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FARE Blog March 20, 2020

Q&A on COVID-19 and Food Allergies with Dr. Tom Casale

FARE's Chief Medical Advisor for Operations answers questions submitted by members of the food allergy community.


Dr Thomas Casale

Hi, I'm Dr. Tom Casale, Chief Medical Advisor for Operations of FARE. In these troubling times, we've been receiving a lot of inquiries about what to do in the face of coronavirus the COVID-19 pandemic. Questions especially relate to patients with asthma and allergic diseases, including those with food allergy. We've received a number of questions that I'd like to address. I'm not sure I'll be able to get through all of them, but I'll try. And we're always here to help you if you have any questions.

So here we go.

Q1. Are there any allergies that would have negative side effects or reaction if given with any of the COVID-19 treatments?

Good question. But unfortunately, right now, we don't have any good treatments. You're probably aware that the federal government is really trying to ramp up treatments for COVID-19 and there's a number of drugs, probably seven to 10, that looked like they might be promising in the test tube. But whether or not they'll actually be effective and safe for patients is not clear.

Probably the one that you've heard the most about recently is the anti-malarial drug Hydroxychloroquine. This drug has been around for over 50 years and again in the test tube has some positive effects. In addition, it's been shown anecdotally to work well in patients with COVID-19. Now, what does that mean? It hasn't been studied in a systematic way. So we don't know whether it truly is effective. What we don't want is patients to ask to get this drug as a prophylaxis to prevent the infection or for that matter, if you have a mild infection, if it does prove to be effective, we want to be able to offer it to the most severely ill patients.

Q2. In regard to COVID-19, should we take extra precautions for children that have asthma and/or a history of respiratory distress?

As you're probably aware, people with food allergy are much more likely to have asthma. And you've been seen on the news that patients with respiratory disorders, along with underlying cardiovascular disorders like hypertension and diabetes, may be at higher risk for having a worse course with COIVD-19.

Fortunately, the data to date suggests that patients with asthma are not at increased risk for having any more problems from the infection than the normal population that is, people without asthma. That's not true for people with chronic obstructive pulmonary disease. That is mostly the older population that especially have smoked cigarettes.

Q3. Are people with asthma considered to be in the high-risk category or should we just treat this the same as any other respiratory illness and follow the same protocols?

I think I addressed that pretty much already. But just to remind you that COVID-19, is a respiratory infection. And if you do have underlying asthma, as with any other respiratory infection, we urge you to make sure that your asthma is under optimal control so that with an infection from COVID-19 influenza or anything else, you'll be in a much better situation to handle that without having any problems.

Q4. If a person with asthma and allergies falls into a respiratory distress due to coronavirus/ COVID-19, will epinephrine help?

That's a very good question and one that deserves some consideration. Because if you're having acute shortness of breath from asthma, epinephrine is a wonderful drug to help you. And in the old days, we used to use it all the time for patients that came into the emergency department or urgent care visits because it works by dilating or making the bronchial airway's bigger, relaxing them from contracting and also decreases some of the swelling in the airway. So people do get better.

So if you have asthma and you have an acute problem, regardless of whether it's due to an infection or anything else, if you're having asthma symptoms and don't have access to your inhaler but do have your epi pen, you could use it and get relief.

Q5. Will steroid/other asthma medications or even Motrin make people more vulnerable to COVID-19?

The fifth question, will steroid or other medications or even Motrin make people more vulnerable to COVID-19 or even make their course worse? Another interesting set of data has been coming out of China because they have the most experience and they've indicated that there may be certain medications,that put patients at risk for having either a worse course or a higher susceptibility to the virus. Unfortunately, a lot of these are again, somewhat anecdotal, so we don't know what are the drugs that have been mentioned, Motrin or non-steroidal anti-inflammatory drugs have been mentioned. And a French government official raised the alarm with this particular drug, saying that people should not use it. However, both the World Health Organization and our own experts like Dr. Anthony Fauci indicate that there is no evidence to support that at present.

The other drug that you're hearing a lot about is angiotensin converting enzyme inhibitors, ACE inhibitors, which are commonly used for hypertension. Why would these two drugs make the virus worse? Well, there's evidence that the receptor that is where that virus binds on cells appears to be similar to the receptor that can be up regulated, that is expressed in higher numbers by drugs like Motrin and ACE inhibitors. So the virus made have an easier access into cells, although that appears to be the case in some experimental models.

Again, the American Heart Association and the European physicians that are examining this also state that there is no reason to stop your ACE inhibitors at this point.

Q6. Are people who have had pneumonia more susceptible to getting COVID-19? Is there any way to prepare or lessen the respiratory effects if infected?

If you've had pneumonia, there's no evidence that you would be at higher risk to have a worse outcome. We do know that if you have a chronic underlying respiratory disorder like COPD, as I mentioned earlier, you are at higher risk.

But previous pneumonias that have gone away and you've recovered completely pose no further risk, at least as far as we know to date.

Q7. Do we know if, once recovered, an infected person will have immunity from COVID-19 (like other viruses)?

Another excellent question. And again, we're just trying to get more of this information, but it appears that people that have recovered from the virus do make antibodies that probably are protective against COVID-19.

Now, what we don't know is whether that virus, like influenza, will mutate over the time that the infection is around. So that immunity may wane a little bit. But right now, it appears to be protective. And let's hope that that's the case for the future as well.

Q8. How is COVID-19 impacting food allergy research and clinical trials?

And I want to expand that to patient care in general. As a physician, I think we have a big concern in that we are not able to access enough personal protective equipment to protect our staff and ourselves when we see patients with COVID-19, which puts us at higher risk.

We can not get masks that are necessary. And as a result now we are not stopping clinical trials, but we are very, very careful on limiting visits to those that are absolutely necessary, taking a more detailed history to make sure that patients that do come in for a visit don't have any history of shortness of breath, cough, and certainly don't have a history of fever. And we're now taking temperatures for everybody that comes in. To make sure that we're not putting our staff and others at risk because we lack some of the personal protective equipment that would protect us when we see patients with food allergies or other disorders that we're researching.

Q9. Do you anticipate a shortage (or delay in shipping/receiving) in epinephrine due to COVID19?

I have heard that there is no issue with that particular problem or potential problem. That is, the supply of epinephrine has not been affected, as you would expect, because it's not a drug that you would typically use COVID-19.

Q10. Is it okay to cook food and send it to others? I’d love to bake for family and neighbors but not sure if it would put anyone at risk.

I know a lot of us have neighbors that are elderly or friends or family, and you're concerned about them, especially if they're in self-isolation.

So far, it doesn't appear that there's any issues with infecting patients due to exposure to various foods that may or may not have been contaminated. However, I think we have to be careful, especially if you do have a food allergy in regards to some of the mechanisms that we're using to reduce exposures. What do I mean by that? Well, as you know, a lot of restaurants have closed due to COVID-19, but those that are open are offering curbside delivery or delivery to your house.

I think for people that have food allergy, they need to reinforce when they order foods for pickup that they do have food allergies so that whoever is preparing that food is very careful about the preparation and make sure that when you pick up that order, it is indeed what you ordered so that there isn't any mix up which we've heard has been happening occasionally. So that's all the time I have right now. But we appreciate the fact that you listening to this podcast and we hope to stay with you throughout this crisis to provide whatever information we can to maintain your safety from the virus, but also from your underlying condition.

That is food allergies and perhaps asthma and other allergic disorders. Remember, this is a time to protect yourselves. And by protecting yourselves, you protect others, because if you don't get infected, you're not going to transmit it. Stay isolated. If you need to or the government tells you to. And practice good hygiene, wash those hands for at least 20 seconds. Clean surfaces that may be exposed. I put out some information about that earlier in the week what products would work best. But the bottom line is stay safe, stay healthy and we'll all get through this together. Thank you.


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