Rationale: Immunotherapy Units (IU) went through an unexpected transformation in order to get re-organized during the COVID pandemic. The aim of the present work is to share our experience in the IU through this rapid conversion during the outbreak. Methods: The current investigation was carried out at the IU located serving the Allergy Department in a public Tertiary-care referral Hospital, regularly managing an average of 320 in-patients/mo. Standard scheduled regimes included hymenoptera venom s.c. immunotherapy (SCIT), cluster or specific SCIT schedules for respiratory conditions and subjects with documented previous SCITadverse reactions. Results: During the enforced COVID-19 confinement, only hymenoptera SCIT was maintained in the IU, while all SCIT-associated respiratory disease was postponed. Telehealth, including telephone e-mail consultations and previously developed electronic consultations, enabled the virtual management of the IU. The number of re-scheduled SCIT was over 100 subjects per mo. During confinement, a total of 65 starting and 176 maintenance SCIT doses were re-scheduled reaching 494 starts and 332 maintenance SCIT doses, with a median of 23 telephone and 16 mail resolved user's questions per wk. A full re-allocation of human resources, spaces and operation hours have been achieved, regardless of the increase in the absolute number of SCIT adverse reactions during this period. Conclusions: In our experience, telemedicine greatly aided in the transition to the re-organization of the IU, favoring further work in this direction. The unexpected COVID-19 outbreak resulted in no increase of AIT-associated adverse reactions in the IU despite the associated greater work pressure related to this period.