Digital health for allergen immunotherapy.

In the recent past, digital healthcare technologies are experiencing a significant leap in development, with an additional unforeseen acceleration in implementation due to the SARS-CoV-2 pandemic. The increased use of mobile applications as well as communication technologies to search for services and support hold particular advantages for the management of chronic diseases requiring medium- to long-term treatments and regular follow-up visits. Allergen immunotherapy (AIT), requiring regular application of treatment, represents an optimal scenario for feasible digital support. From patient stratification and care pathways, over personalized decision support for complex clinical scenarios, towards a close and flexible patient-doctor communication in blended care settings: the current article summarizes the latest knowledge on the use and potential of digital health technologies in the area of AIT .

The first, holistic immunological model of COVID-19: Implications for prevention, diagnosis, and public health measures.

The natural history of COVID-19 caused by SARS-CoV-2 is extremely variable, ranging from asymptomatic or mild infection, mainly in children, to multi-organ failure, eventually fatal, mainly in the eldest. We propose here the first model explaining how the outcome of first, crucial 10-15 days after infection, depends on the balance between the cumulative dose of viral exposure and the efficacy of the local innate immune response (natural IgA and IgM antibodies, mannose-binding lectin). If SARS-CoV-2 runs the blockade of this innate immunity and spreads from the upper airways to the alveoli in the early phases of the infections, it can replicate with no local resistance, causing pneumonia and releasing high amounts of antigens. The delayed and strong adaptive immune response (high-affinity IgM and IgG antibodies) that follows, causes severe inflammation and triggers mediator cascades (complement, coagulation, and cytokine storm), leading to complications often requiring intensive therapy and being, in some patients, fatal. Low-moderate physical activity can still be recommended. However, extreme physical activity and oral breathing with hyperventilation during the incubation days and early stages of COVID-19 facilitates re-inhalation and early direct penetration of high numbers of own virus particles in the lower airways and the alveoli, without impacting on the airway's mucosae covered by neutralizing antibodies ("viral auto-inhalation" phenomenon). This allows the virus to bypass the efficient immune barrier of the upper airway mucosa in already infected, young, and otherwise healthy athletes. In conclusion, whether the virus or the adaptive immune response reaches the lungs first is a crucial factor deciding the fate of the patient. This "quantitative and time-/sequence-dependent" model has several implications for prevention, diagnosis, and therapy of COVID-19 at all ages.