Subcutaneous immunotherapy with aeroallergens in a central hospital in portugal during the covid-19 pandemic

Abstract

Background: Allergic disease, allergic rhinoconjunctivitis/bronchial asthma, are very prevalent worldwide, and the poten-tially modifying therapy is immunotherapy with aeroallergens. In December 2019 a new coronavirus (SARS-CoV-2) was iden-tified in China, causing a pandemic with devastating effects. For this reason, the State of Emergency (SE) was declared in Portugal for the first time in this pandemic, between 18 March and 2 May 2020, and all non-urgent activity was suspended in our hospital, including the administration of subcutaneous immunotherapy with aeroallergens (SCITA). Objective: Cha-racterize the dose adjustments according to the delay in SCITA administration, verify the safety of the dose administered when resuming SCITA and evaluate the worsening of symptoms of the allergic disease, in patients under SCITA program that inter-rupted it during the SE. Material and methods: An analysis of the SCITA clinical records of the 195 patients who interrupt-ed the maintenance dose during EE was performed. According to the symptoms and the delay interval, the dose was reduced or a new initiation protocol was performed, according to our Allergen Immunotherapy Functional Unit protocol, adapted from international guidelines for this specific time. Results: 7.7% of patients had worsening of allergic symptoms during the interruption period and 6.2% resorted to rescue therapy. 96.4% decreased the dose in SCITA resumption, with a decrease that was mostly greater than predicted, according to our protocol. Immediate local reactions were recorded in 9.2%, with no ana-phylactic reactions. After recovery, 9.7% worsened symptoms and 5.1% resorted to rescue therapy. Conclusions: The pandemic made it very difficult to monitor patients’ chronic pathologies, including allergic diseases. The majority of patients did not report worsening of symptoms and few had adverse reactions in the resumption of SCITA, demonstrating the safety of the dose adjustment protocol.