Subject(s)
Environmental Medicine , Nasal Polyps , Nasal Surgical Procedures , Sinusitis , Humans , OmalizumabABSTRACT
Background: Vaccinations against Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) are intended to induce an immune response in the sense of protection against infection/disease. Allergen-specific immunotherapy (AIT) is also thought to induce a (different) immune response in the sense of tolerance to allergens. There is uncertainty among patients and physicians regarding the use of vaccination and AIT in temporal relation, which this position paper aims to clarify. The four vaccines currently approved in Germany for vaccination against SARS-CoV-2 are described and possible immunological interactions with AIT are highlighted, as well as practical recommendations for action. Methods: Based on the current internationally published literature, this position paper provides specific recommendations for action regarding the use of AIT in temporal relation to a SARS-CoV-2 vaccination. Results: The present recommendations for action relate to the following conditions for which AIT is used i) allergic rhinitis, ii) allergic bronchial asthma, iii) insect venom allergy, iiii) food allergy (peanut). Conclusions: If vaccination is imminent, initiation of subcutaneous (SCIT), sublingual (SLIT), or oral (OIT) AIT should be delayed until 1 week after the 2nd vaccination date. Thus, there should generally be an interval of approximately 1 week between SCIT and COVID-19 vaccination. For the continuation of an ongoing AIT, we recommend an interval of 1 week before and after vaccination for SCIT. For SLIT and OIT, we recommend taking them up to the day before vaccination and taking a break from SLIT and OIT for 2 – 7 days after vaccination.
ABSTRACT
BACKGROUND: The COVID(coronavirus disease)-19 pandemic is characterized by high infectivity, droplet transmission, and high viral load in the upper respiratory tract. Severe disease courses are associated with interstitial pneumonia and ventilated patients, in whom tracheotomy (TT)-a droplet- and aerosol-producing medical intervention-is regularly necessary. TT as a potential infection risk for medical staff is scarcely found in the literature. Therefore, the aim of this study was to quantify droplet exposure of the surgical team during TT, to better define the requirements for personal protective equipment (PPE). MATERIALS AND METHODS: Surgical TT was performed in four non-infectious patients, during which the surgeon and his assistant both wore a surgical nasal mask with a transparent visor. After the procedure, the type, distribution, and number of droplets on the visor were determined macroscopically and microscopically. RESULTS: An average of 29 droplets were found on the middle third of the visor, 4 on the right third, and 13 on the left third, with an average droplet size of 571⯵m (±â¯381⯵m). The smallest droplets were 55⯵m, the largest 1431⯵m. An increase in the number of droplets was found with increased ventilation during the procedure. Blood droplets were more common than secretion droplets. CONCLUSION: Contamination of the visor with droplets was demonstrated. Especially in the case of TT in highly infectious patients, e.g., COVID-19 patients, the use of hooded headgear in combination with breathing apparatus with air purification and power supply is recommended to ensure best protection from infection for the surgeon and the surgical assistant.
Subject(s)
COVID-19 , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics , SARS-CoV-2 , Tracheotomy/adverse effectsABSTRACT
Mit den Biologika stehen zunehmend mehr Therapeutika zur Verfügung, die zielgerichtet bestimmte Schaltstellen im Pathomechanismus immunologisch dominierter Erkrankungen adressieren. Damit steht mehr die individuelle Krankheitsausprägung des einzelnen Patienten im Fokus der Diagnostik und Therapie (Präzisionsmedizin). Bezüglich der unterschiedlichen Phänotypen atopischer Erkrankungen war das schwere Asthma die erste Entität, für die Biologika zugelassen wurde, gefolgt von Urtikaria, und schließlich der atopischen Dermatitis und der chronischen Rhinosinusitis mit nasalen Polypen. Die Erfahrungen in der Therapie des schweren Asthma bronchiale machten deutlich, dass die Intensität des Ansprechens auf eine Biologikatherapie entscheidend von der Qualität der klinischen und immunologischen Phänotypisierung der Patienten abhängt, wobei diese Unterscheidung z. T. schwierig sein kann und sich verschiedene Phänotypen durchaus überlagern können. Das gilt auch für unterschiedliche Erkrankungen des atopischen Formenkreises, da Patienten in jeweils entsprechend unterschiedlicher Ausprägung unter mehreren atopischen Krankheiten gleichzeitig leiden können. Es bilden sich bereits Biologika heraus, die eine geeignete Therapie für das allergische Asthma bronchiale, das häufig gemeinsam mit einer schweren Neurodermitis auftritt, sowie die chronische Rhinosinusitis mit nasalen Polypen darstellen können. In der Praxis stellt sich dennoch zunehmend die Frage nach möglichen Biologika-Kombinationen zur Therapie komplexer Krankheitsbilder einzelner Patienten. Dabei gilt es, das Nebenwirkungsprofil zu beachten, zu denen auch Hypersensitivitätsreaktionen gehören, deren diagnostisches und logistisches Management eine sichere und effiziente Therapie der Grunderkrankung zum Ziel haben muss. Erhöhte Aufmerksamkeit gilt auch für eine Biologikatherapie bei Schwangerschaften und geplanten (planbaren) Impfungen sowie bestehenden Infektionen, wie zum Beispiel die SARS-CoV-2-Infektion. Vor dem Start einer Biologikatherapie sollten der Immunstatus in Bezug auf chronische Virusund bakterielle Infektionen geprüft und gegebenenfalls vor Therapieeinleitung der Impfstatus aufgefrischt bzw. fehlende Impfungen nachgeholt werden. Derzeit liegen verlässliche Daten zum Effekt von Biologika auf die immunologische Situation der SARS-CoV-2-Infektion und COVID-19 nicht vor. Daher ist die Erforschung und Entwicklung geeigneter Diagnostikverfahren zur Erfassung immunologisch bedingter Nebenwirkungen sowie der Erfassung potenzieller Therapie-Responder und -Non-Responder von großer BedeutungAlternate abstract:With the advent of biologicals, more and more therapeutics are available that specifically address specific switch points in the pathomechanism of immunologically dominated diseases. Thus, the focus of diagnostics and therapy (precision medicine) is more on the individual disease characteristics of the individual patient. Regarding the different phenotypes of atopic diseases, severe asthma was the first entity for which biologicals were approved, followed by urticaria, and finally atopic dermatitis and chronic rhinosinusitis with nasal polyps. Experience in the treatment of severe bronchial asthma has shown that the intensity of the response to biological therapy depends on the quality of clinical and immunological phenotyping of the patients. This also applies to different diseases of the atopic form, as patients can suffer from several atopic diseases at the same time, each with different characteristics. Biologics are already emerging that may represent a suitable therapy for allergic bronchial asthma, which often occurs together with severe neurodermatitis, and chronic rhinosinusitis with nasal polyps. In practice, however, the question of possible combinations of biologicals for the therapy of complex clinical pictures of individual patients is increasingly arising. In doing so, the side effect profile must be taken into account, including hypersensitivity reactions, whose diagnostic and logistical management must aim at a safe and e ficient therapy of the underlying disease. Increased attention must also be paid to biological therapy in pregnancy and planned (predictable) vaccinations as well as existing infections, such as SARS-CoV-2 infection. Before starting a biological therapy, the immune status should be checked with regard to chronic viral and bacterial infections and, if necessary, the vaccination status should be refreshed or missing vaccinations should be made up for before starting therapy. Currently, reliable data on the effect of biologicals on the immunological situation of SARS-CoV-2 infection and COVID-19 are not available. Therefore, research and development of suitable diagnostic methods for detection of immunologically caused side effects as well as detection of potential therapy responders and non-responders is of great importance.