 means it can be difficult for healthcare providers to always make an accurate diagnosis. The start of autumn thus marks the onset of flu and fall allergy seasons, which may become all the more complicated during the ongoing 

, Lakiea Wright, MD, allergy and immunity, Brigham and Women’s Hospital, stressed that during this pandemic it becomes all the more essential for healthcare providers and clinicians to encourage their patients to receive their flu vaccination.

Many providers and healthcare system have developed novel strategies to ensure that individuals have easy and safe access to the vaccination. For example, drive-through flu clinics have become a more prevalent means of administering the vaccine.

, Wright explained that fever, sore throat, cough, and shortness of breath are typical overlapping symptoms between flu and allergies, as well as with COVID-19. Nonetheless, she emphasized the increasing necesseity to utilize the healthcare resources that are currently available.

“Even though that the symptoms overlap, it’s really important to make sure that patients are vaccinated, which will be really important for this upcoming season.” she said.

Videos

An expert discusses the importance of getting vaccinated for the flu this year as well as strategies healthcare systems are taking to ensure easy access for patients.

Lakiea Wright, MD: The Importance of Flu Vaccination

Providers, experts, and patients alike are preparing for a combination of 

 outbreaks. That means healthcare providers and patients are poised for potential threats from various places, and there is a great need to be able to differentiate between all 3.

Flu and COVID-19 present similarly because they are both viral illnesses that can cause respiratory symptoms, Lakiea Wright, MD, allergy and immunology, Brigham and Women’s Hospital, said in a recent interview with 

®. Although flu and COVID-19 are similar, there are distinguishing factors between such viruses and allergies.

The CDC recently published a Venn diagram to help identify some overlapping and distinguishing factors.

For example, when talking about environmental allergies, fever is not associated, so it would not typically indicate solely allergies. Itchy and watery eyes and sneezing are typical of allergies but not flu or COVID-19.

Other distinguishing factors like body and muscle aches, vomiting, diarrhea, and loss of taste and smell could help indicate flu and COVID-19.

Fever, headache, sore throat, cough, and shortness of breath all overlap in 1 way or another, Wright said.

“So, it’s really important to focus on those distinguishing factors I mentioned,” she concluded.

Lakiea Wright, MD: Differentiating Between Allergies, COVID-19, and Flu

Treating a patient with Arachis hypogaea (Palforzia) requires the child 

 to peanut to consume a tiny dose of peanut protein each day. Such treatment, considered novel, could allow for the dose to slowly be bumped up to make peanuts bite-safe for children.

“This is quite a bit different from other therapies and other pill options that we are used to giving our patients,” Christina Ciaccio, MD, MSc, of the University of Chicago Medical Center, said in a recent interview with 

The difference between Arachis hypogaea and other treatments for peanut allergy is the child is actually being given peanuts. With that, there is a risk of the child having an allergic reaction.

Providers must talk extensively to the family before using this treatment. Families are asked to be diligent about the dose being taken at the same time every day and for the child to eat a large meal at the same time to decrease the risk of stomach pains.

Another big thing that must be remembered is the child cannot get their heart rate up for 2-3 hours after they have their dose.

“What we don’t want is for the peanut protein to get into the bloodstream too quickly, we want it to slowly be introduced to the immune system on any given day,” Ciaccio said.

If patients are counseled and aware of the guidelines, they tend to do well on the therapy, she concluded.

How the treatment differs from others for peanut allergy.

Christina Ciaccio, MD, MSc: Treating Patients with Arachis Hypogaea

 is the second most common food allergy in children and cases are rising.

But arachis hypogaea (Palforzia) has been tested to treat children with the allergy. With arachis hypogaea, providers give children who are allergic to peanut a tiny dose of peanut and then slowly bump up the dose to get the children to eat a peanut’s worth of peanut protein every day.

“By doing so, we know we can make them bite-safe, which to us means that if they were accidentally to have a bite of peanut, they would be much less likely to have a severe allergic reaction with that ingestion,” Christina Ciaccio, MD, MSc, of the University of Chicago Medical Center, said in a recent interview with 

Arachis hypogaea differs from other peanut allergy therapies because it is the first-ever FDA-approved treatment for the condition, according to Ciaccio.

Prior to the approval, the strategy was to tell families their child needed to strictly avoid peanuts and carefully read the labels of all foods being consumed. Such families would need to be prepared with an epinephrine auto-injector just in case their child did have an allergic reaction with an accidental bite.

The expert discusses the first FDA-approved drug of its kind for peanut allergy.

Christina Ciaccio, MD, MSc: Arachis Hypogaea for Peanut Allergy

 to continue caring for patients virtually. But the technology comes with many challenges.

The primary concern is a lack of a physical exam, Daniel Albert, MD, of Dartmouth-Hitchcock, said in a recent interview with 

. Rheumatologists often rely on a physical examination to get a better look at the whole patient.

“It’s a very difficult transition for providers to care for patients without a physical exam,” he said.

There are workarounds, however, but they require ingenuity. For example, patients often show Albert how they walk, how they use their upper extremities for activities, and physical exam maneuvers can be done similarly to how they would be done in person, but they have to use a visual rather than sensory input. Sometimes rheumatologists can elicit tender points on an individual if they are asked to put pressure on certain areas.

Other concerns exist, such as patients who are simply not suited for a virtual appointment, whether it be because they have a visual impairment or less cognitive ability than is required to conduct such an interview virtually. Sometimes diseases are just too complex and there are too many comorbidities, or the patient has too severe of a disease.

Lastly, it’s important for patients to buy into the idea of virtual encounters. If patients are uncomfortable, you have to give them the opportunity to be seen in the clinic.

Three key issues with using the technology over in-person visits.

Daniel Albert, MD: Telemedicine Challenges for Rheumatologists During COVID-19

t, Jeffrey Curtis, MD, MS, MPH, of the University of Alabama at Birmingham, discussed how 

 must be more attuned to patient risk for 

CV risk can increase as a result of the rheumatic condition or certain therapies that may have an adverse effect on lipid profiles.

In this final part of our interview, Curtis elaborated a bit further on this shortcoming in rheumatological care and a potential direction for the specialty.

“Although rheumatologists are certain specialists, I think many of us feel rather compelled to get back a bit more to our internal medicine roots,” he said.

This would mean engaging more in CV risk management, such as prescribing appropriate therapies and more actively monitoring aspects of CV health.

Curtis attributed this limitation in care to knowledge and willingness gaps. He believed this assuming of greater responsibility would meet a pushback in the field. After all, rheumatologists are already spread thin with time pressures for treatment.

“It doesn’t have to be that rheumatologists are always the prescribers,” said Curtis. “I think in many offices it’s just not realistic. But we can think through how we can better comanage and how we can communicate more effectively.”

He concluded with a hope that rheumatologists can take on greater responsibility and opportunities to optimize patient outcomes.

Care of rheumatic patients must factor in cradiovascular risk and conditions.

Jeffrey Curtis, MD, MS, MPH: The Future of Rheumatological Care

This past spring, the American College of Rheumatology has published 

on best practices for managing reproductive health in patients with 

The goal of these recommended guidelines is to encourage open communication and inform shared decision-making between patients and their physicians on issues related to reproductive health, including pregnancies.

“This area of reproductive health in rheumatic diseases has become increasingly important as our patients are in better health because of our better therapies,” said Lisa Sammaritano, MD, of Weill Cornell Medicine and Hospital for Special Surgery, in an interview with 

As improved treatments and technologies have become available in this domain, it has become increasingly important for patients, rheumatologists, and primary care physicians to make decisions together about the best strategies for optimal care.

Sammaritano noted that rheumatologists should still actively engage in these conversations on reproductive health, even if they themselves feel unable to provide comprehensive information.

She emphasized the usefulness of the ACR recommendations in providing guidance for rheumatologists and patients in these discussions.

“There are really helpful guidelines and management suggestions that are easy to refer to if one needs that,” she said.

Sammaritano is the lead author on the ACR reproductive health recommendations.

The recently published American College of Rheumatology guidelines on reproductive health is a great resource for rheumatologists.

Lisa Sammaritano, MD: Final Thoughts, ACR Guidelines on Reproductive Health

Telemedicine has been a boutique enterprise for the last dozen years, but recently, due to the 

 pandemic, it has become front and center for many practitioners, including those focused on 

Daniel Albert, MD, of Dartmouth-Hitchcock, told 

 in a recent interview that many providers and patients have had to do a quick ramp-up for the tools necessary to conduct such care and be cared for in such a way.

“It seems like it’s been very appealing to both groups and hopefully it will continue in largely the current format rather than the one that was unfortunately highly, highly regulated with a lot of barriers before COVID,” Albert said.

For Albert, he has an electronic health record (EHR) with a variant for his institution which permits a great deal of flexibility in terms of communication between patients and providers. The EHR allows for written documents, videos, still photos, and verbal and written interchange.

The platform that allows Albert to have a seamless video interaction with patients is called Vidyo. There are other variants that may have improved video or audio. A newer variant could allow for more devices being connected to the same interphase, and on Albert’s end, other students and staff members can be a part of the call to facilitate the conduct of the counter.

Providers are being careful to stay away from non-HIPAA compliant platforms like FaceTime and Skype.

How rheumatologists use telemedicine during COVID-19.

Daniel Albert, MD: Telemedicine for Rheumatic Care

Unless there was an unusual emergency, interventional pain procedures were considered elective, Alan Kaye, MD, PhD, of LSU Health School of Medicine, told 

 in a recent interview. Most were canceled because of concerns about supplies and the doctors did not want patients to get exposed.

“Pain medicine has gone through radical changes with telemedicine becoming the norm,” Kaye said.

The pandemic has been a serious challenge, he added.

Research has been published touching on all of the issues related to treating pain during COVID-19.

While pain doctors and rheumatologists alike have needed to shift its focus and use telemedicine to treat patients, some rheumatologists may have already been leveraging the technology for consults with patients.

“Every doctor and every person in America and probably worldwide have been affected by COVID,” Kaye said. He added it should not be surprising the 