Indian Journal of Allergy, Asthma and Immunology

EDITORIAL
Year
: 2021  |  Volume : 35  |  Issue : 1  |  Page : 1--2

Allergy testing amidst COVID pandemic


Nitin Goel, Raj Kumar 
 Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi, India

Correspondence Address:
Prof. Raj Kumar
Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, Delhi-110007
India




How to cite this article:
Goel N, Kumar R. Allergy testing amidst COVID pandemic.Indian J Allergy Asthma Immunol 2021;35:1-2


How to cite this URL:
Goel N, Kumar R. Allergy testing amidst COVID pandemic. Indian J Allergy Asthma Immunol [serial online] 2021 [cited 2022 Jan 20 ];35:1-2
Available from: https://www.ijaai.in/text.asp?2021/35/1/1/331802


Full Text



The unprecedented situation due to coronavirus disease-2019 (COVID-19) pandemic has unleashed havoc on health-care systems worldwide. This has resulted in a radical change in the practice and management of non-COVID diseases so as to minimize the spread of infection. But now, as the community infection risk is declining, many such testing and management practices are being restored. Hence, the in vivo allergy testing, especially the skin prick test (SPT), has to be resumed, although with certain precautions.

 Measures at Staff Level



All staff should be trained and should adhere to the standard COVID-19 infection prevention and control practices.[1] They should always maintain safe distance from patients, wear personal protective equipment as advocated, especially the face masks and gloves appropriately, and also follow stringent hand hygiene practices. Further, all health-care workers should undergo COVID vaccination.

 Patient-related Measures



Prior to giving an appointment for allergy testing, patients should be screened with a structured questionnaire related to COVID-19 symptoms and signs. If a patient has any suspicious symptom, history of contact, or fever on examination, he should undergo reverse transcription–polymerase chain reaction testing. In addition, allergy testing should be delayed till the patient is completely asymptomatic and tests negative for COVID-19. It should be ensured that patients wear face masks at all times during hospital visits. The importance of proper allergological history by experienced doctors before scheduling a patient for allergy testing can never be overstressed. Further, physical distancing of patients also is to be ensured at all times, even in waiting areas by placing chairs at least 1 m apart. Limited appointments with adequate time gaps should be given for allergy testing to minimize crowding.[2],[3] Furthermore, the maximum number of companions with the patient should be limited to one.

 Engineering Controls



Optimized utilization of space in allergy testing room should be done with minimum essential furniture only to be placed. Use of tapes/markers to facilitate spacing and workflow is advisable. The allergy testing room should have adequate ventilation; if it has windows, they should be kept open. If the allergy testing room has central ventilation, its regular maintenance and replacement of filters should be done.

Creation of a physical barrier is another helpful precautionary step. Physical barriers made using acrylic (plexiglass) or polycarbonate plastics have been used to good effect in commercial areas such as grocery stores, bank counters, and reception areas. These barriers have also been recommended by the US Centers for Disease Control and Prevention for use in airport retail or food service workers, and studies have also found them to be effective.[4],[5] It is recommended that the height of such barrier should be determined, keeping the tallest user in mind. To cover the breathing zone, a diameter of at least 12 inches extending in all directions from the mouth and nose needs to be covered.[6] We utilized this principle and innovated to use physical barrier protection as an add on while performing SPT.

A transparent acrylic sheet of about 30 inches height (from the tabletop surface), 50 inches width, and with two semi-circle (about 6 inches diameter) punched out holes at the level of the table, was fixed on top of the SPT table [Figure 1]. The patient places the forearms on the table through the punched-out holes [Figure 2] for SPT. This added to the physical barrier between the patient and doctor/staff performing the SPT.{Figure 1}{Figure 2}

 Priority Order of Allergy Tests



Skin allergy test and patch tests do not involve aerosol generation and are considered low-risk procedures, whereas food challenge test, drug challenge tests, and skin testing in younger children fall under medium risk category. Tests such as spirometry, exhaled nitric oxide, and peak flow meter entail higher exposure risk. Further, patients can be prioritized based on their history and condition.[2]

 Review and Modification



A regular review of safety and prevention measures should be undertaken. Modifications in protocols and practices may be warranted accordingly if community COVID-19 infection detection rates change. An uprise in local pandemic conditions shall require curtailing of these allergy tests.

References

1Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html. [Last accessed on 2021 Nov 17].
2Available from: https://education.aaaai.org/resources-for-a-i-clinicians/prepare-your-practice_covid-19. [Last accessed on 2021 Nov 17].
3Pfaar O, Klimek L, Jutel M, Akdis CA, Bousquet J, Breiteneder H, et al. COVID-19 pandemic: Practical considerations on the organization of an allergy clinic-An EAACI/ARIA Position Paper. Allergy 2021;76:648-76.
4Available from: https://www.cdc.gov/coronavirus/2019-ncov/community/airport-retail-factsheet.html. [Last accessed on 2021 Nov 18].
5Bartels J, Estill CF, Chen IC, Neu D. Laboratory Study of Physical Barrier Efficiency for Worker Protection against SARS-CoV-2 While Standing or Sitting. Available from: https://www.medrxiv.org/content/10.1101/2021.07.26.21261146v1.full.pdf+html. [Last accessed on 2021 Nov 18].
6Available from: https://www.ccohs.ca/covid19/physical-barriers/#:~:text=Physical%20barriers%20may%20include%20curtains, a%20variety%20of%20different%20materials. [Last accessed on 2021 Nov 18].