Category: COVID-19

COVID-19 Vaccine

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We have received numerous questions over the past several weeks regarding the Covid vaccines, and we will try to address most of them in this post. We have compiled this information from different sources which are listed at the end of this piece. Please note, the Pfizer and Moderna COVID-19 vaccines are some of the safest and most effective vaccines for an infectious disease. These vaccines will end this pandemic if almost every human around the world is inoculated.

 

Will our practice (Allergy, Asthma & Food Allergy Centers) receive vaccines to immunize our patients?

As of 4/28/21, we will NOT as the mRNA approved vaccines require extremely cold temperatures (-70°C or -94°F for Pfizer; -20°C or -4°F for Moderna) for storage, and there is now good access for the general population (except most kids) to receive all 3 approved vaccines.

 

I have allergies (to foods, drugs, pollens, etc.). Am I at risk for a severe allergic reaction to the vaccine?

If you have an allergy to polyethylene glycol or some injectable medications, you may be at risk, but food allergies, drug allergies to oral medications, and environmental allergies do not put you at any significant risk over the general population. You will also be monitored for at least 15-30 minutes after vaccination, and vaccination sites should have epinephrine on hand on the off chance you have a reaction. Remember, no one has died from Covid vaccination despite millions of doses and as of this post, over 400,000 people have died due to COVID in the US.

There was a recent CDC  report with 71% of anaphylaxis cases being in the first 15 min. Anyone with an anaphylactic history can and should wait 30 mins. 

There is currently no validated testing for suspected allergy to polyethylene glycol or for other components of the vaccine. You can find more information here: American College of Allergy, Asthma & Immunology (ACAAI) Guidance on Risk of Allergic Reactions to mRNA COVID-19 Vaccines.

Remember, allergic reactions to the vaccine are relatively infrequent; roughly one in every hundred thousand injections — more than 100 times less common than allergic reactions to penicillin. Reactions are being observed because so many people are being immunized. Importantly, everyone who has had a reaction has been effectively treated and stabilized without any long-term problems.

Large local reactions have been reported, especially after Moderna vaccines, including:

  • Itching, redness, and swallowing are not uncommon. This comes on late (>5 days from vaccination) and can last for weeks. Treatment is symptomatic: antihistamine, NSAIDs (like ibuprofen)/Tylenol, ice. You CAN still get the second dose! In the Moderna vaccine trial, delayed large locals like these occurred 4 times less with the 2nd dose than the 1st dose.
  • Consider switching to the other arm for the second dose if you had a local reaction to the first dose.
  • These large local rxns are all very delayed in onset (often after day 8) so mechanistically they are different from immediate reactions.

 

I’ve heard that the vaccines are made from fetal tissue. Is this true?

NO, the Pfizer and Moderna vaccines are synthetic- made from chemicals. The AstraZeneca (AZ) vaccine (not approved as of 1/25/21) does use an immortalized cell line (HEK 293) derived from an abortive fetus from the 1960s for vaccine production. Here is a commentary that discusses this.

 

Where can I get information on how to get the Covid vaccination?

 

How do the Covid vaccines work?

COVID-19 vaccines help boost the immune system against the pandemic-causing SARS-CoV-2 virus. As of 1/25/21, two COVID-19 vaccines are available in the U.S. One by Pfizer/BioNTech and the other by Moderna.  Both of these utilize messenger RNA (mRNA) to make the spike protein found in the SARS-CoV-2 virus, which attaches to human cells leading to infection. The spike protein stimulates the immune system to make antibodies against this virus, making a person less susceptible to contracting it. Having antibodies against the spike protein can prevent the virus from attaching and infecting human cells.  Both vaccines require two doses, three or four weeks apart in order to achieve an optimal immune response.

 

Are there any safety concerns with the new technologies (mRNA and nanotechnology) being used in the development of COVID-19 vaccines?

There are no known additional risks of mRNA vaccines or lipid nanoparticles. Live attenuated viral vaccines, such as the measles vaccine, induce an immune response that is similar to natural infection. mRNA vaccines, on the other hand, simply give the body instructions to produce one very specific part of a virus – in this case the spike protein – to then induce an immune response.  Because mRNA is broken down very quickly in the human body, it is wrapped in a lipid nanoparticle to be able to get into our cells to do its work. Once it gets into the cells to deliver the instructions, the mRNA breaks down very quickly. There are rumors that mRNA vaccines will alter DNA because the RNA molecule can convert information stored in DNA into proteins. That is not true. It is important to note that the mRNA vaccines never enter the nucleus of the cell, where DNA is stored. After injection, the mRNA from the vaccine is released into the cytoplasm of the cells. Once the viral protein is made and on the surface of the cell, mRNA is broken down and the body permanently gets rid of it, making it impossible to change DNA.

This is a nice set of tweets from Andrew Nowalk, MD, Ph.D., a pediatric infectious disease specialist in Pittsburgh. He presents some information on the vaccines that may alleviate some concerns people have about the speed at which the vaccines were developed. They are presented below (but here is a link to his tweets).

  • This is NOT a vaccine created in 9 months. The origin goes back many years.
  • The first reports of an mRNA vector in a lipid particle used as a transfer vehicle go back to 1989 at the Salk Institute. Vaccines were considered using this in the 1990s. Kariko and Weissman made a big leap forward in 2005.
  • They modified the nucleosides of the mRNA, the building blocks that encode the viral protein so that they would be recognized as host RNA and properly translated.
  • Moderna (ever notice the last 3 letters) started in 2010 to expressly use this technology.
  • The first vaccines of this variety are NOT against #COVID it was MERS and OG SARS. Those trials are more than 3 years old.
  • The real analog here is 2009. That’s when we took the pandemic H1N1 strain and made a vaccine with it in 6 months. That’s a good analogy.
  • When this vaccine technology and development started, REM and Nirvana were the big bands, Clinton was president, and an i-anything from Apple was more than half a decade away.

Risk of Covid vaccine in context by Aaron E. Carrol, M.D., who is a professor of pediatrics at Indiana University.

 

What about Covid-19 vaccination in pregnancy?

Please contact your OBGYN to see what his/her current recommendations are.  Most OBs are recommending it for pregnant and nursing mothers.  The Centers for Disease Control and Prevention (CDC), the American College of Obstetrics and Gynecology (ACOG), and the Society for Maternal-Fetal Medicine agree that the new mRNA COVID-19 vaccines should be offered to pregnant and breastfeeding individuals who are eligible for the vaccine. Here is a piece on the Covid vaccine in pregnancy.

More recently, preliminary findings of a study published in the New England Journal of Medicine on 4/21/21 find COVID-19 mRNA vaccines made by Pfizer and Moderna are safe for pregnant women. A study in JAMA Pediatrics found pregnant women who became infected with the virus were at increased risk for maternal mortality, preeclampsia and preterm birth. Therefore, it is particularly important for those who are pregnant to receive the COVID vaccine, and the CDC now recommends that all pregnant women be vaccinated.

 

What if I have already had COVID, do I still need the vaccine?

Yes, you should still receive the vaccine. Due to the severe health risks associated with COVID-19 and the fact that reinfection with COVID-19 is possible, you should still be vaccinated.

 

How soon after being infected from COVID should I get the vaccine?

 Current CDC guidelines state you can receive the vaccine as soon as you are fully recovered from symptoms and out of the quarantine period.  However, reinfection within 90 days of illness is uncommon, so it may be less critical to get the dose right away.  They can wait until closer to the end of the 90 days if they want.

If you were treated for COVID-19 symptoms with monoclonal antibodies or convalescent plasma, you should wait 90 days before getting a COVID-19 vaccine. 

 

The vaccines are not 100% effective, so why should I take them? 

The mRNA vaccines are nearly 100% effective against severe illness from COVID-19. Of the 32,000 people in the Pfizer trial, only one developed COVID-19 severe enough to require hospitalization. Beyond the 95% prevention of any clinical COVID-19 infection, the 5% that got the illness had a very minimal illness. So these vaccines are almost totally effective in preventing COVID-19 illness in all qualifying age groups.

 

If I can still spread the disease after I’ve received the vaccines, why should I take them? 

Disease spread was not a specific endpoint in the clinical trials, but if the clinical illness is reduced by 95%, the spread of the virus should also be reduced by 95%. In the Moderna trial, the asymptomatic disease appeared to be as reduced as significantly as symptomatic diseases.

 

Will the vaccines protect me against the new variants of Covid?

The current data suggest that the vaccines offer varying amounts of protection against the known mutant strains of Covid. While the protection may not reach 95%, it is still very significant.

 

There are (or will be) different Covid vaccines approved. Which one should I get?

The simplest answer is take whatever vaccine you can get as soon as you can get it since all of the approved (or likely to be approved) vaccines essentially eliminate the risk of a severe Covid infection that will lead to death.

 

Does the vaccine contain toxic chemicals that will make me sterile?

NO! There are no toxic chemicals in the vaccine. The lipid component is in many foods and cosmetics. The amount of this material you are exposed to every day is hundreds of times more than in the vaccine. All these substances have been shown to be safe in large studies because they are in food and cosmetics. Therefore, it is unlikely that anything in the vaccine would cause a toxic effect.

There are many false rumors about the Covid vaccines, specifically targeting women. Some of them are debunked here.

 

The information above was compiled from different sources, including:

Here are more links to frequently asked questions: 

Welcome patients of Dr. Esswein to Allergy, Asthma & Food Allergy Centers!

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Dear Dr. Esswein Patients,

We are delighted to welcome you to our practice! While we did not anticipate this particularly trying time, we aim to make your transition as smooth as possible. 

If you are on allergy injections, we should now have your vials. Once we have entered your vials into our electronic system and have you registered in the practice, we will call to let you know that you can come for your injections.  Please wait for this call before you come to our office, but in the meantime, please download the new patient paperwork from this page and allergy shot treatment consent and financial consent. Email the completed new patient paperwork, consent forms, copies of the front and back of your insurance card, and driver’s license to info@aascare.com. Please include in the subject line “transferring Dr. Esswein patient”. If you have not received a phone call in the next 1-2 weeks, please call us. Please also schedule a telemedicine visit at your earliest convenience in order to become further established in our practice. You will need to have that visit before we can refill medications and answer medical questions. The first telemedicine visit will be with Dr. Esswein or one of our advanced practice providers (Lauren Davis, PA-C, Laura Kahle, PA-C, or Dani Loftus FNP-BC) so we can get you established as soon as possible. You can read more about telemedicine visits here.

  • Allergy injections are administered:
    •  8:30AM – 4:30PM Mon-Thur
    •  8:30AM – 2:30PM Fri
    • You will notice we have shot hours on Tue evenings (not currently offered during the COVID-19 pandemic) and Sat mornings. We ask that you kindly avoid these times until further notice, as they are typically our busiest times with the longest wait periods. 
  • We follow the guidelines from our professional allergy societies  that all allergy injection patients will need to wait in the office for 30 minutes after their injections.
  • During this time of concern for COVID-19, we will not escalate your dose. This is to help minimize the risk of an adverse reaction, particularly as we are now in the spring season. We will also allow you an extra week “grace period” where you will not be considered late. 

If you are on a biologic for asthma or hives (ex. Xolair, Fasenra, Nucala, Cinqair, or Dupixent), please call to schedule a telemedicine visit at your earliest convenience. This will allow us to get you registered in the practice and enable us to go through the necessary prior authorization process to obtain your medications. When you are due for your injection(s), and we have verified that we have your medication, we will schedule an in person visit in the office. Please note that our policy is that you will need an office visit for each biologic injection administered in the office. New Patient paperwork is available on this page and information on telemedicine visits is available here. Email the completed new patient paperwork, consent forms, copies of the front and back of your insurance card, and driver’s license to info@aascare.com. Please include in the subject line “transferring Dr. Esswein patient”.

For all other patients, we request that you please schedule a telemedicine visit at your earliest convenience to become established in our practice. We will need to see you for the telemedicine visit in order to refill medications or answer any medical questions. This is also an excellent time to do an annual visit. We can provide updated food allergy and asthma action plans at the time of the visit if needed. New Patient paperwork is available on this page and information on telemedicine visits is available here. Email the completed new patient paperwork, consent forms, copies of the front and back of your insurance card, and driver’s license to info@aascare.com. Please include in the subject line “transferring Dr. Esswein patient”.

We recommend that you follow us on Facebook. We will be posting practice updates, particularly as we do our best to navigate the challenges posed by COVID-19. 

It is our pleasure to play a role in keeping you well. We look forward to meeting you!

Telemedicine Services Available!

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Allergy, Asthma & Food Allergy Centers has been using the doxy.me platform for telemedicine visits since Thursday, March 19, 2020, and this has been working very well for patients at all of our current locations (Swansea, Illinois; Bloomsdale/Ste. Genevieve, Missouri, and south county). Telemdicine appointments can also be done for those currently scheduled to be seen in our Chesterfield (west county) location at 16216 Baxter Rd. Suite 299, Chesterfield, MO 63017. As you know, we have moved most of our patients to telemedicine visits in the interest of public safety to decrease the spread of COVID-19 in our community while continuing to provide essential medical care.

If you are scheduled for any upcoming office visits, other than for biologic medication administration, our staff will continue to contact you before your appointment to convert your appointment to a telemedicine visit. The telemedicine visits enable new and established patients to keep their originally scheduled visits to discuss medical problems, treatment plans, allergy shots, and prescription medications while following the “stay at home” rules. These visits will be increasingly important for patients and families as the spring tree pollen season ramps up. The spring pollen season gets busy, and appointments can be scarce in the greater St. Louis area, but Allergy, Asthma & Food Allergy Centers has 8 active providers who are able to see patients via telemedicine even during these troubled times. Call 314-849-8700 or 618-233-8700 to schedule your telemedicine visit to help you stay healthy during this allergy season.

Telemedicine Frequently Asked Questions:

  1. How does telemedicine work?
    1. A staff member will call you in the morning on the day of your scheduled appointment to collect insurance information and copays.
    2. You will receive a text in most cases (an email if you cannot receive texts or prefer to do the visit using a computer/laptop/tablet) with a link from doxy.me. You can watch a brief instructional video here and/or review this document.
    3. Open the link through your phone or use Chrome browser when on a computer/laptop. You will need a strong internet connection and will need to give permission for the website to use your camera and microphone.
    4. Sign in with the patient’s first and last name and click the “Check In” box, which will place you in the virtual waiting room. You can also review the telemedicine consent and test your connection while in the waiting room.
    5. Once the visit has started, your provider will be able to see you, and you will be able to see them. Your provider may not always be looking at the camera, because they will have another screen open with your medical record so they can document and review your information. Please be assured that if the provider looks away, they are not being distracted from the visit, and your medical care is their sole focus during your appointment.
  2. Do I need to download any program or application?
    1. No, because the doxy.me platform is web-based, you can access it from a browser on an internet connected device.
  3. What type of device do I need?
    1. You need an internet connected smartphone, tablet, computer, or laptop that has a camera and microphone. You will have to give the camera and microphone permission to access your web browser, which you should be able to do in the settings of your device, and we recommend you confirm this before your appointment.
  4. What else should I do to prepare for the visit?
    1. If you have a thermometer, please take your temperature before the visit to let the provider know so they can document it in your chart.
    2. Please take your pulse manually (instructions here) or with an apple watch, fitbit, or other device before the visit and let your provider know so they can document it in your chart.
    3. You can also review the telemedicine consent form here.
  5. Is the telemedicine visit secure?
    1. Yes, the doxy.me telemedicine platform is secure and HIPAA compliant. 
  6. What if I do not receive a text or an email?
    1. If it is 5 minutes past your scheduled appointment and you have not received a text or email, please call our office.
  7. Is telemedicine more expensive than an office visit?
    1. No, you will have the same copay as you would with an in person office visit, but you do not have to leave the comfort of your home.
  8. I have read that insurance companies are waiving copays for telemedicine visits, so why do I have a copay?
    1. Insurance policies vary on this. If your insurance pays for the telemedicine visit, including the cost of the copay, you will receive a refund. You should be able to determine this by the explanation of benefits (EOB) that you will eventually receive from your insurance company.
  9. What if my primary allergist is not available for a telemedicine visit?
    1. Do not worry! Our fantastic advanced practice providers, Lauren Davis, PA-C, Laura Kahle, PA-C, or Dani Loftus, FNP-BC can see you if your primary allergist is not available.

Allergy, Asthma & Food Allergy Centers Telemedicine COVID-19 update 3/20/20

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Dear Allergy, Asthma & Food Allergy Centers Patients and Families,

As we informed you a couple of days ago, our professional societies released COVID-19 Pandemic Contingency Planning for Allergy and Immunology on Tuesday, March 17, 2020. We implemented the guidelines in order to continue providing essential medical care for our patients while keeping our community safe. Social distancing remains one of the centerpieces of prevention, and we are minimizing the amount of time patients may have to spend outside the home. We have updated the information regarding telemedicine visits from the blog posted on Wednesday March 18, 2020. 

  1. Anyone who is currently scheduled for a new patient office visit or a follow up office visit through April 3, 2020, will have the option of converting the in person office visit to a telemedicine visit or rescheduling the in person visit to a later date. The telemedicine platform we are using is https://doxy.me/. You do not have to sign up for an account. You will receive a link to the virtual appointment via text message or email, which you should access through your mobile phone, tablet, or a computer with a video camera and microphone.  Starting on Saturday, March 21, 2020, the telemedicine visits will be billed to your insurance carrier and appropriate copays (depending on your insurance) will be collected over the phone. We will also read you a verbal consent form, which you can review here (informed consent).
  2. If you are on biologic injections (ex. Xolair, Nucala, Fasensra), you should keep your appointment as long as you are not acutely ill with any symptoms suggestive of an infection. However, there may be issues with delivery of the biologic medications, so please confirm with our office on the morning of your appointment to make sure we have received the shipment of the medication.
  3. If you are on allergy shots and have an annual visit coming up at which time you planned on receiving your allergy shots, you can keep that in person office visit.
  4. Patients currently on allergy shots may also continue to receive their injections in our office. However, if you have been building up once weekly, you may start coming every 2 weeks for your buildup phase during this time period. If you are currently on maintenance dosing receiving injections every 2 or every 3 weeks, you may increase your interval to every 4 weeks.
  5. If you are having acute environmental allergy or asthma symptoms, please contact the office to schedule an acute telemedicine visit with one of our providers.
  6. Office based food challenges, oral immunotherapy (OIT) new starts, and OIT dose escalations will need to be rescheduled. Our staff will be contacting families regarding this, so there is no need to call our office. However, if you need more capsules, please make sure to inform the staff member who calls.
  7. If you are ill with fever, cough, and shortness of breath, have any possible COVID-19 exposures, or have traveled (domestic or international) in the past 2 weeks,  please do not come to the office. If you suspect you need testing, please check with the following screening resources:
    1. MO hotline:  877.435.8411
    2. IL hotline:  800.889.3931
    3. Mercy screening:  314.251.0500
    4. SSM Virtual screening:  www.ssmhealth.com

 

For more information regarding COVID-19, please see the CDC website: http://bit.ly/CDC-COVID-19_info 

While COVID-19 is appropriately on all of our minds, allergy season is also upon us. If you have not already started your seasonal allergy medications, you should do so ASAP. In addition, remember to follow routine environmental controls:

  • Keep doors and windows closed in your home to prevent pollen from coming inside.
  • Keep sunroofs and windows on vehicles closed and use recirculation mode for the vehicle’s air conditioner.
  • Bathe or shower and change your clothes after spending time outside during the spring pollen allergy season, because pollen can settle into your clothing and hair. This will also decrease the spread of pollen throughout the home.

We will continue to post updates on Facebook in this evolving situation. Stay safe and healthy. 

Allergy, Asthma & Food Allergy Centers COVID-19 Update 3/18/20

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Dear Allergy, Asthma & Food Allergy Centers Patients and Families,

Our professional societies released COVID-19 Pandemic Contingency Planning for Allergy and Immunology on Tuesday, March 17, 2020. We are implementing these guidelines in order to continue providing essential medical care for our patients while keeping our community safe. As the virus spreads through our community, social distancing remains one of the centerpieces of prevention. Therefore, we are looking to minimize the amount of time patients may have to spend outside the home and are instituting the following:

 

  1. All food challenges and oral immunotherapy (OIT) new starts currently scheduled through April 3, 2020, will be rescheduled. Our staff will be contacting families regarding this, so there is no need to call our office at this time.
  2. All OIT dose escalations (updosing) currently scheduled through April 3, 2020, will need to be rescheduled. Our staff will be contacting families regarding this, so there is no need to call our office at this time. However, if you need more capsules, please make sure to inform the staff member who calls.
  3. Patients currently on allergy shots may continue to receive their injections. However, if you have been building up once weekly, you may start coming every 2 weeks for your buildup phase. If you are currently on maintenance dosing receiving injections every 2 or every 3 weeks, you may increase your interval to every 4 weeks. In the spirit of social distancing, if you have flexibility, please try to avoid any peak times to minimize the number of people in the waiting room. We have decreased the seating capacity in the waiting room. However, if you are uncomfortable coming into the office, you may skip injections during this period of social distancing.
  4. If you are on biologic injections (ex. Xolair, Nucala, Fasensra), you should keep your appointment as long as you are not acutely ill with any type of infection.
  5. Anyone who is currently scheduled for a new patient office visit through April 3, 2020,  will have the option of converting the in person office visit to a telemedicine visit or rescheduling the in person visit to a later date. The cost for the telemedicine visit will be $200 for the new patient appointment. We will collect payment at the time of service. Please contact your insurance company to see about reimbursement for your out of pocket costs.
  6. Anyone who is currently scheduled for a follow up visit through April 3, 2020, will also have the option of converting the in person office visit to a telemedicine visit or rescheduling the in person visit to a later date. The cost will be $50-$100 out of pocket depending on the complexity and duration of the telemedicine visit. This amount may be less than an in person office visit copay for some patients depending on their insurance.
  7. If you are having acute environmental allergy or asthma symptoms, please contact the office to schedule an acute telemedicine visit with one of our providers.
  8. If you are ill with fever, cough, and shortness of breath, have any possible COVID-19 exposures, or have traveled (domestic or international) in the past 2 weeks,  please do not come to the office. If you suspect you need testing, please check with the following screening resources:
    1. MO hotline:  877.435.8411
    2. IL hotline:  800.889.3931
    3. Mercy screening:  314.251.0500
    4. SSM Virtual screening:  www.ssmhealth.com

 

For more information regarding COVID-19, please see the CDC website: http://bit.ly/CDC-COVID-19_info 

We as a practice will continue to follow the precautionary measures recommended by the CDC and our professional societies to keep our office as safe as possible for our patients, families, and staff. Please continue to monitor our Facebook page for updates. Thank you for your understanding and continuing to partner with us to improve health outcomes. Working together in our local community and as a nation, we will overcome this crisis. Stay safe and healthy.