LAUSR

The COVID-19 pandemic has led to severe disruption of healthcare systems and elective planned care. While pandemics are infrequent, the disruption of elective care by acute respiratory viral infections is an annual occurrence, including administration of oral food challenges (OFCs) to children with suspected allergy. A major barrier to performing OFCs outside tertiary centres is the risk of adverse events including anaphylaxis. 3 We recently reported a large series of food challenges in a COVID-19 stepdown facility, and here we describe our process of managing anaphylaxis in this setting. Five regional paediatric allergy clinics across Ireland jointly used a vacant COVID-19 field hospital over 6 weeks. OFCs were performed within a pod system, with each pod containing up to six patients (figure 1). Resuscitation protocols and equipment trolleys were identical to those in hospital. For anticipated anaphylaxis events, patient journey was mapped out prior to commencing challenges at the facility, using a ‘Go/No Go’ principle to anticipate and resolve all issues at each step before proceeding to the next. A simulation exercise was supervised by a base hospital’s resuscitation training team. A resuscitation room was built and equipped onsite and staffed by a consultant paediatric anaesthesiologist. This room was close to both the OFC clinical area and to the main exit, should outward transfer to a base hospital be required. We implanted a traffic light approach according to patient status to guide the role of team members. Of the 474 OFCs performed, 25 (5%) children experienced anaphylaxis and their clinical information is summarised in table 1. Nine children required transfer from bedside to resuscitation room, and eight patients required outward ambulance transfer to base hospital and an overnight admission. Seven children required two doses of epinephrine, with a median interval between epinephrine doses of 35 min. All transferred patients remained stable following ambulance transport to base hospital, and none required advanced airway management or admission to paediatric intensive care unit. All eight were transferred in compliance with an agreed safety standard, having received two doses of intramuscular epinephrine, not because they remained unstable. There were no biphasic anaphylactic reactions and no further treatment was required apart from routine observations. The most frequently occurring unanticipated event Figure 1 POD and Resusciation Team Systems. CNS, clinical nurse specialist; CVS, cardiovascular system; IM, intramuscular; IV, intravenous; NIBP, noninvasive blood pressure monitoring; OFC, oral food challenge; Rx, medication; SpO2, oxygen saturation.