ABSTRACT
Genotypic definition of monogenic inborn errors of immunity (IEIs) continues to accelerate with broader access to next generation sequencing, underscoring this aggregated group of disorders as a major health burden impacting both civilian and military populations. At an estimated prevalence of 1 in 1200 individuals, IEIs affect ~8,000 patients within the Military Health System (MHS). Despite access to targeted gene/exome panels at military treatment facilities, most affected patients never receive a definitive genetic diagnosis that would significantly improve clinical care. To address this gap, we established the first registry of IEI patients within the MHS with the goal of identifying known and novel pathogenic genetic defects to increase diagnosis rates and enhance clinical care. Using the registry, a research protocol was opened in July 2022. Since July we have enrolled 75 IEI patients encompassing a breadth of phenotypes including severe and recurrent infections, bone marrow failure, autoimmunity/autoinflammation, atopic disease, and malignancy. Enrolled patients provide blood and bone marrow samples for whole genome, ultra-deep targeted panel and comprehensive transcriptome sequencing, plus cryopreservation of peripheral blood mononuclear cells for future functional studies. We are also implementing and developing analytical methods for identifying and interrogating non-coding and structural variants. Suspected pathogenic variants are adjudicated by a clinical molecular geneticist using state-of-the-art analysis pipelines. These analyses subsequently inform in vitro experiments to validate causative mutations using cell reporter systems and primary patient cells. Clinical variant validation and return of genetic results are planned with genetic counseling provided. As a proof of principle, this integrated genetic evaluation pipeline revealed a novel, candidate TLR7 nonsense variant in two adolescent brothers who both endured critical COVID-19 pneumonia, requiring mechanical ventilation and extracorporeal membrane oxygenation. Our protocol is therefore poised to greatly enrich clinical genetics resources available in the MHS for IEI patients, contributing to better diagnosis rates, informed family counseling, and targeted treatments that collectively improve the health and readiness of the military community. Moreover, our efforts should yield new mechanistic insights on immune pathogenesis for a broad variety of known and novel IEIs.Copyright © 2023 Elsevier Inc.
ABSTRACT
Health inequalities in respiratory disease are widespread, and monitoring them is important for advocacy, the design and delivery of health services, and informing wider health policy. In this chapter, we introduce the different ways in which health inequalities can be quantified, including measures that quantify absolute and relative inequalities, and those that measure gaps between groups or differences across the entire social gradient. We consider the strengths and limitations of these different approaches and highlight things to look out for when reading a paper on health inequalities in respiratory health. These include how common the outcome is and whether other factors have been adjusted for, as both can have a crucial impact on interpretation and can lead to misleading conclusions.Copyright © ERS 2023.
ABSTRACT
Studies for vaccine development have been completed in an unprecedented time to prevent further outbreak of the dangerous and potentially fatal coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Some of these vaccines have been approved by various authorities and made available worldwide. While vaccine applications continue globally, the number of dermatological side effects reported after vaccination is increasing daily. Many cutaneous reactions have been reported in the literature, such as injection site reactions, pernio lesions, pityriasis rosacea, herpes zoster, and exacerbations of chronic inflammatory dermatoses such as atopic dermatitis and psoriasis. Most COVID-19 vaccines require two doses and a booster dose, and considering the new variants of the coronavirus, vaccination is estimated to continue for a while. In this context, dermatologists are more likely to encounter vaccine-related dermatological side effects in their daily practice. Dermatologists play an essential role in many issues such as diagnosis and treatment of cutaneous reactions after COVID-19 vaccination, informing patients and providing necessary counseling. This perspective will also provide helpful information for the future in terms of vaccination strategies to be developed for repeated doses. In this study, most of the cutaneous reactions reported after COVID-19 vaccination in the current literature are reviewed.
ABSTRACT
Background: Adverse reaction's reported after COVID 19 vaccination had a negative impact on public opinion. These adverse reactions may be or may be not be mediated by hypersensibility reactions. The proper assesment and the manegament of adverse reactions are crucial in order to offer a safer inmunitation and also to reduce the misinformation and the growing rejection to COVID 19 vaccination. Objective(s): To describe clinical characteristics and the allergological study done in different patients who had an adverse event right after COVID 19 vaccine administration Method: Descriptive study in patients who have experienced an adverse event after one single dose of the SARS CoV2's vaccine. Sex, age, atopy, drug allergies, anaphylaxis reaction (according to EEACI), syntoms, timing, vaccine and dose are described on this study. Skin test were done in every patient (Prick-Test and intradermo reaction) with ARN vaccine samples (Pfizer and Moderna), Adenovirus vaccine extract (Astrazeneca) and a battery of excipients (Polietilenglicol, Polisorbato80 and Trometamol). Result(s): The study included 44 patients with an average of 48,76 +/- 12,23 years, (93% women-29% atopic). 29% of the patients reported to be allergic to other drugs (AINES especially). The most frequent reaction according to EEACI anaphilaxy's classification was Grade 1 with a 61%. Grade 2: 18%, Grade 3: 21%. Urticaria and/or angioedema were the most frequent syntoms (60%) followed by disnea (20%) and being late syntoms (50%) the most usual ones. Pfizer was the most implicated vaccine (64%) with the first dose (84%). Skin tests with Polietilenglicol, Trometamol and Polisorbato80 at different concentrations were negative in all patients but two, one positive to Polisorbato80 0.004mg/ml with a previous sensitization to Prontosan (contains Polisorbato) and another one positive to Trometamol 0.1mg/ml. Conclusion(s): Allergists play a main role to offer the maximum befenits to their patients and to improve the vaccine's safety. Skin tests were the most efective tool to diagnose hypersensibility reactions. The 93,17% of the patients with a negative test result tolerated the second dose. The others did not get the second dose due to their own will. Avoiding the COVID 19 vaccine was recommended in those patients with a hypersensibility to the vaccine components diagnose.
ABSTRACT
Background: Mass vaccination seems to be the most effective way to turn back to the pre-pandemic period and end the pandemic. Unfortunately, COVID-19 vaccines have some side effects. In phase studies of currently-approved COVID-19 vaccines, patients with a known allergy or a history of anaphylaxis were excluded from the studies. This situation creates doubts about the course of atopy and the presence of allergic disease related to the side effects of COVID-19 vaccines in patients with allergic diseases. Therefore, our aim with this study was to evaluate local side effects (LSE) and systemic side effects (SSE) after COVID-19 vaccines in patients with allergic diseases and to determine possible risk factors. Method(s): Six hundred forty-eight adult patients who received any COVID-19 vaccine between April 1, 2021 and September 30, 2021 and agreed to participate in the study were included in this case-control retrospective study. Result(s): Six hundred forty-eight adult patients [Female: 446 (68.8%), Male: 202 (32.2%)] participated in the study. After the 1st dose of COVID-19 vaccine, 24.1% of patients reported SSE. After the 2nd dose of COVID-19 vaccine, 67 patients (12.3%) developed SSE. Female gender (OR: 1.757, 95%Cl: 1.143-2.702, p: 0.010), history of previous COVID-19 infection (OR: 1.762, 95%Cl: 1.068-2.906, p: 0.026), and COVID-19 vaccine type administered (OR: 4.443, 95% CI: 2.640-7.476, p < 0.001) were found to be independent risk factors for SSE after COVID-19 vaccines. Premedication (OR: 0.454, 95% Cl: 0.281-0.733, p < 0.001), was found to be a protective factor for SSE developing after COVID-19 vaccines. Conclusion(s): CoronoVac and Pfizer-BioNTech COVID-19 vaccines are shown to be well tolerated. Patients with allergic disease do not have an increased risk for SSE that may develop after COVID-19 vaccines. Moreover, doubts or fears about possible side effects in the allergic patient group should not be an obstacle to COVID-19 vaccination.
ABSTRACT
Background: Although there are case reports and guideline recommendations that states omalizumab can be used in chronic spontaneous urticaria (CSU) patients during SARS-CoV- 2 pandemic, there are scarce studies showing the course of Coronavirus disease 2019 (COVID-19) in CSU patients receiving omalizumab. Method(s): A total of 370 patients with chronic urticaria were included in the study between June 2020 and December 31, 2020. Result(s): Sixty patients (16.2%) became infected with the SARS-CoV- 2. The rate of pneumonia and hospitalization were 4.1% and 1.9%. There was no significant difference was determined between the CSU patients with omalizumab treatment and the non-receivers in regard to the rate of SARS-CoV- 2 (+) (p: 0.567) and in regard to the rate of SARS-CoV- 2 related pneumonia and hospitalization (p: 0.331 and p: 0.690). Gender, duration of CSU, serum IgE levels, omalizumab treatment, and atopy were not found to be associated with an increased risk for SARS-CoV- 2 positivity in patients with CSU. Conclusion(s): Our study shows that the use of omalizumab does not increase the risk of COVID-19 infection, COVID-19- related pneumonia and hospitalizations in CSU patients and supports the views that omalizumab can be used safely in patients with CSU during the COVID-19 pandemic.
ABSTRACT
Background: Little is known about the course of COVID-19 in patients with severe asthma/chronic spontaneous urticaria (CSU) using biological agents. To assess the incidence and course of COVID-19 in patients with severe asthma/CSU using biological agents Method: A total of 202 patients (142 with asthma, 60 with CSU) were enrolled. The subjects were questioned via face-to- face or telephone interview whether they had been diagnosed with COVID-19 and the course of the disease. Result(s): Study group consisted of 132 women, 70 men (median age: 48 years). Thirty-one (15.3%) patients were diagnosed with COVID-19, 22 (71%) of whom were receiving omalizumab and 9 (29%) were receiving mepolizumab. Diagnosed with asthma or CSU, age, sex, smoking, weight, comorbidities, atopy and receiving biological agent were not statistically different between patients with or without COVID-19. Nine COVID -19 patients were hospitalised, three of them required intensive care. Mepolizumab usage was higher in hospitalised patients (5, 55.6%), whereas omalizumab usage was higher in home-treated patients (18, 81%). The mean duration of biologicals usage in home treated patients was significantly higher than that of the hospitalised patients (35.64 months vs.22.56 months, p = 0.024). Biological treatments were interrupted in 47 (23%) patients, self-interruption due to the infection risk was the foremost reason (34%) while having COVID-19 took the next place (28%). Conclusion(s): The incidence of COVID-19 among patients with asthma and CSU on mepolizumab and omalizumab was higher compared to studies from other countries. The disease course appeared mild in patients receiving long-term biological therapy.
ABSTRACT
Background: Covid-19 pandemic had an important impact on health care, in particular on the approach to respiratory diseases. Aim(s): To characterize asthmatics patients hospitalized in a tertiary hospital during Covid-19 pandemic. Method(s): Retrospective analysis of the clinical data of the patients hospitalized in our Hospital for asthma exacerbation during the first 12 months of Covid-19 pandemic (from March 2020 to February 2021) compared with the corresponding period before pandemic (from March 2019 to February 2020). In order to identify admitted patients for asthma, we used ICD9 and IC10 asthma diagnostic codes attributed to the main diagnosis. Result(s): A total of 56 hospitalizations were identified, corresponding to 53 patients, 81.1% females and 18.9% males, with a mean age of 47.3 years [ +/- 20.8 years;8-93 years]. Ten cases were excluded (missing information, in three, and other reason for admission, in seven). We identified 17 hospitalizations in the considered pandemic period and 39 in the pre-pandemic period, representing a significant reduction in asthma hospitalization during covid-19 pandemic (30.4% vs 69.6%, p < 0.001). When comparing the main characteristics between the two groups (pandemic vs pre-pandemic), namely age (47.1 vs 47.3 years, p = 0.972), gender (82.4% vs 79.5% female, p = 1.0), atopy (50.0% vs 64.5%, p = 0.366), hospitalization length (5.8 days vs 5.7 days, p = 0.9), previous therapy (37.5% vs 30.8% only SABA/LABA, p = 0.754), therapy after discharge (p = 0.842) or exacerbation trigger, no statistical differences were found. In both groups, viral respiratory tract infection was the main trigger for asthma exacerbation. In neither case SARS-CoV- 2 infection was identified. Conclusion(s): There was a significant decrease in asthma hospitalizations in the first 12 months of the Covid-19 pandemic, compared to the same period pre-pandemic. However no statistically significant differences were found between the characteristics of hospitalized patients in the two periods.
ABSTRACT
Autoantibodies against melanoma differentiation-associated protein 5 (MDA5) associated with dermatomyositis have recently been described in Asians with rapidly progressive respiratory disease. Here we report the case of a middle-aged white woman with anti-MDA5 antibody-associated amyopathic dermatomyositis with interstitial lung disease (ILD), which is stable with minimal immune suppression. A 55-year-old woman was referred to a virtual dermatology clinic during the COVID-19 pandemic suspected of having widespread eczema involving the chest, face, arm and hands on the background of atopy. On direct questioning, she admitted to having constitutional symptoms, exertional dyspnoea, joint pain and symptoms of proximal muscle weakness. On clinical suspicion of possible connective tissue disorder, she was urgently reviewed in the hospital, where she was found to have a photodistributed rash involving cutaneous ulceration and violaceous plaques. Hand examination showed mechanic's hand mimicking hand eczema, ragged nail cuticles and acute tenosynovitis in the left index finger. Her upper and lower limb muscle power was normal and respiratory examination revealed bi-basal fine end-expiratory crepitation. Her repeated biochemical, haematological and muscle enzymes remained normal. Skin biopsy taken from photosensitive rash over the wrist showed hypergranulosis, Civatte body formation, colloid bodies and dyskeratotic keratinocytes, in keeping with severe lichenoid eruption. Superficial dermis showed patchy red-cell extravasation, perivascular chronic infiltration, dermal oedema and serum on the surface, in keeping with ulceration secondary to severe inflammatory processes. There were no eosinophils and eccrine coils were free of inflammation, raising the suspicion of a drug eruption. Her antinuclear antibody and double-stranded DNA were repeatedly negative. Myositisspecific antibody panel was performed owing to a high clinical suspicion of photosensitive dermatoses, both clinically and histologically. Histology revealed positive anti-MDA5 antibodies;repeated positive testing confirmed this. Although lung function was normal, computed tomography revealed evidence of ILD. We made a diagnosis of anti-MDA5 antibodyassociated amyopathic dermatomyositis with ILD. Her malignancy screening was negative. The patient was started on lowdose prednisolone and hydroxychloroquine 200 mg twice daily, with topical steroid applications, which resulted in remarkable clinical improvement. Anti-MDA5 associated dermatomyositis has characteristic cutaneous lesions consisting of skin ulceration and tender palmar papules, mechanic's hands, inflammatory arthritis and rapidly progressive ILD, which is frequently fatal. Although our patient had ILD, she was relatively stable on minimal immunosuppression. It is important for clinicians to have an increased awareness of this disease as it could have a highly variable clinical presentation in the white population.
ABSTRACT
Objective: To evaluate the role of passive smoking (PS) on the incidence of wheezing and overall respiratory morbidity in infants born during the first peak of the coronavirus (COVID-19) pandemic, compared to infants born during the preceding year. Method(s): We used data collected in our recently published retrospective birth cohort study of 588 infants, 294 in each group, born in February-March 2020 (COVID-19 group) compared to a control group born in February-March 2019 (pre-COVID-19 group), at one year of age, using parental, telephone questionnaires. The primary outcome of wheezing/bronchodilator were similarly decreased, in PS and in non-PS (NPS)1. We further, conducted a post-hoc subgroup analysis of the respiratory outcomes: recurrent wheezing, emergency-room (ER) visits, pneumonia and admissions due to lower-respiratory-tract-infections (LRTI), to account for PS exposure. Atopy, daycare attendance, breastmilk, cesarean-section, siblings and gestational age were included in logistic regression models. Result(s): Demographic, perinatal, and atopic characteristics were similar between the groups. In NPS, secondary outcomes, including wheezing (OR 0.43, 95%CI 0.24-0.76), LRTI admissions (OR 0.1, 95%CI 0.01-0.89), recurrent wheezing (OR 0.28, 95%CI 0.11-0.7), ER admissions (OR 0.32, 95%CI 0.13-0.8) and pneumonia (OR 0.16, 95%CI 0.04-0.57) showed significant decreases during the COVID-19 first year pandemic. However, in PS, we did not observe these decreases in the respiratory morbidities. Conclusion(s): This study uncovers the overwhelming hazard of PS in abolishing the effect of the first year of COVID19 pandemic lock-downs, on infant's major respiratory morbidities.
ABSTRACT
A 46-year-old man with no known allergies or history of atopy was referred for the investigation of a severe anaphylactic reaction following root canal dental treatment. The procedure had been done under local anaesthetic and involved drilling the tooth, removal of dental pulp, cleaning and insertion of a temporary filling. Preliminary skin prick tests (SPTs) and intradermal tests were negative to natural rubber latex, articaine (the local anaesthetic used for his procedure), lidocaine and chlorhexidine. He had negative specific IgE to chlorhexidine and latex, and a negative lidocaine challenge, confirming that he was not allergic to lidocaine. He returned for further dental treatment, which was done without local anaesthetic. As the procedure was completed, he developed severe anaphylaxis again. He made a full recovery and his dentist was asked for detailed information and samples of all the materials used during the procedure. Subsequent SPT showed a positive weal of 12 x 6 mm to the dental lubricant, Glyde, which was used on both occasions. Its ingredients included polyethylene glycol (PEG) 4253. SPT to other high-weight macrogol-containing products showed positive reactions to a 5% lidocaine ointment, Movicol, EMLA cream and Depomedrone. On further questioning he recalled minor immediate irritation after using a brand of children's shampoo, but a SPT to the shampoo was negative. An open test, closed test and SPT to a lower-molecular-weight patch-test allergen (PEG400 in petrolatum) were negative. PEGs or 'Macrogols' are hydrophilic polymers used in food, cosmetics and pharmaceutical reagents. They have recently attracted attention as they are excipients in several COVID-19 vaccines and have been suggested as a possible cause of anaphylaxis. Anaphylaxis to higher-molecular-weight PEGs has been reported from the use of bowel preparations and parenteral steroids. There are a handful of reports of contact urticaria to PEG-containing medicaments. We report this case to raise awareness of severe immediate hypersensitivity to these apparently innocuous ingredients and a novel source of exposure. A low index of suspicion, lack of standardized nomenclature and commercial reagents for testing are current barriers to diagnosis.
ABSTRACT
SESSION TITLE: Unique Inflammatory and Autoimmune Complications of COVID-19 Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Acute eosinophilic pneumonia is a rare illness characterized by eosinophilic infiltration of the lung parenchyma. Cases often present with fever, severe dyspnea, bilateral infiltrates, and eosinophilia on BAL exams. The cause of eosinophilic pneumonia is unknown, but is thought to be related to inhalational exposure of an irritant or toxin. Most cases are responsive to steroid treatment. This case demonstrates acute eosinophilic pneumonia in a patient who recently recovered from COVID-19 pneumonia. CASE PRESENTATION: A 50 year old female with a history of multiple sclerosis, seizure disorder secondary to MS, Irritable Bowel Syndrome, and a distant history of tobacco smoking and opiate dependence on chronic suboxone therapy, presented with dyspnea secondary to respiratory failure. The patient was urged to present by her husband after findings of hypoxia to 79% on room air with cyanosis of the lips and fingers. She recently recovered from COVID-19 1 month prior, at which time she had symptoms of cough productive of red mucus, fever, and exhaustion;but states she never returned to her baseline. With ongoing hypoxia, the patient was intubated for mechanical ventilation. Subsequent bronchoscopy with BAL resulted in a elevated eosinophil count to 76%, with fungal elements and PCR positive for HSV-1. The patient was initiated on high dose glucocorticoid therapy in addition to Acyclovir and Voriconazole. A CT with IV contrast revealed extensive bilateral pulmonary emboli involving the segmental and subsegmental branches throughout both lungs and extension into the right pulmonary artery;the patient was started on anticoagulation. Shortly after beginning glucocorticoid therapy, the patient had significant improvement and was able to be weaned off ventilation to simple nasal cannula. She was able to be safely discharged home with two liters of supplemental oxygen and steroid taper. DISCUSSION: Acute Eosinophilic pneumonia is a rare condition with an unknown acute disease process. The diagnostic criteria for acute eosinophilic pneumonia includes: a duration of febrile illness less than one month, hypoxia with an SpO2 <90%, diffuse pulmonary opacities, and otherwise absence of inciting causes of pulmonary eosinophilia (including asthma, atopic disease, or infection). Diagnosis of eosinophilic pneumonia is attained after meeting clinical criteria with a BAL sample demonstrating an eosinophilia differential of >25%. The mainstay of treatment for this condition is glucocorticoid therapy with most cases resolving rapidly after treatment. CONCLUSIONS: Fewer than 200 cases of acute eosinophilic pneumonia have been reported in medical literature. It is imperative to keep a wide differential as critical illness may be rapidly improved with appropriate therapy. The cause of acute eosinophilic pneumonia is largely unknown, it is unclear what role COVID-19 may have played in the development of this pneumonia. Reference #1: Allen J. Acute eosinophilic pneumonia. Semin Respir Crit Care Med. 2006 Apr;27(2):142-7. doi: 10.1055/s-2006-939517. PMID: 16612765. Reference #2: Nakagome K, Nagata M. Possible Mechanisms of Eosinophil Accumulation in Eosinophilic Pneumonia. Biomolecules. 2020 Apr 21;10(4):638. doi: 10.3390/biom10040638. PMID: 32326200;PMCID: PMC7226607. Reference #3: Yuzo Suzuki, Takafumi Suda, Eosinophilic pneumonia: A review of the previous literature, causes, diagnosis, and management, Allergology International, Volume 68, Issue 4, 2019, Pages 413-419, ISSN 1323-8930 DISCLOSURES: No relevant relationships by Tayler Acton No relevant relationships by Calli Bertschy No relevant relationships by Stewart Caskey No relevant relationships by Shekhar Ghamande No relevant relationships by Tyler Houston No relevant relationships by Zenia Sattar No relevant relationships by Heather Villarreal
ABSTRACT
Introduction: Polyethylene glycol (PEG) is one of the ingredients in the Pfizer/BioNTech COVID 19 vaccine (mRNA vaccine) and has been known to cause hypersensitivity [1-3]. Polysorbate is an ingredient in the Johnson vaccine (adenovirus vaccine) which may crossreact with PEG. Objective: We report a case of cross-reactivity between Pfizer/ BioNTech and Johnsson vaccines. Methods: This observation was notified in the pharmacovigilance center of Sfax, Tunisia (faculty of medicine of Sfax). The study of drug imputability was carried out according to the WHO method. Results: We report the case of a 32-year-old Tunisian woman with a history of atopy and intolerance to non-steroidal anti-inflammatory drugs (NSAIDs) but no history of SARS-CoV-2 infection. On August 15, 2021 (at 08:30), she developed sweating, vomiting and dizziness immediately after receiving the initial dose of Johnson COVID-19 vaccine. Her blood pressure became lower (less than 90/60 mmHg). She had to stay at the vaccination centre for one hour, and the clinical signs improved spontaneously after one hour. In the evening of the same day, the patient presented a febrile maculopapular eruption in the abdomen, trunk, and face. The rash resolved spontaneously over a week. The patient was referred to the pharma-covigilance center of Sfax (Tunisia). The messenger RNA vaccine was advocated for the second vaccine. On December 2021, she was received the second dose of the Pfizer/BioNTech COVID 19 vaccine (mRNA vaccine). Six hours later, she experienced a pruritic maculopapular rash on the abdomen, trunk, neck, and face. These clinical signs improved spontaneously after two days. the diagnosis of cross-allergy between these two vaccines was retained for this patient Conclusion: To our knowledge, this is the first cross-allergy between mRNA and adenovirus COVID-19 vaccines notified in Tunisian population. Healthcare professionals should be aware that hypersen-sitivity can occur with COVID-19 vaccines containing macrogols/ PEGs and those containing polysorbates. Its recognition may be challenging and often require skin testing. Per CDC guidance, con-sultation with an allergist-pharmacologist should be considered to help determine if the patient can safely receive vaccination [4].
ABSTRACT
It is hard to make a conclusion about relationship between Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and Bronchoobstructive Syndrome (BOS) in the postcovid period based on the literature. The aim. To determine the optimal treatment approaches by conducting a comprehensive assessment of clinical, laboratory and functional parameters, taking into account the risk factors for the development of BOS. Methods. 10,456 patients with Coronavirus Disease-19 (COVID-19) were examined, and 7,459 patients were randomized into 2 groups with a newly diagnosed BOS. Group 1 (n = 3,245) was prescribed beclomethasone/formoterol (BDP/FORM) as Maintenance And Reliever Therapy (MART). Group 2 (n = 4,252) was prescribed budesonide suspension (BUD) and salbutamol solution (SAL). The study assessed severity of COVID-19, presence of atopy and frequency of acute respiratory viral infections (SARS) in the medical history, spirometric parameters, blood eosinophils, Asthma Control Questionnaire-5 (ACQ-5) score, use of pro re nata medications, and adverse events. Results. Patients who had mild COVID-19 were diagnosed with BOS at weeks 8 – 24 (73.3%), while patients with moderate or severe COVID-19 were diagnosed at week 4 (54.9%). Virus-induced BOS (VI BOS) was diagnosed in 71.8% of the cases. 13% of the patients with BOS in postcovid period were diagnosed with asthma. Conclusion. The incidence of BOS is significantly higher in patients with atopy and history of frequent SARS who had moderate or severe COVID-19. A fixed combination of extrafine BDP/FORM as MART was superior to nebulized BUD + SALM in the treatment of VI BOS.
ABSTRACT
CDDFTExplore the meaning of the COVID-19 pandemic for parents of children with asthma in relation to healthcare seeking for their child.MethodsInterpretive phenomenological analysis (IPA) – allows researcher to focus on personal meaning in a particular context (healthcare seeking), for people (parents of children with asthma), who share a particular experience (COVID-19 pandemic). IPA ensures congruence between researcher paradigm, philosophical stance, personal stance, positionality statement, phenomenon to be studied, data collection method, and analysis.Eligibility criteria•Parents of a child (2-16 years) with a diagnosis of asthma.•Parents of a child with a diagnosis of asthma without other respiratory conditions•Parents of a child with asthma not associated with prematurity (gestation >37/40) or chronic lung disease.•Parents of a child with asthma and any of the following co-morbidities: eczema, hay-fever or food allergies (atopy)•Parents who are able to read and speak EnglishData collection and analysis:Unstructured interviews lasting 30-60mins, recorded using Zoom. Transcripts transcribed verbatim and uploaded to Nvivo – data coded using descriptive, linguistic and conceptual comments. Codes mapped in to groups according to inter-relatedness, an iterative and interpretive process using deconstruction, reconstruction and re-organisation of text to identify themesResultsThemes identified1. Protecting the child: mothers’ perception of threat from COVID-19, and what this meant they needed to do, to protect their child.2. Balancing needs and conflicts of interest: the difficulty mothers’ face in trying to balance the physical, mental, and emotional health needs of the child with the need to socialise, go to school, and learn;and for mothers that needed to go to work, the conflict of interest this created3. Accessing healthcare: the positive influence of knowledge and experience on the speed of accessing healthcare, the barrier of timing in relation to availability of service, and the effort required to access services4. Being heard, understood and responded to: mothers’ perception of not being heard, understood or responded to whilst seeking healthcare for their child and the psychological consequences that result5. Changing perception of risk over time: the changing perception of risk to the child’s health during the pandemic, as related to perception of reality.ConclusionDuring a pandemic, information conveyed to parents needs to be updated in line with emerging evidence. Parents may be operating on high alert - it is not sufficient to issue the message that the NHS is still available. The importance of face-to-face consultations for worried and stressed parents should not be under-estimated and where this is not possible, video consultations should supersede other forms of communication so that information is not lost in translation and parents feel heard and understood. Wider society should implement good hand hygiene, social distancing and face masks when they have a viral infection, to protect those around them.Healthcare professionals need to recognise the daily burden of asthma for mothers, who are always on the look-out for symptoms, and the fear that an acute exacerbation can induce. Management should include emotional support as well as medical, to ensure parents feel in control and able to manage.
ABSTRACT
RATIONALE4,4-44,4% of children suffer from post-COVID syndrome, commonly known as long- COVID, after an acute SARS-CoV-2 infection. However, an uniform clinical definition, and guidelines to diagnose or treat children suspected of long-COVID are lacking. Multiple careprograms have been initiated worldwide. In this study, we aimed to assess the currently available pediatric international long-COVID care programs and explore the characteristics of their patient cohorts.METHODSWe established an international network (IP4C) and performed a crosssectional analysis from aggregated data collected by its members using a survey. Topics included: the used definition for long-covid in children, the organization of pediatric long-COVID clinics and long-COVID patients characteristics. Descriptive analysis of the aggregated data was used to summarize and compare each of these categories across countries. RESULTSWe included data concerning organization of care from 17 cohorts based in 13 different countries. A wide range of definitions for long COVID was used, which differed mostly in duration of symptoms and the necessity of microbiologically proven SARS-COV-2 infection. 66,6-100% of patients in the long- COVID cohorts suffered from complaints for more than twelve weeks, and 49,5-97,3% of patients had a positive RT-PCR or serology for SARS-CoV-2. Most long-COVID care programs consisted of real-life visits with multidisciplinary teams, consisting of general pediatricians, pediatric lung specialists, cardiologists and infectiologist, a physiotherapist and psychologist. The type of investigations performed at the long-COVID clinics ranged from assessment of medical history (100%) and standardized questionnaires (91%) to in depth evaluation of organ functioning (e.g. spirometry performed in 0-100% of patients). Aggregated data of 431 long-COVID patients from 11 dedicated long-COVID care programs were analyzed. Mean age of patients ranged from 6,5-16,4 years old. Girls were overrepresented in most cohorts (20-65%). 28-81,8% of patient had a positive medical history, most commonly atopic syndrome, asthma and prematurity. Most patients (90- 100%) suffered from asymptomatic or mild acute COVID-19. Frequent long-COVID symptoms were fatigue, headaches, concentration difficulties, dyspnea and sleep disturbances. 5-37% of patients had severe limitations in daily life. CONCLUSIONSThis is the first study to describe the organization of pediatric long-COVID care. It demonstrates that pediatric long-COVID is recognized worldwide as a multisystemic disease, but its definition and care programs for pediatric long- COVID patients differ between cohorts. A clear definition of pediatric long-COVID is needed to improve international scientific collaboration and patient care. Our international network will facilitate further collaboration in investigation pathophysiology and therapeutic interventions in order to provide evidence based medical care for these patients.
ABSTRACT
Background: A 29-year-old woman, with personal history of atopy, presented with face and neck dermatitis lasting 6 months. During the past year, she worked as a nurse in a COVID-19-dedicated ward. The dermatitis had developed since she started using FFP2 masks. She referred using three FFP2 masks, with similar symptoms: 3 M© 9320+, Halyard© Fluidshield N95 and PM 2.5©. She also mentioned history of contact-hypersensitivity reactions to metals, green clothes and leather shoes for several years. Physical examination exhibited erythematous plaques distributed along the contact area of the elastic bands of the FFP2 masks. Patch tests revealed delayed hypersensitivity to the elastic bands 3 M© 9320+ and PM 2.5© (++), mercapto mix (++), 2-mercaptobenzothiazole (MBT) (++), 2-(4-morpholinylmercapto)benzothiazol (MOR) (++), N-cyclohexyl-2-benzothiazolesulfenamide (++), textile dye mix Mx-30 (++), disperse yellow 3 (++), disperse blue 106 (+), potassium dichromate (+), cobalt dichloride (+) and nickel sulfate hexahydrate (+). A latex skin prick test was negative. Allergic contact dermatitis (ACD) caused by elastic bands of FFP2 masks (3 M© 9320+ and PM 2.5 ©) was diagnosed. She was prescribed methylprednisolone aceponate 0.1% cream bid during five days and masks were changed to a type with cotton cloth bands, with resolution of the complaints. ACD to FFP2 masks components in health care workers can be severe, given the prolonged and continuous contact with the source of allergens. The rubber additives thiurams and dithiocarbamates are the main allergen groups involved in ACD to rubber bands in FFP2 masks. This seems to be the first report caused by mercaptobenzothiazole.
ABSTRACT
BACKGROUND: Functional iron deficiency facilitates allergy development and amplifies the symptom burden in people experiencing allergies. Previously we selectively delivered micronutrients to immune cells with ß-lactoglobulin as carrier (holoBLG), resulting in immune resilience and allergy prevention. OBJECTIVE: The clinical efficacy of a food for special medical purposes-lozenge containing ß-lactoglobulin with iron, polyphenols, retinoic acid, and zinc (holoBLG lozenge) was assessed in allergic women. METHODS: In a randomized, double-blind, placebo-controlled pilot study, grass- and/or birch pollen-allergic women (n = 51) were given holoBLG or placebo lozenges over 6 months. Before and after dietary supplementation, participants were nasally challenged and the blood was analyzed for immune and iron parameters. Daily symptoms, medications, pollen concentrations, and well-being were recorded by an electronic health application. RESULTS: Total nasal symptom score after nasal provocations improved by 42% in the holoBLG group versus 13% in the placebo group. The combined symptom medication score during the birch peak and entire season as well as the entire grass pollen season improved in allergic subjects supplemented with the holoBLG lozenge by 45%, 31%, and 40%, respectively, compared with the placebo arm. Participants ingesting the holoBLG lozenge had improved iron status with increased hematocrit values, decreased red cell distribution width, and higher iron levels in circulating CD14+ cells compared with the placebo group. CONCLUSIONS: Targeted micronutrition with the holoBLG lozenge seemed to be effective in elevating the labile iron levels in immune cells and reducing the symptom burden in allergic women in this pilot study. The underlying allergen-independent mechanism provides evidence that dietary nutritional supplementation of the immune system is one of the ways to combat atopy.
Subject(s)
Conjunctivitis, Allergic , Hypersensitivity, Immediate , Rhinitis, Allergic, Seasonal , Allergens , Double-Blind Method , Female , Humans , Iron/therapeutic use , Lactoglobulins/therapeutic use , Pilot Projects , Poaceae , Tablets/therapeutic useABSTRACT
Purpose of Study To identify whether asthmatic and atopic children and adolescents had less severe disease and lower mortality from COVID-19 than their non-asthmatic counterparts. Methods Used This was a retrospective chart review from March 1, 2020, through January 31, 2021. Subjects recruited were over a year of age and below 20 years of age and tested positive for COVID-19 or were COVID-19 antibody positive when they presented to the emergency department (ED). Subjects were grouped according to disease severity and divided into asthmatic and atopic or non-asthmatic. A total of 1,933 patients were included, 1,821 non-asthmatic, and 112 asthmatic and atopic. Summary of Results Asthmatic and atopic children are less likely to be seen in the ED for COVID-related disease, but if presented to the ED, they were significantly more likely to be hospitalized, require oxygen, have longer hospital stays, and have more severe forms of COVID-19 than non-asthmatic children. Conclusions Asthmatic and atopic children, though less likely to be seen in ED with COVID-19, were more likely to have severe disease than non-asthmatic children once they presented to the ED. (Table Presented).