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Why Some People Still Need Their Allergy Shots During the COVID-19 Pandemic

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As COVID-19 continues to ravage the world, I’ve seen more and more allergy and immunology office closures across the United States. This has been occurring despite the CDC, WHO, FDA and other national and international health authorities all informing patients who take allergy medications and asthma medication to continue their medication and other treatment regimens to prevent increased susceptibility to COVID-19 and increased severity in the event they become infected. This seems to be a very serious lapse in judgment by providers as many of the symptoms of COVID-19 can mimic an allergic reaction. In fact, I’ve seen many people report having thought they were experiencing an allergy attack and were then actually diagnosed and tested positive for COVID-19.

What Do Allergy Shots Do for Patients and Why Is This Such a Big Deal During COVID-19?

Allergy shots have been proven time and again to help patients’ immune systems to stop overidentifying common substances as threatening invaders. When the body has allergic reactions of any form it begins an inflammatory process that is driven partly by histamine, cellular activity and other chemical reactions. This process then creates the symptoms we are all familiar with such as runny nose, stuffy nose, sinus blockage, sinus pressure, chest congestion, chest pressure, wet or dry cough, nausea, headaches, increased migraine attacks, increased asthma symptomatology and attacks and breathing problems, skin rashes and hives and even anaphylaxis.

The Problem of Allergic Asthma

Since the start of the pandemic, it has been driven home time and again by the World Health Organization and other health authorities that asthma is considered to be a predisposing risk factor for the SARS-cov-2 virus that causes the COVID-19 disease. Asthma, like many other conditions, comes in a variety of forms and differs in severity from patient to patient. Allergic asthma, in specific, is especially dangerous for patients when their treatments are interrupted or medications are stopped. When a patient with allergic asthma receives allergy injections, a majority have been proven to experience often dramatic relief from symptoms, less severe asthma attacks, less allergic rhinitis, and other allergy related conditions and symptoms. Most importantly, many experience a great increase in their ability to breathe easily and some have even gone on to require less treatments overall and less emergency hospital visits related to their conditions.

What’s the Issue With These Closures?

The issue with these closures has many sides to it. Allergy injections are helping patients with already overactive immune systems remain balanced so that the body is not putting all of its resources into fighting off things that it doesn’t need to be. From my experience, when allergy shots are stopped prematurely (and in some cases stopped at all as there are many patients who need these lifelong due to a combination of medical reasons and conditions) the body begins recognizing these items as invaders again as time goes on. This draws the finite resources of a patient’s body away from the tasks it needs to be focusing on such as fighting off and defending itself against pathogens of various origins. When this happens allergy patients report an increase of influenza, colds, bronchitis, pneumonia, migraine attacks, asthma attacks requiring emergency medical attention, severe rhinitis, sinus infections, dermatitis and other skin reactions such as rashes, increase in hive cases requiring emergency medical attention, and multiple other issues ranging from mild to severe.

Secondly, as COVID-19 puts immense strain on our already overcrowded hospitals, urgent cares, and medical offices, keeping patients out of the hospitals who don’t need to be there is of utmost importance. Preventing outbreaks of other diseases, ailments, flair up of chronic conditions such as allergies and asthma, etc. is perhaps one of the most important things we can do. When these patients need emergency care, regardless of age, gender, etc. they are then being put in further danger of contracting the virus than they were before just by having to be in the hospital itself and in the vicinity of other cases. These are unnecessary exposures as they would not have been in the hospital or urgent care, etc. if their allergic conditions were being controlled as they generally are. In addition, the finite resources such as IV fluids, medications, beds, ventilators, etc. that we are already struggling to have on hand are put under even more strain.

Thirdly, we are approaching what is known as the beginning of allergy season. Those with seasonal allergies are just beginning to experience a very large uptick in symptoms and illnesses in those who both receive and do not receive allergy shots. This seems to be a very serious lapse in judgment by providers as many of the symptoms of COVID-19 can mimic an allergic reaction. In fact, many people report having thought they were suffering from an allergy attack and were then actually diagnosed and tested positive for COVID-19. In addition, allergy injections have been proven to reduce sinus infections, and other conditions that could be

Fourthly, many allergy patients also have other severe health conditions (comorbid conditions). These conditions have the potential to be activated, reactivated, agitated or altogether flared up, worsening patient outcomes and quality of life. Many of the conditions are life threatening when activated in combination together. Among these conditions, there are many we may not actually consider that have huge ramifications.

One patient story recently shared in a support group involved a young woman in her mid 20s who was receiving allergy injections. Her allergist decided to cease injections at this time due to the pandemic. Over the course of the next two weeks, especially as seasonal allergies have begun to ramp up, she began having itching and crawling sensations on her skin. For her, this phenomena was one that had been suppressed for over two years now by her allergy injections. The return of these symptoms inadvertently ended up reactivating a previously well controlled case of trichotillomania that was inadvertently positively affected by the injections. (In other words, when the allergies were controlled, she was actually better able to cope with her trichitillomania.)

This caused her to experience a great mental and physical distress as she began to uncontrollably scratch and pick at her skin. She dug so deep that she required medical attention, medication adjustments that rendered her even more unstable in other areas of her multiple health conditions, and intervention to control the infections that were occurring from her wounds. These open wounds also then made her more susceptible to other severe health conditions. The woman’s mental health was further harmed as she was now grappling with the fact that she was having these uncontrollable, unconscious behaviors associated with trichotillomania. For instance, the clinical depression she also had ramped up as she then felt devastated to be facing this uncontrollable self-harm behavior which turned inward, resulting in suicidal ideation and other severe mental health reactions despite her being adherent to all her mental health treatments and regular therapy.

While this may seem like an extreme case, it is actually more common than you may realize, but presents as different situations for different patients.

Everything Has an Equal and Opposite Reaction

With this in mind, we must remember that our good intentions have the potential to cause severe harm if they are not analyzed in a fully informed scope. I guarantee the young woman’s physician in the above case did not ever intend for her to have this happen to her. However, it did. And it was because of their initial action of ceasing a vital treatment without recognizing that there are ramifications in individual patient lives beyond what they are treating. In many aspects, it is a case of a physician being too specialized to the point of an inherent or subconscious bias that clouds them from seeing the possible scope of their decision. The main problem all stems from a subconscious bias that is easy to fall into in the medical field where a physician or other professional begins to view “patients” as a singular entity versus individuals who are affected by very individual circumstances.

While that may paint a picture of a mad doctor carelessly mistreating their patients in a horror film, that is generally not the reality here. In fact, it is often the most caring, most involved physicians that experience a struggle with this bias. It is seldom intentional or conscious, but rather, subconscious (to no fault of their own). This results in a failure to recognize that as a physician or health care professional, actions must be tailored to individual cases. Experience and history tells us that when we treat all cases the same without considering the independent variables involved in each and every case, (even ones that seem similar have unique facets to them that require careful consideration) we generally cause harm to patients unintentionally. Whether it is mental, physical or systemic, these actions create hardships that threaten a patient’s ability to live well and a physician’s ability to treat well. In the face of a pandemic it becomes even more important for physicians to take time to reflect on these biases and how they may be present in their own ideas before they make any decisions like shutting down their practice or suspending treatments for an entire group of patients. It must be considered which individuals may be able to either lengthen times between certain treatments or forego them altogether, and which cannot. And specific care for those who cannot is imperative to ensuring patient safety and wellbeing in the face of a pandemic. When we don’t do this we worsen the pandemic. We put people in jeopardy unintentionally and cause the very harm that was sworn against.

Sweeping closure policies in healthcare are detrimental anytime, let alone during a pandemic. E-visits are great, but it is important to remember that there are important treatments that cannot be done over e-visits and without those, we are straining our already fragile system, along with the very lives we swore to protect and treat. It may seem like just allergies. But, regardless of the condition, it is never just anything. We must remember that together as patients and providers alike. Allergy shots are important and like other treatments affect the entire body which includes the mind. There are ways of administering these and still ensuring patient and staff safety such as utilizing patient vehicles as personal waiting rooms where a patient is called one at a time to enter the building or office or receive treatment at the carside in certain cases. There are also countless other innovative ways to solve these barriers. They all require innovative and per patient thinking.

There are still many unknowns about this virus and the disease it causes, but one thing is for certain: if we continue to use this same way of thinking that we have been, we will inadvertently send the curve flying upwards when it doesn’t need to (and that applies to all areas of healthcare). It wasn’t the intention, but we can fix it now and align our intentions with the reality of the situation for individual patients beyond the local clinics, and thus, all patients. We won’t be able to later.

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Originally published: May 5, 2020
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