The COVID-19 pandemic has caused a disruption in subcutaneous therapy (SCIT) for many patients. One survey designed to determine experiences of allergists during the pandemic found that 31% had discontinued providing SCIT at some point during the pandemic.(1) Now practices are considering the best way to re-engage allergy immunotherapy patients, shifting from acute only to re-opening for full clinics.(2)
“For patients on SCIT, re-starting after a prolonged absence can result in a serious systemic adverse event,” according to the American Academy of Otolaryngic Allergy, which adds that dosing can be reduced to allow for a more gradual introduction. “The time since the last injection is a major factor in determining how far back to reduce the dose in the escalation plan.”(3)
A paper published in July 2020 in the Annals of Allergy, Asthma, and Immunology stated that providers utilize different approaches for restarting SCIT after an interruption. Over 1,000 providers reported their technique in an online survey. “Most reduced the dose a certain number of steps back, others reduced a percentage, and a few reduced a certain volume.”(4) The paper’s authors cautioned that some patients are at higher risk for systemic reactions when returning to SCIT. These include patients with the following: “history of anaphylaxis or mast cell disorder; moderate to severe asthma; high sensitization pattern or systemic reaction during skin prick testing; systemic reactions to previous SCIT administration; and patients receiving SCIT during peak pollen season for an allergen to which they are highly sensitized.”(4)
Xtract Immunotherapy Software, a secure digital platform developed for allergy practices, offers several features helpful for providers restarting SCIT. The software enables doctors and nurses to run reports, instantly displaying which patients have not come in for their shots in over a certain period of time, so patients can be contacted to discuss restarting their treatment. This can help office staff be proactive with patient follow-up, possibly reducing the gap in treatment.
Xtract software allows the provider to adjust the patient dose down to a level that is safe in order to restart treatment and also adjust the treatment plan that suggests future doses accordingly. All previous injections and any reactions are visible on a single screen, making clear the very last injection and precise dosage.
Xtract provides text and email reminders about shot clinic hours or changes in policy regarding COVID protocols so patients can make informed decisions about coming into the office to get their shots.
(1) Ozturk, A. M.D., Barcioglu, A. M.D., et. al., International Archives of Allergy and Immunology, Change in Allergy Practice During the COVID-19 Pandemic, https://www.karger.com/Article/
(2) ENT Today, How to Safely Re-engage Allergy Immunotherapy Patients after Coronavirus Shutdown, https://www.enttoday.org/article/
(3) American Academy of Otolaryngic Allergy, Resuming SCIT During COVID-19 Pandemic, https://aaoallergy.org/
(4) American College of Allergy, Asthma, and Immunology, Gaps in Allergen Immunotherapy Administration and Subcutaneous Allergen Immunotherapy Dose adjustment Schedules, https://www.ncbi.nlm.nih.gov/pmc/articles/