The arrival of COVID-19 vaccines inspired hope and relief around the world, but it also raised another emotion — uncertainty — for those with a history of allergic reactions to certain vaccines. A new clinic at the Brigham is helping employees across the system assess and alleviate allergy concerns by helping them better understand their risk and, in many cases, develop a plan to safely receive the vaccine.
Launched in late December, the service is part of the Division of Allergy and Clinical Immunology. It is one of two specialized clinics to offer skin and allergy testing for employees across Mass General Brigham (MGB) who are at risk of an allergic reaction to the COVID-19 vaccine. The second clinic is located at Massachusetts General Hospital (MGH).
“When we were developing our plan for vaccination for employees across MGB and saw the emerging reports about allergic reactions to the COVID-19 vaccine, we knew we had to work across our system to develop a framework so that our employees felt safe, comfortable and supported,” said Paige Wickner, MD, MPH, an allergist and immunologist who developed the framework for the Brigham clinic.
Providing these services and support to colleagues who might otherwise decline the vaccine has been tremendously gratifying, said Jeanette Cote, MSN, RN, charge nurse for the Allergy and Clinical Immunology Clinic, who led the implementation of the new clinic’s skin testing protocol.
“There’s a lot of anxiety about vaccination, especially for people with allergies, so it’s nice to offer some peace of mind,” Cote said. “This is why nurses go into our profession — it’s rewarding to know that you’re helping somebody.”
Although it’s been a fast-moving project and the additional visits have added to the Allergy and Clinical Immunology team’s usual caseload, providers and staff are committed to supporting their colleagues across the system, said Jeremy Dias, DNP, RN, NEA-BC, nursing director for Allergy and Clinical Immunology.
“Despite the challenges, it’s gone really smoothly, which speaks to everybody’s willingness to step up and go above and beyond to make this happen,” Dias said. “What was most important to us was making sure this vaccine could be available to as many people as possible, as fast as possible, so that our community is protected.”
Creating a Safe Plan for Vaccination
The team has worked closely with colleagues in Ambulatory, IS and Occupational Health Services to proactively identify employees who might be at risk for an allergic reaction to the vaccine.
Before employees can schedule a vaccine appointment in COVID Pass, they must complete a brief questionnaire to assess their allergy risk. Those whose indicate they have a history of allergies to ingredients in the vaccine or a history of anaphylaxis — a rare but severe allergic reaction throughout the body — are referred to the clinic for a consult with an allergist.
The team aims to schedule virtual consults within three days of receiving an employee’s responses to the questionnaire. In the five weeks the clinic has been operational, the team has conducted hundreds of virtual consults.
“We are aware that many employees are very anxious to get their vaccination, so it’s important that we get them in for a consult in a timely manner, especially if they’re concerned about a possible reaction,” said Kenisha Lewis, practice manager for the Allergy and Clinical Immunology Clinic, who led efforts to develop the scheduling strategy for the vaccine allergy and skin testing clinic.
If an allergist determines the employee would benefit from skin testing, a follow-up appointment is scheduled. During a skin test, small amounts of three vaccine ingredients that are known allergens are injected into the skin. In this controlled setting, a reaction would be far milder than if an allergic person received the full amount present in the vaccine.
The team also maintains a pager for an on-call allergist to assist with allergy questions that arise at the employee vaccination clinic. In addition, the small subset of employees who had an unanticipated reaction to their first dose can arrange for an allergist to be present for their second-dose appointment.
In many areas of the country, those with vaccine allergies are simply advised not to receive the vaccine or to forego their second dose if they have a reaction to the first. Leaders at the Brigham, MGH and MGB saw an opportunity to support their workforce by leveraging the system’s expansive allergy expertise, Wickner said.
“A lot of systems in the U.S. don’t have anything like this in place,” she added. “Our goal was to be risk-averse and develop a framework to help our employees safely get vaccinated. We’ve also learned a lot from this process, and this collaboration will inform what we’ll be able to offer patients.”
‘Passionate About the Power of Immunization’
Launched just 10 days after the Brigham vaccinated its first employees, the clinic rapidly came together thanks to interdisciplinary collaboration.
“It needed to be multidisciplinary because everybody’s expertise was needed,” Dias said.
Designing the framework and protocols from scratch in such a short timeframe was an intense process with a rapid cycle of process improvement.
“When we started, it was two to three meetings per day, every day. If we saw something wasn’t working, we were like, ‘Let’s jump on a call to figure this out,’ and within a week it was running very smoothly,” Lewis said. “It was challenging because we’re working with the same amount of staff and still running the regular allergy clinic as well, but we put in the time and made it a priority because we know how important this is.”
Collaboration also extended beyond the core team at the clinic. For example, nurses worked closely with Pharmacy Services at 850 Boylston St. to make the process seamless for providers who conduct skin testing. Cote recognized the efforts of Tamara Roldán Sevilla, PhD, BPharm, senior pharmacist, who sought to support her nurse colleagues by preparing convenient, individualized packets of medications for the skin-testing orders.
“Tamara went the extra mile to make sure we had what we needed and delivered it to us in a way that eliminated any guesswork,” Cote said. “We didn’t have to go hunting for anything. She made it very easy for us.”
The entire team’s dedication has been nothing short of remarkable, Wickner said.
“This has been a very heavy lift for everyone. Like everything from the past year, this clinic has been an ‘add on,’ not an ‘instead of,’ and it’s a real testament to all our staff who have worked tirelessly on this effort,” Wickner said. “We all feel so passionate about the power of immunization and helping those who have a history of allergies get vaccinated safely.”