Tratamiento de la rinitis alérgica en época de pandemia. Documento de consenso de sociedades médicas de América Latina y el Caribe / Treatment of allergic rhinitis in pandemic times. Consensus statement from medical societies of Latin America and the Caribbean

La rinitis alérgica ha ido en aumento en los países latinoamericanos, dando lugar a una creciente población de pacientes que necesitan tratamiento médico para esta afección respiratoria. Su similitud con la COVID-19 en cuanto a síntomas y la posibilidad de concurrencia con esta, hacen que la rinitis alérgica sea de particular interés para los sistemas de salud. Los países de América Latina y el Caribe han sido particularmente vulnerables por múltiples desafíos, entre estos, las altas tasas de pobreza, el acceso limitado a la atención médica y las limitaciones en la prestación de servicios básicos de salud, así como la ausencia de guías de tratamiento para la rinitis alérgica en situación de pandemia. Con el objetivo de proporcionar orientación esencial para los equipos multidisciplinarios de América Latina y el Caribe con respecto a la evaluación y el tratamiento de la rinitis alérgica durante la pandemia de COVID-19, se revisó literatura científica publicada sobre tratamiento de la rinitis alérgica y COVID-19, y se consideró la opinión de profesionales líderes de sociedades científicas de la región. Se analizaron las diferentes medidas para evitar contagios, y las diferentes estrategias de tratamiento con énfasis en la terapia intranasal y el tratamiento con vacunas contra la alergia. Se formuló una declaración de posicionamiento con la intención de mantener la continuidad del servicio médico en el contexto de una pandemia y minimizar la propagación, infección y complicación asociada con el coronavirus tipo 2 del síndrome respiratorio agudo severo en pacientes con seguimiento o comenzando tratamiento para la rinitis alérgica(AU)

Allergic rhinitis has been increasing in Latin American countries, leading to a growing population of patients who need medical treatment for this respiratory condition. Its similarity to COVID-19 in terms of symptoms and the possibility of concurrence with it, make allergic rhinitis of particular interest to health systems. The countries of Latin America and the Caribbean have been particularly vulnerable due to multiple challenges, including high poverty rates, limited access to medical care and limitations in the provision of basic health services, as well as the absence of guidelines of treatment for allergic rhinitis in a pandemic situation. With the aim of to provide essential management for multidisciplinary teams in Latin America and the Caribbean regarding the evaluation and treatment of allergic rhinitis during the COVID-19 pandemic, published scientific literature on the treatment of allergic rhinitis and COVID-19 was reviewed, and the opinion of leading professionals from scientific societies in the region was considered. The different measures to avoid infections and the different treatment strategies were analyzed, with an emphasis on intranasal therapy and treatment with allergy vaccines. A position statement was formulated with the intention of maintaining continuity of medical service in the context of a pandemic and minimizing the spread, infection and complication associated with severe acute respiratory syndrome coronavirus 2 in patients undergoing or starting treatment for allergic rhinitis(AU)

Característica clínica e topográfica do glioma maligno em adolescente - Influência do tratamento intranasal com álcool perílico / Clinical and topographic characteristics of primary glioma in youth - Influence the response to perillyl alcohol treatment

Objetivo: Analisar a influência da topografia da lesão tumoral na resposta ao tratamento intranasal com álcool perílico (POH) em jovens com glioma maligno recidivo. Método: Tendo como padrão a faixa etária de 0 a 19 anos, foram incluídos pacientes do sexo masculino (#153; #31) e feminino (#178) com glioma maligno em estágio terminal, recebendo terapia de suporte paliativa e administração intranasal diária de 440 mg de POH. Resultados: Cefaleia intensa, tontura, vômito, crise convulsiva, alteração de comportamento, fraqueza muscular, alteração visual e hemiplegia à direita foram os sintomas prevalentes antes da confirmação diagnóstica de glioma. Análise de imagem mostrou lesão tumoral nas regiões troncocerebral (#153), talamomesencefálica esquerda (#178) e frontotemporal e insular direita (#31). Paciente #178 não respondeu ao tratamento, evoluindo a óbito em três semanas, e paciente #31 permaneceu em tratamento com POH por aproximadamente 54 semanas. Apesar de nova recidiva, paciente #153 apresenta doença estável, sem qualquer evidência clínica de recorrência para mais de 200 semanas em tratamento exclusivo com álcool perílico por via intranasal. Conclusão: Pacientes adolescentes com glioma maligno recidivo apresentaram heterogeneidade de sintomas compatível coma região anatômica comprometida, indicando que a topografia da lesão tumoral foi um fator prognóstico de sobrevida, influenciando inclusive na resposta ao tratamento intranasal com o álcool perílico.

Objective: Analyze the influence of tumor topography on response to intranasal perillyl (POH) treatment in youths with high grade glioma. Method: It was included male patients (#153; #31) with 19 years old and female (#178) with 15 years old with recurrent high grade glioma in terminal stage using supportive therapy and 440 mg POH daily intranasal administration. It was established a relation of clinical data and topographic image with therapeutic response to intranasal POH. Results: Intense headache, dizziness, vomiting, seizures, behavior change, muscle weakness, visual changes and right hemiplegia were the symptoms prevalent before the diagnostic confirmation of glioma. Image analysis showed tumoral lesionin the brain-stem (#153), in the left thalamus-mesencephalic region (#178), and right frontal-temporal and insular regions (#31). Patient #178 did not respond to intranasal POH treatment and rapidly progressed to death within 3 weeks; patient #31 remained in treatment with POH for nearly 54 weeks, and despite new recurrence, patient #153 presents stable disease, without any clinical evidence of recurrence for more than 200 weeks and under treatment exclusively with POH by intranasal route. Conclusion: Childhood patients with high grade malignant glioma had heterogeneity of clinical symptoms compatible with anatomical compromised region indicating that topography of the tumoral lesion was a prognostic factor influencing the overall survival and response to intranasal POH.

Posicionamento da Academia Brasileira de Rinologia sobre terapias tópicas nasais / Brazilian Academy of Rhinology position paper on topical intranasal therapy

Opresente documento tem por objetivo esclarecer àqueles que tratam das doenças nasossinusais, tanto especialistas quanto generalistas, sobre as terapêuticas tópicas nasais. Por meio de uma revisão das evidências científicas, a Academia Brasileira de Rinologia vem proporcionar sua visão prática e atualizada sobre as medicações tópicas nasais mais utilizadas, excetuando-se as medicações que possuam antibióticos tópicos na sua formulação.

This documents aims at educating those who treat sinonasal diseases - both general practitioners and specialists - about topical nasal treatments. By means of scientific evidence reviews, the Brazilian Academy of Rhinology provides its practical and updated guidelines on the most utilized topical nasal medication, except for the drugs that have topical antibiotics in their formulas.