key: cord-0796588-3hkjgt1s
authors: Pattini, Stefano; Malizia, Velia; Travaglini, Alessandro; Brighetti, Maria Antonia; Della Giustina, Auro; Sfika, Ifigenia; Di Menno Di Bucchianico, Alessandro; Tripodi, Salvatore
title: Telemedicine for allergic patients during COVID‐19
date: 2020-11-24
journal: Pediatr Allergy Immunol
DOI: 10.1111/pai.13346
sha: d101e622962ca5bc49a8f7d80cab47cab83eb953
doc_id: 796588
cord_uid: 3hkjgt1s

In the last few years, we have witnessed an important development in the medical field of both Mobile Health, such as the use of mobile communication devices, and other telemedicine tools in general, in order to support the surveillance of diseases from the moment of the first diagnosis to the therapeutic follow‐up. Long before COVID‐19, some authors had analyzed various possible evidence‐based scenarios and had indicated how the use of telemedicine could prove to be extremely useful in epidemic situations, especially for the management of chronic patients, such as immune‐allergic ones, who are notoriously in greater need of regular follow‐up; however, as expected, the advent of the COVID‐19 pandemic has amplified the differences between various countries, from the point of view of the propensity to use technological solutions in the health sector. The hope is that one positive outcome of the ongoing pandemic is that it will lead to an acceleration, by all the stakeholders involved, of the process of modernization of health care.

In the last few years, we have witnessed an important development in the medical field of both Mobile Health, such as the use of mobile communication devices (eg, smartphones and tablets, with related apps), and other telemedicine tools in general (a mix of medical and technological techniques that allow the treatment of a patient remotely), in order to support the surveillance of diseases from the moment of the first diagnosis to the therapeutic follow-up, while improving the possibility of "self-management" by patients, with the aim of a general increase in the quality of care. In this regard, some guidance documents have recently been published, which have assessed quality, usability, efficiency, advantages, limitations, and risks (with particular reference to data protection) of the aforementioned mobile solutions, both in the general context (WHO) and specifically in the immune-allergic one (EAACI 1 ), underlining how at this moment the tools of "digital health" certainly cannot be considered substitutes for traditional medicine but can represent a valid complement (precision medicine); however, a recent Cochrane review has confirmed similar clinical efficacy outcomes by comparing remote monitoring (video consultations) in relation to traditional monitoring for chronic conditions such as diabetes and congestive heart failure. 2 Long before COVID-19, some authors had analyzed various possible evidence-based scenarios and had indicated how the use of telemedicine could prove to be extremely useful in epidemic situations, with a high potential for improving both epidemiological investigations and clinical case management; 3 (and of their contacts) and their monitoring is of the utmost importance, and, as a last resort, a general quarantine. 4 Recently, the infection caused by SARS-CoV-2, recognized as a pandemic by WHO on March 11, 2020, has had a disruptive effect in that sense, first in Asia and then in the Western world. A great deal of the infection has been correlated to intra-hospital transmission, particularly in China; this underlined the need to limit patients' movements to the bare minimum, to reduce at the same time both the possibility that, if infected, they could infect other people (doctors and other patients),

and their likelihood of getting infected in a highly at-risk setting like a hospital. In this context, therefore, telemedicine ("arriving" at the patient's home without putting them at risk) could be really useful, allowing for the treatment of patients with mild-moderate symptoms directly at home; at the same time, it would allow for the triage of suspected COVID-19 patients, for example, by video call, in order to carry out not only a medical history but also a direct observation of the patient, including for any early signs of respiratory distress. 5 However, as expected, the advent of the COVID-19 pandemic has amplified the differences between various countries, from the and prefer digital medical-patient communication whenever possible (telemedicine). 9 In addition, the same scientific societies that operate in the immune-allergic area (in Italy, SIAIP and SIMRI in the pediatric field, SIAAIC and AAIITO regarding adult population) have recently published handbooks to help patients in the "differential self-diagnosis" between the symptoms of COVID-19 infection and those of respiratory allergies typical of the spring period, 3 • Using digital apps is highly recommended to automatically monitor and communicate your own symptoms to the referring physician.

• In this specific situation, communicating with one's own physician through popular digital messaging apps can also prove to be particularly helpful.

One final fascinating aspect of telemedicine in times of COVID-19 concerns the development of smartphone applications capable of tracing the contacts of the user with potential confirmed/suspected cases of recent infection of SARS-CoV-2, suitable for monitoring the trend of the epidemic and for the consequent possibility of timely response, with particular regard to the aspects of protection of sensitive data and usability by the very same user; such projects are being carried out in various countries, including Italy ("Immuni" app). 10 Ultimately, the hope is that one positive outcome of the ongoing pandemic is that it will lead to an acceleration, by all the stakeholders involved, of the process of modernization of health care, which is already underway but still curbed, both because of the reticence of a part of the medical world and the need to combine the effectiveness of these new tools with compliance with the current regulatory frameworks (in particular those regarding privacy; in this regard NTD Committee SIAIP is conducting a survey among Italian doctors); in this particular health context, the possibility of using an adequate but at the same time safe medical service in terms of avoiding contagion, as telemedicine could be, could also allow to overcome the patient's remaining level of distrust, therefore contributing to definitively perfecting and implementing such a method, not only today but also in a post-pandemic future. 4

The authors have no conflict of interest to declare.

The use of telemedicine proves to be extremely useful in epidemic situations, especially for the management of chronic patients, such as immune-allergic ones. 

The peer review history for this article is available at https://publo ns.com/publo n/10.1111/pai.13346.

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