnant Patients with Asthma during the COVID-19 Pandemic (Updated 5/19/21) 

Coronavirus Disease 2019 (COVID-19) with a Focus on Older Adults: A Guide for Allergist/Immunologists and Patients (Updated 4/13/21) 

The Relationship Between COVID-19 and Asthma: A Summary of the Research to Date (9/4/20) 

Immunotherapy during the COVID-19 Pandemic: a Work Group Report on Administration of Subcutaneous Allergen Immunotherapy from the AAAAI IASAD Committee (3/25/20) 

  • The COVID 19 Task Force does not anticipate any contraindication with the COVID-19 vaccine for patients on allergen immunotherapy (AIT). However, it would be best to not get the 2 shots within 48 hours of each other to avoid confusion should a reaction occur. 

An Additional Vaccine Dose for Moderately to Severely Immunocompromised Patients Age 12 and Above

  • On August 19th 2021, the CDC made the recommendation that immunocompromised patients should receive a third COVID-19 dose in order to improve their chances of protective immunity. They specifically recommended that patients with moderate to severe primary immunodeficiency disorders should be among those who receive a third dose. 
  • The AAAAI Primary Immunodeficiency Diseases Committee (PIDD) have reviewed available evidence on SARS-CoV-2 vaccine responses in patients with inborn errors of immunity (IEI), and acknowledge that information regarding the types of IEI that represent higher risk of either severe COVID-19 and/or suboptimal response to current SARS-CoV-2 vaccinations is still emerging. The AAAAI PIDD committee endorses the third dose for people with immune deficiencies as it believes most patients will benefit from the extra dose.  However, the timing and specifics should be discussed with one’s own immunologist. 

    Pediatric Patients

    As of September 2021, cases of COVID-19 in children are surging due to the ongoing spread of the Delta variant. Allergists need to remember that children, who have returned to school, may not be required to wear masks, are not currently eligible to be vaccinated if they are younger than 12, and thus could be a risk to other children and immunocompromised adults. Be aware of your local school district requirements and be an advocate for your patients’ safety. 

    Vaccines

    FDA and AAP Warn Against Off-Label Use of the Pfizer Vaccine 
    There have been a significant number of children in the United States younger than 12 years who have been given this vaccine. Both the FDA and the AAP strongly advise against this. Studies are currently ongoing to determine the proper dose and to evaluate the response. Giving this vaccine off-label could threaten your liability protection. 

    Vaccine Safety and Efficacy in Adolescents                                                                                               
    Despite the earlier approval for the mRNA vaccines in adolescents, only a minority have received the vaccine. This update from the ongoing phase 2-3 placebo-controlled trial of the mRNA-1273 (Moderna) shows that local reactions (primarily injection site pain, swelling and erythema) occurred in 93.1% and 92.4% after the first and second dose respectively. 95% of these reactions were mild to moderate. Systemic reactions (headache, fatigue, chills were the most common) occurred in 68.5% and 86.1% respectively, with 85% being mild to moderate. Efficacy was similar to that in young adults. You can use this information to help convince your adolescent patients and their parents to consent to the vaccine. In another study, cardiologists report that in a small study of adolescents with myocarditis following the mRNA vaccine most tended to have a mild course, similar to young adults. 

    CDC: How to Talk with Parents about COVID-19 Vaccination 

    Case and Hospitalization Rates 

    Hospital Data Compared with Vaccination Coverage
    This study demonstrated that ER visits and hospitalizations are four times greater in areas with low vaccine coverage compared to those with high vaccine coverage.  (MMWR, Sept 10, 2021)

    Hospitalization Among Children and Adolescents 
    Weekly COVID-19-associated hospitalization rates among children and adolescents rose nearly five-fold during late June to mid-August 2021, coinciding with increased circulation of the highly transmissible SARS-CoV-2 Delta variant. The proportions of hospitalized children and adolescents with severe disease were similar before and during the period of Delta predominance. Hospitalization rates were 10 times higher among unvaccinated than among fully vaccinated adolescents. 

    Schools/Transmission 

    Importance of Vaccines and Masks in the School Setting 
    The CDC reported an outbreak in Marin County, California in May-June of 2021 associated with an unvaccinated, symptomatic elementary teacher who was periodically unmasked, where 55% of her students were subsequently infected. The secondary attack rate was 80% in the rows closest to the teacher. The school had high adherence to masks among the students, six foot separation of desks and increased ventilation. 

    Pediatric Household Transmission of SARS-CoV-2 Infection 
    This study is particularly relevant as school reopens across the United States. It did take place prior to the dominance of the Delta variant. The study was done in Ontario, Canada and involved 6,280 households with pediatric index cases. 1,717 households (27.3%) experienced secondary transmission. The age group with the highest odds of transmitting the infection to household contacts compared with children aged 14-17 was the 0-3 year age group (1.43, 95% CI 1.17-1.75). Children in the 4-8 year age group also had a higher odds ratio (1.40, 95% CI 1.18-1.67). Since these age groups cannot be vaccinated, it is important for parents to take other precautions and be sure that the school or daycare is doing the same. As allergists who care for pediatric patients or young adults with children, we need to be aware of the family dynamics, childcare and school status in order to counsel our patients about prevention and precaution. 

    Guides for Masks for Children 
    Now that it is back to school time, some of your patient’s parents may ask which mask is best for their child. There are good resources here and here

    External Resources for Pediatric Patients

    AAP Critical Updates

    CDC: Helping Young Children and Parents Transition Back to School  

    CDC COVID-19 Data Tracker – Pediatric Data

    CDC Multisystem Inflammatory Syndrome in Children (MIS-C) Healthcare Provider Resources

    Children and COVID-19: State-level Data Report

    Your Local Epidemiologist BlogCOVID-19 Vaccine Update Table (Your Local Epidemiologist blog and COVID-19 Vaccine Update table are credited to Katelyn Jetelina, PhD, MPH, Assistant Professor in the Department of Epidemiology, Human Genetics and Environmental Sciences at the University of Texas School of Public Health, and are linked with permission.) 


    Ask the AAAAI

    See what other AAAAI members are asking the COVID-19 Task Force about their patients and practices: 


    External Resources

    American College of Physicians (ACP): COVID-19 Information for Internists 

    American Academy of Pediatrics (AAP): Critical updates on COVID-19 

    Centers for Disease Control and Prevention (CDC) COVID-19 Resources   

    Clinical Characteristics of Multisystem Inflammatory Syndrome in Adults: A Systematic Review JAMA Netw Open. 2021;4(9):e2126456

    National Institutes of Health (NIH) COVID-19 treatment guidelines

    Trust for America's Health (TFAH) webinar/slides/transcript: Ensuring COVID-19 Vaccine Access, Safety and Utilization: Building Vaccination Confidence in Communities of Color