Allergy & Rhinology最新文献

Background: Coronavirus disease (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2, a novel virus that emerged in China in December 2019. In many cases of COVID-19, olfactory dysfunction (OD) is the only symptom.

Objectives: This study aimed to examine the incidence of OD in patients with COVID-19 and identify an association between OD and COVID-19-related morbidity and admission.

Design: This was a cross-sectional study.

Methods: Real-time reverse transcription polymerase chain reaction-confirmed cases of COVID-19 from the Security Forces Hospital electronic registry from June 2020 to September 2020 were included in our study. Data on medical background, severity of the disease, and other related factors were collected through phone calls and electronic healthcare systems and analyzed to investigate OD in the participants.

Results: Of the participants, 68% had OD, with a mean recovery time of 18 days and a mean follow-up time of 129 days (76-211 days). OD was negatively correlated with admission and morbidity.

Conclusion: OD is a common presentation of COVID-19 and is more prevalent in mild cases of infection.

Introduction: Inverted papillomas of the middle ear are extremely rare tumors that carry an increased risk of recurrence and malignant transformation. There are currently 59 cases of middle ear inverted papillomas reported in the literature. The objective in this study was to systematically evaluate outcomes regarding middle ear inverted papillomas with respect to demographics, anatomical tumor sites, malignant transformation status, recurrence rate and HPV status.

Study design: Retrospective case series and systematic review.

Methods: A systematic review was completed on June 25, 2020 with a search strategy including PubMed, Embase, Scopus and Google Scholar. This revealed 181 articles. Full-text review was completed, and 66 articles were included. 115 articles were eliminated due to duplication of articles from databases, article titles not applicable to the aims of the systematic review and articles describing inverted papilloma of body sites other than middle ear.

Discussion: Thirty-one cases of primary inverted papillomas of the middle ear were found in the literature with an additional 26 cases of secondary tumors. Four case reports did not specify primary versus secondary. The malignant transformation rate was 34.4% with a 53.6% recurrence rate. Treatment of middle ear inverted papillomas is primarily surgical with adjuvant radiation therapy considered for patients with recurrence or malignant transformation. Frequent clinical follow up of these patients is critical due to the increased rate of recurrence and malignant transformation.

Conclusion: Inverted papillomas of the middle ear are rare tumors that carry a high risk of recurrence and malignant transformation necessitating complete resection and frequent clinical follow up.

Objective: Sinusitis or rhinosinusitis is a very common disease worldwide, and in some cases, it leads to intracranial complications (ICS). These are more common in immunocompromised patients or with underlying comorbidities, but even healthy individuals, can be affected. Nowadays, ICS have become less common thanks to improved antibiotic therapies, radiological diagnostic methods, surgical techniques and skills. Nonetheless, they can still cause significant morbidity and mortality. For this reason, management of these complications requires a multidisciplinary approach to plan and customize treatment options. This paper presents our strategy in the management of a series of intracranial complications induced by acute sinusitis and compares our experience and outcomes with the literature.

Study design: Single institute experience, retrospective analysis of cases series and literature review.

Methods: Adult and child patients who were treated for ICS in the Department of Otorhinolaryngology at Sion Hospital, in Switzerland from 2016 to 2020 were included. Their symptoms, medical history, clinical and radiological findings, treatment, and outcome were documented.

Results: Eight patients (6 males- 2 females) aged from 14 to 88 y.o., were enrolled. None had any previous history of chronic, or recurrent sinusitis. Moreover, very few presented specific rhinological symptoms, but with neurological or other symptoms. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) were used to confirm the diagnosis of all ICS. All types of known intracranial complications were observed in our cohort with a wide range of extension and severity of sinusitis. A multidisciplinary approach with individual treatments was tailored to each patient. Outcomes were favorable in almost all patients with neither recurrence, nor neurological sequels being observed in the follow-up. Only one patient was lost due to fatal complications of advanced lung cancer.

Conclusion: ICS remain a challenging clinical problem due to substantial associated morbidity and mortality. The incidence of these complications is relatively low. Therapeutical management guidelines are lacking. Early detection and multidisciplinary approach are key to successful treatment.

Objectives: Chronic rhinosinusitis with nasal polyposis (CRSwNP) is a pathological condition which leads to high healthcare-related costs and low quality of life for patients. The introduction of new biological therapies (monoclonal antibodies, MAbs) in CRSwNP patients has allowed new therapeutic options for non-responders to conventional therapies and Dupilumab represents the first approved biological agent. The aim of this paper is to provide a practical clinical multidisciplinary protocol which might help clinicians involved in this field to monitor the clinical outcomes.

Methods: Our centre of Rhinology and Rhino-Allergology has developed a dedicated collection form to observe the outcomes of patients treated with Dupilumab. Our research started from the indications given in EPOS 2020 as main reference. We then implemented these references in an electronic database trying to apply Evidence Based Medicine (EBM) in current clinical practice.

Results: The result consists of three parts: an anamnestic collection data, a clinician reported outcome and two patient reported outcomes (PROMs) questionnaire, the visual analogue scale (VAS) and the Sino-Nasal Outcome Test-22 (SNOT-22). The tables we propose should provide an adequate correlation with the patients' adherence to therapy and their treatment outcomes. Such periodical evaluation (after a month, after 3 months, after 6 months and at one year) should quickly allow to monitor if the patient is correctly assuming the therapy and the eventual objective improvements.

Conclusions: We propose a practical monitoring protocol formulated to analyse both objective and subjective aspects of patients with severe uncontrolled CRSwNP treated with MAbs, thus helping to define in future a better comparison between the clinical results of different institutes.

Introduction: Lime phytodermatitis, also known as margarita dermatitis, is a condition that results in a skin rash after sunlight exposure when handling certain plants. Misdiagnosis is common due to its resemblance to skin burns or allergic contact dermatitis. Detailed history and disease recognition is important to provide accurate treatment recommendations.

Case report: A 32-year-old woman presented with a recurrent rash on her hands that would only occur in the summer months. She was previously misdiagnosed as allergic contact dermatitis. History revealed yearly vacations involving margaritas and squeezing lime into her drinks followed by exposure to sunlight. A presumptive diagnosis of lime phytodermatitis was made and she was advised to avoid contact with limes followed by exposure to direct sunlight.

Discussion: Lime phytodermatitis occurs after direct contact with lime and sunlight exposure. A phototoxic compound found in limes, Furocoumarin, has been implicated as a cause for lime disease. Detailed history is important in establishing a diagnosis of lime disease. Treatment is symptomatic with topical corticosteroids, avoidance of furocoumarin-containing objects, cold compresses, and subsequent UV exposure.

Conclusion: We present the first case of recurrent, bilateral phytodermatitis in a 32-year-old woman following contact with limes and subsequent sunlight exposure in the summer months.

There are few reports describing adverse events associated with nasopharyngeal swab specimen collection in patients tested for SARS-Cov-2 (COVID-19). Despite the lack of data, providers should be aware of complications associated with swab collection. Instances of nasopharyngeal swab as a syncope trigger are mostly anecdotal and not well described in the medical literature. We present a case of neural reflex mediated syncope associated with the nasopharyngeal swab specimen collection process in a healthy patient undergoing COVID-19 testing prior to elective surgery. This response may be mediated by the trigeminocardiac reflex or via glossopharyngeal nerve stimulation. Less invasive collection practices, such as saliva sampling, may be warranted, particularly in those predisposed to syncopal episodes.

New adverse reactions to the COVID-19 vaccines are being identified as vaccination rates increase worldwide. Recently, there have been two reports of Moderna (mRNA-1273) vaccine induced relapse of chronic spontaneous urticaria (CSU) that was previously well controlled. Herein, we report a case of AstraZeneca/Oxford (ChAdOx1) vaccine triggered CSU in a patient with no history of CSU with achieved remission.

Background: Chronic spontaneous urticaria (CSU) can be extremely debilitating to the patient and challenging for the treating clinician. The National Institute of Health and Clinical Excellence (NICE) in the United Kingdom (UK) recommendation of omalizumab for patients who fail to respond to high-dose anti-histamines has improved treatment options and quality of life. However, there is still lack of clear guidelines for treatment of patients resistant to standard and anti-IgE therapies.

Methods: We discuss the therapeutic strategies employed among nine extremely resistant CSU cases and the heterogeneity between guidelines from different societies.

Results: Patients with anti-histamine-resistant urticaria either remained on omalizumab or started on immunosuppressive drugs (dapsone or ciclosporin) when they stopped responding to omalizumab. We used clinical assessment, skin biopsies (when available) and previous published reports to consider dapsone (for predominantly neutrophilic infiltration), or ciclosporin at doses between 2 and 4 mg/kg/day. One patient with ciclosporin-resistant urticaria responded to mycophenolate mofetil. Two patients remain on long-term omalizumab due to its relative safety and efficacy including 1 patient with underlying antibody deficiency where omalizumab was preferred over risks of using immunosuppressive medications.

Conclusions: These case studies bring to light the real-world difficulties in managing patients with resistant CSU and the need for generating the evidence base on alternative therapeutic options such as synergistic use of biologics and immunosuppressive drugs.

Objectives: To assess the frequency of loss of smell and taste in children during Covid-19 infection and their prevalence along with other symptoms, as well as the recovery of chemosensory function once healed.

Methods: To evaluate symptoms during infection, we adapted the Scandinavian adaptation of the Multi-Clinic Smell and Taste Questionnaire and the modified Monel-Jefferson questionnaire. For smell analysis we used Odor Identification (OI) and two variants of the Odor Discrimination (OD) test, and we compared the results with those of a control group.

Results: We enrolled nine patients in our experimental group and nine in our control group. Fever was the most frequent symptom (55% of cases), followed by anosmia and ageusia (44% of cases), muscle pain and asthenia (22% of cases) and diarrhea, abdominal pain, cough, and headache (11% of cases). In 11% of cases, olfactory symptoms were the only manifestation of the disease. There was no statistically significant difference in OI test and OD tests between the two groups (Children healed from Covid-19 and Control Group).

Conclusion: Loss of smell and taste are the second most common symptoms of pediatric Covid-19, and they should always be tested because they can be the only manifestations of infection. Olfactory function in Covid-19 children decreases with increasing age and improves with the passage of time after illness.