Here in New York City, the US center of the COVID-19 pandemic, I closed my private practice entirely except for telemedicine. In the very early days of this epidemic, I restricted shot hours to avoid overlapping immunotherapy (IT) patients with office visits.
In retrospect, I should have stopped even earlier. Since closing the practice, only a couple of my patients have inquired about resuming shots; most of my patients are appropriately laying low and staying home. With most of us on lockdown anyway, there seems little point in worrying about IT now—so when the American Academy of Allergy, Asthma, and Immunology (AAAAI) published recommendations to continue allergen IT during this time, I felt the need to respond.
Among other things, the AAAAI recommendations include the following:
Increase the interval between both maintenance and buildup injections.
Continue venom IT.
For patients with allergic rhinitis, do not initiate immunotherapy during the pandemic except for rare extenuating circumstances.
Stop routine peak flows prior to IT.
Establish measures for limiting total patient and family traffic during IT.
I agree with stopping peak flows now—and probably for a long time to come—until the pandemic has fully resolved. However, we should also stop all inhalant IT and limit venom IT to the highest-risk patients.
