ABSTRACT
The COVID-19 pandemic severely hit Italy in early 2020, forcing the government to arrange a general lockdown across the country. The condition of forced quarantine, already experienced in China, has led to a worsening of symptoms in subjects already suffering from psychopathology, including Eating Disorders. To avoid this, after the closure of the Service, the Day Hospital of the Regional Center on Eating Disorders of the UO of Child Neuropsychiatry of the Azienda Policlinico S. Orsola-Malpighi of Bologna has activated an online treatment program aimed at five adolescent patients and their parents. The meetings were conducted by the Psychotherapist, the Child Neuropsychiatrist, the Dietitian and the Family Psychotherapist. During the lockdown, tests were administered to the patients, compared with test administered in the entry, to see if the symptoms related to the eating disorder and general psychopathology had changed. In addition, other tests were administered to both patients and parents with the aim of investigating the dynamics established during quarantine, which measured psychological well-being and general functioning. The observation made it possible to identify five psychological phases that the patients faced, related to eating symptoms, family dynamics and adaptation to the pandemic. The tests did not show significant changes in the psychopathology of the patients, while comparing the results of the tests also administered to the parents, an influence between mother and daughter can be seen, with often overlapping trends in relation to symptoms. The online treatment was effective and satisfactory for both patients and parents, and within the families greater moments of communication, listening and mutual involvement in the life of family members developed while maintaining personal spaces. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Italian) La pandemia COVID-19 ha gravemente colpito l'Italia nei primi mesi del 2020, costringendo il governo a predisporre un lockdown generale in tutto il paese. La condizione di quarantena forzata, gia sperimentata in Cina, ha portato un peggioramento dei sintomi in soggetti gia affetti da psicopatologia, compresi i Disturbi del Comportamento Alimentare. Per evitare questo, dopo la chiusura del Servizio, il Day Hospital del Centro Regionale sui Disturbi Alimentari dell'UO di Neuropsichiatria Infantile dell'Azienda Policlinico S. Orsola-Malpighi di Bologna ha attivato un programma di trattamento online rivolto a cinque pazienti adolescenti e ai loro genitori. Gli incontri sono stati condotti dalla Psicotera-peuta, dalla Neuropsichiatra Infantile, dalla Dietista e dalla Psicoterapeuta della famiglia. Durante il lockdown sono stati somministrati dei test alle pazienti, confrontati con quelli in entrata, per osservare se i sintomi relativi al disturbo alimentare e alla psicopatologia generale si fossero modificati. Inoltre sono stati somministrati altri test sia alle pazienti sia ai genitori con l'obiettivo di indagare le dinamiche instaurate durante la quarantena, che misuravano il benessere psicologico e il funzionamento generale. L'osservazione ha permesso di individuare cinque fasi psicologiche che hanno affrontato le pazienti, legate alla sintomatologia alimentare, alle dinamiche familiari e all'adattamento alla pandemia. I test non hanno riportato cambiamenti significativi nella psicopatologia delle pazienti, mentre confrontando i risultati dei test somministrati anche ai genitori si evince un'influenza fra madre e figlia, con andamenti spesso sovrapponibili relativamente ai quadri sintomatici. Il trattamento online e stato efficacie e soddisfacente sia per le pazienti sia per i genitori e all'interno delle famiglie si sonosviluppati maggiori momenti di comunicazione, ascolto, coinvolgimento reciproco nella vita dei familiari pur mantenendo gli spazi personali. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
ABSTRACT
Background: Vaccination has proven to be the best viable tool for preventing the spread of SarsCov2 infection. The fear of adverse events represents one of the limits of this vaccination campaign. As Allergists, we had a fundamental role evaluating the allergological risks and performing specific tests. The only absolute contraindication to SARS-CoV- 2 vaccination is hypersensitivity to its components. When an individual is allergic to an indispensable medication, it is possible to resort to desensitization. Given the lack of a standardized scheme, the aim of our study is to propose a desensitization protocol for anti-SARS- CoV- 2 vaccines. Method(s): The desensitization protocol we developed consists in the fractioned administration of the entire vaccine dose into 5 separate injections of increasing quantity, through a 2-hour period. Premedication with antihistamines and chromones was administrated. Between January 2021 and January 2022, 23 patients referred to our Unit were deemed with a high risk of hypersensitivity reactions to the vaccines and underwent the desensitization protocol. We here describe 23 consecutive cases of patients who underwent desensitization to anti-SARS- CoV- 2 vaccine. Result(s): 4/23 had positive allergy skin test to Polysorbate and underwent desensitization for their entire vaccination cycle. 19/23 had a previous hypersensitivity reaction to an anti-SARS- CoV- 2 vaccine (18 after the first dose and 1 after the second one). Among 4 patients with sensitization to Polysorbate none developed hypersensitivity reactions after fractionated administration of BNT162b2 vaccine. Among 19 patients that underwent desensitization because of hypersensitivity reactions after I or II dose of vaccine, 15 experienced a reaction following vaccination with BNT162b2, 4 with mRNA-1273 and 4 with ChAdOx1-S recombinant. Furthermore, we categorized their reactions according to WAO score per systemic reactions: 15/19 (79%) grade1, 2/19 (10.5%) grade2, 2/19 (10.5%) grade3. No severe late hypersensitivity reactions were observed. All but one of this 19 patients had no hypersensitivity reactions after vaccination through the desensitization protocol. 1 patient experienced anaphylaxis during desensitization with BNT162b2 vaccine (WAO grade4). No late hypersensitivity reactions were observed. Overall, 22/23 (95.6%) patients that underwent anti-SARS- CoV- 2 vaccination through the desensitization protocol did not experience hypersensitivity reactions. Conclusion(s): Our results suggest that desensitization can be implemented to extend the vaccination to currently ineligible individuals. Larger studies are needed to prove the safety and efficacy of this approach.
ABSTRACT
Background: Novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccines have been recently approved, and public concern regarding the risk of anaphylactic reactions arised after few cases during the first days of mass-vaccination. Polyethylene glycol (PEG) has been suggested as the most probable culprit agent for allergic reactions. We describe the allergy work-up protocol implemented for the vaccination campaign in our Center, aiming to allow the greatest number of people to be vaccinated safely. Method: The protocol included the self-report of a history of suspected drug or vaccine allergies, and subsequent teleconsultation and allergometric tests for PEG and Polysorbate 80 (PS80). A desensitizing protocol of vaccine administration was applied to patients sensitized only to PS80, and to those with a suspect allergic reaction after the first vaccine dose. Results: 10.2% (414 out of 4042) of the entire vaccine population have been screened: only one patient resulted allergic to PEG and therefore excluded from the vaccination. Another patient was sensitized to PS80 only and safely vaccinated applying the desensitizing protocol. Seven subjects without a previous history of allergic disease experienced suspect hypersensitivity reactions to the first administered dose: one of them resulted allergic to PEG and was excluded from the second dose, while the others safely completed the vaccination with the desensitizing protocol. Conclusion: A careful allergological risk-assessment protocol significantly reduces the number of patients who would have avoided SARS-CoV-2 vaccination for their allergies and to effectively identify and manage those rare patients with sensitization to PEGs and/or PS80.