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Covid-19 Q&A with Professor Adam Fox

In order to acknowledge a wide range of concerns surrounding allergies during the pandemic,  Professor Adam Fox worked closely with The Allergy Team to develop and respond to a series of commonly asked questions.

If my child has an allergic reaction, will we still get the help we need?

Obviously hospital services are under very significant strain at the moment. However this relates more to adult services than to paediatric ones. Although some paediatricians will have been redeployed in order to support adult services, paediatric services themselves are not under the same levels of stress and they are better placed to continue to provide urgent care. In fact, interestingly, overall children generally are getting far less infectious problems than they would do in a usual winter, and hence as a result paediatric services are coping well.

There is of course an additional concern that ambulance services are very significantly stretched. As a result there may be a delay to ambulance response times, although a child having a significant allergic reaction such as anaphylaxis is considered the highest priority. It is therefore very important that when you call emergency services if your child is having a severe allergic reaction, particularly one that involves their breathing or their circulatory system (meaning that they are struggling for breath, or have become dizzy, confused or collapsed). then you should ensure the call operator is aware that this is anaphylaxis. This will help prioritise an emergency response.

It is particularly important that if you suspect your child is having a severe allergic reaction and you have an adrenalin-auto injector (such as an Epipen or a Jext) then you use it. If you’re not sure if the reaction is severe enough, then it is completely safe to use it anyway. I would always advise that if there is uncertainty that you err on the side of using it rather than not using it. Intramuscular adrenalin is extremely safe.

As in normal circumstances, if there are two people around to help the child having a severe allergic reaction then one should call the emergency services whilst the other administers the adrenalin auto-injector. If there is only one person, I would always recommend the adrenalin auto-injector is given first, if there is a suggestion of a severe reaction, and the ambulance called once this has been done. If things haven’t improved within the space of 5 mins and you have access to a second adrenalin auto-injector then this should be given too, ideally into the other leg that the first one was given.

Hospital emergency departments are now very well developed in terms of their ability to keep patients Covid safe so do not avoid going to hospital if you otherwise would be going because of a concern about catching Covid.

Of course it remains extremely important to ensure social distancing, wearing a mask at any time within a hospital and washing your hands regularly.

Is coronavirus more serious for people with food allergies or asthma?

To date, it has become clear that the major risk factor for having more severe Covid disease is age as well as a number of other conditions which thankfully are very rare in childhood. Allergy and asthma do not present any additional risk. Severe asthma sometimes requires immune suppressant treatment which could put patients at additional risk but this would only include long courses oral steroids or biologics, not steroid or other inhalers. Fortunately severe Covid disease amongst children remains very rare and food allergy specifically has not been seen to be an issue in terms of increased likelihood of transmission or severe disease.

If you have an allergic reaction to food whilst suffering from Covid is the reaction likely to be more serious than usual?

It’s been well recognised that if you’re already unwell with any form of respiratory viral infection you are more likely to have a reaction that might have been worse than you would have had at a time when you didn’t have such an infection. However, Covid is not a special case in any way here and would only likely impact on the severity of any allergic reaction if it were symptomatic, which fortunately in most cases in children, it isn’t. In this regard Covid can simply be considered the same as any other respiratory virus. If you do have a reaction that requires medical attention whilst either the child or any family member is Covid positive, it is important that this is flagged up to the attending medical team.

I have a young baby and I am worried they might have a food allergy. Should I seek help now or wait?

Reactions to food usually become apparent on the first exposure so I would stick to the usual advice which is to stop further exposure and request non-urgent medical help through your GP. GP services are still operating as they have been for the past few months. It’s always a good idea to take a photograph of any possible allergic reaction and keep a clear record of what the symptoms were and how quickly they developed after exposure to the suspect food. This will help when you have your consultation.

If you are concerned your newborn has a milk allergy it is important to seek medical advice before cutting out milk from a breastfeeding mother’s diet or changing your baby’s formula.

Remind me what the symptoms of a severe allergic reaction are?

Signs of a mild allergic reaction, especially in children, are itchiness, hives, swelling typically focused around the mouth, runny nose and sneezing.

Signs of a severe allergic reaction or anaphylaxis can involve the respiratory system which means it can cause trouble breathing, coughing and wheezing; or the circulatory system, which causes a drop in blood pressure and can include symptoms such as dizziness, confusion or collapse. If you suspect anaphylaxis, as above, it’s important to use your adrenalin-auto injector, if you have one, and call an ambulance and explain you think it’s a severe allergic reaction or anaphylaxis.

What’s the current advice on the coronavirus vaccine if you have a food allergy?

When the Pfizer vaccine was first approved it was recommended that you should only avoid having it if you’d already reacted either to the vaccine itself or a constituent component of it. The Pfizer coronavirus vaccine (and the Moderna one) contains a substance called Polyethylene glycol (PEG), which a very small number of people are allergic to. Therefore, if you know there is an issue with PEG, it’s very important to avoid these vaccines and go for the Oxford/ AstraZeneca one which does not contain PEG (but has similar contra indications regarding avoiding it if you’re allergic to any of the vaccine components).

It is still not completely clear what caused the allergic reactions that have been reported in the media. From the extensive experience in using the Pfizer vaccine in the UK over the last few weeks, with over a million doses given, it looks like allergic reactions effect less than 1 in 100,000 people and there has not been anything to suggest that having food allergies is a particular risk. Whilst there was a brief period when the MHRA in the UK issued cautious advice suggesting that those with a history of anaphylaxis to anything (whether it was a vaccine, drug or food), avoid the Pfizer vaccine, this advice has now been changed back to the original advice and there is no need for food allergic patients, even if they have had anaphylaxis in the past, to avoid the vaccination.

None of the Covid vaccines are approved for use for children as it stands and they are unlikely to be offered them in the near future.

This article was created in conjunction with The Allergy Team.

Useful Links:

Allergy UK has a useful factsheet about coronavirus and allergies and information about the coronavirus vaccines

Check out the Anaphylaxis Campaign’s website here.

For more information about asthma and coronavirus, head to Asthma UK here.

You can follow Adam on Twitter @dradamfox

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