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Aims: Trauma is particularly prevalent amongst Early Intervention (EI) patients and is associated with adverse clinical and prognostic outcomes. To determine the feasibility of a large-scale randomized controlled trial (RCT) of an 'EMDR for psychosis' intervention for trauma survivors with active psychotic symptoms supported by EI services, we conducted a single-blind RCT comparing 16 sessions of EMDRp + TAU versus TAU only. Method(s): EMDRp therapy and trial assessments were completed both in-person and remotely during the COVID-19 pandemic, and key feasibility outcomes (recruitment & retention, therapy attendance/ engagement, adherence to EMPRp treatment protocol, and the 'promise of efficacy' of EMDRp on relevant clinical outcomes) were examined at 6- and 12-month post-randomization assessments. Results and Conclusion(s): 60 participants (100% of the recruitment target) received TAU or EMDR + TAU. The feasibility criteria examined in this trial were fully met, and EMDRp was associated with promising signals of efficacy on a range of valuable post-treatment outcomes, including improved psychotic symptoms (PANSS), subjective recovery (QPR), post-traumatic symptoms (PCL-5;ITQ), depression (PHQ-9), anxiety (GAD-7) and general health status (EQ-5D-VAS) at the 6-month assessment. Signals of efficacy at 12-month were less pronounced, but remained robust for trauma symptoms and general health status. The findings will be discussed with relevance to future clinical trials of trauma-focused therapy in clients with early psychosis, and the provision of more tailored trauma therapies for EI service users.
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Objectives: We would like to report a case in which a COVID-19 patient who was transferred to our hospital due to a lack of medical resources due to the COVID-19 outbreak in Daegu, South Korea, on February, 2020, underwent double lung transplantation after 110 days with VV-ECMO support and performed double lung re-transplantation 865 days after lung transplantation. Method(s): ECMO was performed on a total of 69 patients with COVID-19-related acute circulatory/ respiratory failure from February 2020 to December 2022. Among them, 16 patients were registered for lung transplantation, and 5 out of 16 registered patients performed lung transplants. One in five people who performed lung transplantation performed retransplantation on the 865thday after transplantation. Result(s): A 52-year-old female patient was transferred to our hospital, and VV-ECMO was performed the next day. The double lung transplantation was performed 112 days after hospitalization and was discharged 238 days after surgery. 668 days after lung transplantation, home O2 was applied as bronchitis obliterans syndrome, and her lung function deteriorated rapidly later, and re-transplantation was decided. In the patient;s HLA test, HLA class I cPRA% was 32% and HLA class II cPRA% was 100%. Desensitization was performed six times plasmapheresis with administrating Botezomib and immunoglobulin, and then re-transplantation was performed on the 865th day after lung transplantation. The patient has maintained her daily life without any special complications other than the occurrence of central DI after surgery. The pathological findings of the lung previously transplanted to the patient were acute rejection (ISHLT grade A2), chronic airway rejection (ISHLT grade C1, B0), and chronic vascular rejection (ISHLT grade D1). Conclusion(s): The long term result of patients who performed lung transplantation with COVID 19 related respiratory failure is still unknown. Therefore, even patients who have undergone long-term VV-ECMO support due to COVID 19 related respiratory failure are expected to achieve good results if lung transplantation is needed by carefully approaching and treating with a multidisciplinary approach.
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Introduction: Over 200,000 patients survive an intensive care admission each year in the United Kingdom (UK). For patients, survival is frequently beset by a range of chronic disabilities. Approximately 50% must navigate an often complex convalescence, while suffering serious and persistent symptoms of post-traumatic stress disorder (PTSD), anxiety and/or depression.1 Eye-movement desensitisation and reprocessing (EMDR) is a trauma-focussed psychological therapy, recommended for treating PTSD by the International Society for Traumatic Stress Studies2 and NICE.3 However, EMDR has never been systematically investigated for patient benefit following intensive care admission. Objective(s): CovEMERALD4 evaluated the feasibility of delivering a randomised controlled trial (RCT), testing the effect of EMDR on the psychological health of intensive care survivors, following COVID-19 related critical illness. We also provide preliminary evidence of the effect on clinically relevant outcomes. Findings will inform the design of a subsequent fully-powered RCT. Method(s): This feasibility RCT was conducted at a single-centre, teaching hospital in the UK (University Hospital Southampton). Patients were eligible if they were admitted to intensive care for over 24-hours with confirmed COVID-19, were above 18 years of age, were recruited within 3-months of hospital discharge, and had no cognitive impairment or pre-existing psychotic diagnosis. Participants were randomised (1:1) to receive either up to 8 sessions of remotely-delivered EMDR (Recent traumatic events protocol) or standard care alone as the control group (CG). Psychometric evaluation was undertaken at Baseline and 6-months after hospital discharge. Result(s): Seventy-five consecutive patients were screened at hospital discharge, from October 2020 to April 2021. 51 eligible patients approached. 26 (51%) provided consent. Reasons for declining participation were;no psychological distress (n=16), no internet access (n=7) and being physically unready (n=2). Demographic variables were balanced between groups. Of the 13 patients randomised to EMDR, one withdrew prior to intervention: the remaining attended all sessions recommended by the psychological therapists (mean of 3-4 sessions per patient), giving an overall adherence of 93%. One patient from each group declined the 6-month follow-up evaluation, so trial completion was possible in 23 of 26 (88%) participants. No reasons for trial withdrawal were given. There were no attributable adverse events. Mean change in PTSD score (PTSD Checklist-Civilian) from Baseline to 6-months, was -8 (SD=10.49) in the EMDR group vs. +0.75 (SD=15.17) in CG (p=0.126). Mean change in anxiety (Hospital Anxiety and Depression Scale-Anxiety) was -0.45 (SD=2.3) following EMDR vs. -0.83 (SD=4.0) in the CG (p=0.787), and median change in depression (HADS-D) was -2(IQR:-3.0,1.0) following EMDR vs. +1(IQR-1.5,2.0) in the CG (p=0.263). Figure 1. Box-plot of change in PTSD symptoms (PCL-C) from baseline to 6-months post-hospital discharge for control group and EMDR intervention group. Conclusion(s): EMDR can improve psychological recovery following an intensive care admission for COVID-19, and appeared feasible and safe. Although not powered to determine clinical effectiveness, this single-centre feasibility study returned a positive signal, in reducing PTSD and depressive symptoms. A full results manuscript will be submitted prior to congress. CovEMERALD has supported a successful NIHR doctoral fellowship application, during which protocol refinements will be tested, within existing, and recommended rehabilitation pathways. Trial activity and progression will be consistent with the Medical Research Council framework for developing and evaluating complex healthcare interventions.5.
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Vaccines for SAR-CoV-2 are the most effective preventive treatment able to reduce the risk of contracting the infection and experiencing worse outcomes whenever the infection is contracted. Despite their rarity, hypersensitivity reactions to the anti-SARS-CoV-2 vaccine have been described and could become the reason not to complete the vaccination. Desensitization protocols for other vaccines have been described and validated, while the use of this approach for anti-SARS-CoV-2 vaccines is still anecdotal. We herein describe our experience with 30 patients with previous allergic reactions to anti-SARS-CoV-2 vaccines or to any of their excipients, proving that they are effective and safe; only two patients experienced hypersensitivity reaction symptoms during the desensitization procedure. Moreover, in this article, we propose desensitization protocols for the most common anti-SARS-CoV-2 vaccines.
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This chapter addresses the emerging need to enhance the cross-cultural applications of Eye Movement Desensitization and Reprocessing (EMDR) over telehealth to effectively respond to the COVID-19 crisis. The chapter aims to provide therapists with skills to expand Phase Two of EMDR treatment to increase safety and readiness for online trauma reprocessing. It presents The COME BACK Tool, a set of eight stabilization practices that integrates movement and creative arts, as a comprehensive framework for Phase Two of EMDR. The chapter discusses the benefits of using body-based practices when working with complex trauma and dissociation as well as its application to intercultural work, and also presents a case example of using yoga to facilitate dual attention during trauma reprocessing in Phase Four of EMDR over telehealth. The chapter then outlines eight COME BACK Tool scripts, one practice for each letter, so that readers can easily and immediately begin offering these practices to clients and even applying them to their own self-care routine. By integrating movement and creative arts therapies, the whole body is engaged for a present-moment experience and provides a concrete, external focus so mindfully connecting to thoughts, feelings, and sensations is more tolerable and titrated. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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This chapter presents a model for combining Eye Movement Desensitization and Reprocessing (EMDR) and art therapy for the Gen Z population (young people born in the United States between 1997 and 2007). Adolescents and young adults have increased rates of depression, anxiety, addiction, reports of loneliness, and suicide attempts compared to previous generations. The COVID-19 pandemic has exacerbated these worrisome trends. The chapter offers techniques for enhancing eight phases of EMDR through a variety of art therapy directives identified in multiple case studies. Art prompts, scripts, and case studies for art directives offer readers a comprehensive understanding for creative case conceptualization using EMDR with adolescents and young adults. When EMDR and art therapy are combined, these two disciplines can be incredibly effective and transformative, serving as a new avenue to meet specific needs of young people. Newer research revealing the unique stage of brain development during adolescence reinforces the need to enhance EMDR protocols for adolescents and young adults with the creative interventions of art therapy. This comprehensive model includes a conceptual framework to understand this generation and to provide ideas and directives. Each creative intervention is designed to be replicated by clinicians to help young people. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
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OBJECTIVE: Chemotherapy -related adverse reactions have been steadily in-creasing in recent years. In patients who develop oxaliplatin-induced hypersensitivity reactions (HSRs), prognosis and quality of life are adversely affected. Proper management of cancer patients enables them to safely receive first-line treatments. This study aimed to assess the risk factors in oxaliplatin-induced HSRs and the effectiveness of the rapid desensitization protocol.PATIENTS AND METHODS: In the study, 57 patients treated with oxaliplatin between October 2019 and August 2020 in the Medical Oncology Department of Elazig City Hospital were retrospectively evaluated. We analyzed patients' clinical histories to reveal any associations with the development of oxaliplatin-induced HSRs. Moreover, we re-evaluated 11 patients with oxaliplatin-induced HSRs through infusion time or desensitization procedures.RESULTS: Of 57 patients treated with oxaliplatin, 11 (19.3%) had HSRs. Patients with HSRs were younger and had higher peripheral blood eosinophil counts than those without HSRs (p=0.004, p=0.020, respectively). Prolongation of the infusion time was effective in the re -ad-ministration of oxaliplatin in six of the hyper-sensitive patients. Rapid desensitization proto-col was performed for a total of 11 cycles in four patients with recurrent HSRs, and their chemo-therapy regimens were successfully completed.CONCLUSIONS: This retrospective study has revealed that younger ages and higher peripheral eosinophil counts could be predictive for oxaliplatin-induced HSR. Furthermore, the study confirms that prolongation of the infusion time and rapid desensitization protocol are effective in patients with HSRs.
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OBJECTIVE: The purpose of this study was to collect pilot efficacy data on a novel treatment for refractory chronic cough (RCC), which we call cough desensitization treatment (CDT). DESIGN AND METHODS: In this parallel cohort, sham-controlled, randomized controlled trial, 21 adults with RCC were randomly assigned to 12 sessions of either CDT (progressive doses of aerosolized capsaicin while behaviorally suppressing cough; n = 11) or a sham treatment (repeated exposure to aerosolized saline; n = 9). The Leicester Cough Questionnaire (LCQ) was the primary outcome measure. Perceived cough severity with a visual analogue scale and cough challenge testing (for measuring cough-reflex sensitivity) were secondary outcome measures. Data were analyzed with mixed effects linear regression and follow-up contrasts. RESULTS: Results on all measures favored CDT. Excluding one sham participant, whose baseline LCQ scores were deemed unreliable, mean change in LCQ at 3-weeks post treatment was 6.35 and 2.17 in the CDT and sham groups, respectively. There was moderate to strong evidence of a greater improvement in the CDT group in total LCQ score (p = .058) and LCQ Psychological domain (p = .026) and Physical domain (p = .045) scores. Strong evidence was found for a greater reduction in urge-to-cough during CCT in the CDT group (p = .037) and marginal for a reduction in the capsaicin cough-reflex sensitivity (p = .094). There was weak evidence of a greater reduction in cough severity in the CDT group (p = .103). DISCUSSION: Although the study is limited due to the small sample size, the data provide additional evidence supporting further research on CDT. CDT resulted in a greater change in the primary efficacy measure (LCQ) than both pharmaceutical and behavioral treatments currently found in the literature. TRIAL REGISTRATION: This trial (NCT05226299) was registered on Clinicaltrials.gov on 07/02/2022.
Subject(s)
Carcinoma, Renal Cell , Kidney Neoplasms , Adult , Humans , Chronic Disease , Cough/drug therapy , Capsaicin , Pilot Projects , Surveys and QuestionnairesABSTRACT
Posttraumatic stress disorder (PTSD) treatment options, including the potential use of psychedelic-assisted therapy, are reviewed. Traditional PTSD treatment remains ineffective for many, and includes, trauma focused cognitive behavioral therapy, eye movement desensitization and remodeling, and selective serotonin reuptake inhibitors. Evidence has shown that with further supportive research, psychedelic-assisted therapy may offer an alternative treatment option.
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Background: In our country, allergen extracts (AEs) for house-dust mite (HDM) allergen immunotherapy (AIT), were provided by two companies which are Novohelisen Depot and Alutard SQ. During the Covid-19 pandemics, Novohelisen DepotHDM allergens could not be imported due to the unforeseen reasons. In order to ensure the continuity of AIT, consent obtained patients were treated with the AE of the other company. In this study, it was aimed to determine the frequencies of local and systemic side effects (SEs), clinical response, and the effect of AE change on these parameters during the Covid-19 pandemics. Method(s): 59 patients aged >= 5 years, followed up with the diagnosis of allergic rhinoconjunctivitis (ARC) and/or allergic asthma, and clinically related HDM allergy were included in the study. Demographic data of the patients and SEs during the treatment were recorded from the onset of subcutaneous AIT (SCIT) until September 2021. A transition protocol was created in order to maintain maximum effectiveness and minimize potential SEs of AIT after AE switching. After thetransition protocol, the frequency of SEs, and symptoms and medication scores were recorded during each AIT visit. Result(s): Of 59 patients, 38 (64.4%) were male, 27 (45.7%) had ARC and 32 (54.2%) had both allergic asthma and ARC. Age at the onset of AIT was 12 (6-17) years, and duration of the treatment was 30 (8-48) months. In this study 29 patients received Alutard-SQ (group 1) and 30 patients, Novohelisen-Depot (group 2). 19 patients in group 2 switched to AE of Alutard SQ. During the treatment period, 1209 Novohelisen Depot and 1504 Alutard SQ injections were administered and a total of 140 (5.2%) local reactions (LRs), 50 (1.8%) large local reactions (LLRs), and 7 (0.25%) systemic reactions (SRs) were observed. In group 2, 61 (8.3%) LRs and 1 (0.13%) SR were observed before switching, 5 (1.4%) LRs and neither LLR nor SR were observed after switching. Adherence to SCIT has been increased from 49.1% to 79.6% and the decrease in symptom and medication scores in the pre-transition period continued after switching. Conclusion(s): During the Covid-19 pandemics, HDM AEs transition protocol was safe in terms of local and systemic side effects, and AIT was effective.
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Background: The aims of presenting study were trying to expose the course of SARS-CoV- 2 (severeacute respiratory syndrome-related coronavirus) in patients with allergic rhinitis (AR),to compare the prevalence of SARS-CoV- 2 infection, hospitalization and pneumoniarates in patients with AR receiving allergen immunotherapy (AIT) and patients did notreceiving AIT (non-receivers) and to define possible risk factors for SARS-CoV- 2positivity in patients with AR. Method(s): A total of 419 patients with AR who were being followed- up in a tertiary allergy clinicbetween 1 June 2020 and 31 December 2020, were selected for the study. Onlypatients who were receiving active-continuous treatment for allergic rhinitis during thestudy period, were included in the study. Result(s): Seventy-nine patients (18.9%) became infected with the SARS-CoV- 2 [32 patients(19.6%) in AR patients with AIT and 47 patients (19.0%) in non-receivers] and the rateof pneumonia was 2.4% [12.7% of SARS-CoV- 2 (+) patients]. There was no significantdifference was determined between the AR patients with AIT and the non-receivers inregard of the rate of SARS-CoV- 2 infection, pneumonia and hospitalization (p: 0.864, p: 0.081, p: 0.113). There was a significant difference between the groups in terms ofgender, duration of disease, sensitivity to allergens (atopy) and serum IgE levels (p:0.009, p: 0.001, p: 0.001 and p: 0.001). The accompanying comorbidities, eosinophilcount, AIT and duration of AIT were not found to be associated with an increased riskSARS-CoV- 2 PCR positivity. However, female gender was shown to be associatedwith an decreased risk for SARS-CoV- 2 PCR positivity (OR, 0.571;95% confidenceinterval, 0.330-0.987;p: 0.045) Conclusion(s): The course of SARS-CoV- 2 is similar in patients with AR who underwent AIT andpatients with AR who did not undergo AIT, and AIT does not seem to increase the riskfor SARS-CoV- 2 infection.
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Background: Sars-CoV- 2 infections are hazardous, especially to the elderly and patients with comorbidities. With no efficient treatment available, newly developed vaccines are the only way to change the course of the pandemic. However, reports of allergic reactions resulted in some patients and practising physicians being concerned about the safety of vaccine administration, particularly in people with severe anaphylactic reactions to multiple or unknown factors in their medical history. This study aimed to develop an allergic workup protocol based on skin prick tests (SPT), intradermal testing (IDT) and intramuscular provocations, and desensitization which may contribute to diagnosis and management of anti-COVID- 19 vaccine allergy. Method(s): 285 patients were enrolled. 205 of them entered the study based on severe anaphylactic reaction to unknown or multiple factors in their medical history which disqualified them for standard treatment. Another 80 patients were enrolled after developing an allergic reaction to the first dose of one such vaccine. In all subjects, SPT and IDT were performed with one of 4 available vaccines. Result(s): 277 patients with negative tests were given a vaccine without complications. Six patients with positive skin tests received desensitization with a reasonable tolerance. One patient did not consent to desensitization and one patient resigned despite negative tests. All in all, 283 (99%) patients were vaccinated using this newly developed protocol. Patients with adverse reactions to the first dose of the vaccine before the study had a significantly lower basal serum tryptase concentration (p = 0.001). Conclusion(s): Skin tests with anti-COVID- 19 vaccines are a useful tool in the vaccination protocol. This protocol enables safe immunization of high-allergy- risk patients even cases of positive skin tests.
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Background: Covid-19 viral infection affects strongly the populations in the world by the level of morbidity, mortality and the economic impact. A worldwide vaccination program was developed since the end of 2020 to limit the propagation of the virus and the development of variants. In USA and Europe the risk of an allergic reaction is estimated to be 1.31 (95 % CI, 0.90-1.84) per million vaccine dose. The excipients are considered to be the most probable cause of IgE-mediated allergic reactions: PolyEthylene Glycol (PEG) for the Moderna and the Pfizer-BioNTech vaccines and Polysorbate 80 (P80) for the Astra Zeneca and the Johnson & Johnson. P80 presents clinical cross-reactivity with PEG. Patients with a history of severe allergic reaction to PEG or P80 should avoid the vaccination. However, some of them strongly wanted to be vaccinated because their accumulated risk factors for severe infection. Method(s): To 4 severely PEG/P80 allergic patients (grade 3 of anaphylaxis), we proposed a desensitization protocol (7 steps in 90 min + 60 min of observation) with the Pfizer-BioNTech vaccine. Each injection was performed alternately in the deltoid muscle (SC for 2 treated by apixaban) every 15 min. Two patient received all the injections in the same arm due to insufficient lymphatic drainage post mastectomy. The protocol was repeated 1 month and once again 6 months later for the second and the booster doses respectively. One patient didn't received the last one because she was meanwhile moved in palliative treatment. We followed the modification of their immunological status. All patients took a premedication with bilastine 20 mg and montelukast 10 mg (without PEG/P80) 24 h and 3 h before each protocol. Result(s): No patient developed adverse nor allergic reaction after the successive vaccinations. Conclusion(s): We c an p ropose adesensitization protocol to the COVID-19 Pfizer-BioNTech vaccine to patients with severe hypersensitivity to PEG/P80. The desensitization is well tolerated and followed by an increase of specific antibodies and an evolution of antibody level like patients who received the total dosis (0.3 ml) in one injection. (Figure Presented).
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Background: One of the most disadvantageous group of people in Covid 19 pandemic are those with chronic diseases who have been unable to reach medical services they should have. The aim of our study was to investigate if our patients receiving either subcutaneous allergen immunotherapy (SCIT) or biologicals had been effected in terms of compliance to their treatment. Method(s): All of our patients that were being followed in our outpatient clinic receiving a regular treatment -either SCIT or a biological agent -before January 2020 were included in the study. The study group consisted of a total of 223 adult patients of whom 128 were on SCIT and 95 on a biological agent. We applied a conversation based survey to each patient by means of a phone call or during an office visit to identify any disruption in their treatment. We also screened our patient files to collect demographic data and data related to the diagnosis and duration of therapy. Patients were also asked if they had past Covid -19 infection or not. Result(s): Out of 128 patients receiving SCIT for an aeroallergen or venom,124 patients (median age 38 (min-max 18-66)) could have the survey completed. Eighty one patients (63.3%) reported that they couldn't continue their treatment while 43 (37.6%) patients could. The most common reasons of noncompliance were the reluctance of patients to go to the hospital with the fear of getting Covid 19 infection (n = 36 ;44.4%) and the difficulties in supplying the allergen immunotherapy product (n = 15;18.5%). Fourteen patients (17.3%) left the treatment as they were already close to the end of the scheduled treatment duration. Ninety one patients (median age 53 (min-max 19-75)) out of 95 who were on a biological treatment-either omalizumab or mepolizumab-had completed the survey. Only nine patients (9.9%) left the treatment while 82 patients (90.1%) did not. The most common reason for noncompliance was similarly the reluctance to go to the hospital in 4 (4.4%) of the patients . Twenty one of the SCIT patients (16.9%) and 22 patients (24.2%) receiving biologicals had documented Covid 19 infection. Conclusion(s): Covid 19 pandemic had a negative effect on our patients'compliance to their treatment. This effect was apparently higher in the patients receiving SCIT who should have their shots only in an allergy clinic under close supervision while patients on biologicals may receive their treatments in other healthcare centers.
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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.
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Background: SARS-CoV- 2 impacts on the immune response in a variable way. In pilot study we showed last year that in allergic patients allergen immunotherapy (AIT) seemed to reduce COVID-19 severity. Here we present final results. Method(s): in cooperation with allergists, dermatologists and ENTs we conducted a Latin-American registry of patients with allergic disorders, including urticaria, who got COVID-19. Apart from demographic data, COVID-19 severity, allergic diseases, comorbidities and compliance with underlying allergy/asthma treatment we collected data on AIT. Result(s): Of the 1095 registered patients, 54% female, 89.4% were confirmed and 10.6% highly suspected COVID-19 cases. IgE-mediated allergy was confirmed (81%) or clinically suspected (16%);while 3.2% had only urticaria. 630/1095 (57.5%) received AIT;in both groups (yes or no AIT) median age was 30-39y. For COVID-19 severity, see table. Compared to allergic patients without AIT, receiving AIT reduced the Risk Ratio (RR) for severe disease with lower respiratory symptoms or worse (COVID-4- 7) to 0.78 (.95 CI 0.6703-0.9024), p = 0.0017) and for critical COVID-19 in need of oxygen therapy or worse to 0.65 (.95 CI 0.42-0.9992, p = 0.048). There was only one fatality in the no-AIT group. There was no difference between groups in co-morbidities, public or private practice or allergic disease;AIT patients tended to be younger. Conclusion(s): These data seem to favor the outcome of COVID in allergic patients receiving AIT, but more in-depth analysis is needed.
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Background: Allergic rhinitis, one of the most common chronic allergic diseases, commonly associated with asthma, has a disease modifying therapy, allergen-specific immunotherapy (AIT). AIT can play a significant role in the reduction of clinical and immunological reaction to the culprit allergen, decreasing the onset of new sensitizations, preventing the onset of asthma, and reducing use of pharmacological treatments. This latter aspect is highly relevant for adolescents, a category of patients that frequently prefer to use "as few drugs as possible". AIT continuation may be difficult in some situations, such as the COVID-19 pandemic. Difficulty in accessing hospitals was experienced by many leading to a discontinuation of therapies for chronic conditions, such as allergic rhinitis. Method(s): We report our experience on the management, safety and adherence to sublingual immunotherapy (SLIT) prescribed to 25 adolescents affected by allergic rhinitis (house dust mite (HDM) -8 patients, SLIT grass pollen -12 patients, SLIT parietaria -5 patients), during the COVID-19 pandemic, following EAACI recommendations. The first administration of SLIT was carried out under medical supervision. We used a personalized monitoring approach according to the type of SLIT prescribed and according to the needs presented by each patient, advising them how to recognize and manage a possible reaction. Result(s): No immediate severe adverse reactions were reported by patients. Between the 2nd and 5th day of SLIT, 4 patients in therapy with HDM SLIT, experienced an exacerbation of rhinitis symptoms, with resolution after the use of oral antihistamine and topical cortisone+antihistamine before taking the daily dose of SLIT (for 30 days). Two patients on grass pollen SLIT and 2 patients on HDM SLIT, with gastric upset after taking SLIT daily while fasting, presented a resolution of the symptom after we advised them to take the daily dose in the morning after breakfast. Five patients interrupted SLIT for COVID-19 infection, until complete resolution. To date, all 25 patients are continuing SLIT, with good tolerability, with an improvement of rhinitis symptoms. Conclusion(s): We have reported real-life SLIT adherence and safety in adolescents that started SLIT during the COVID-19 pandemic to confirm how SLIT is a winning strategy and the only modifying treatment for allergic conditions.