BackgroundAllergic rhinitis is a typical type I hypersensitivity reaction, commonlycaused by inhalant allergens. Accurate identification of the causativeantigen is important for rapid diagnosis and treatment initiation.ObjectiveThis study examined the efficiency of serum-based allergen-specificimmunoglobulin E and total immunoglobulin E antibody titers in screening forpollen allergy. We also examined the effect of cross-reactive carbohydratedeterminants on specific immunoglobulin E titers in screening for pollenallergy, one of the causes of false positivity in specific immunoglobulin Emeasurements.MethodsA questionnaire was used to evaluate the symptoms of pollinosis amongparticipants who underwent a medical examination. One hundred and thirty-twoparticipants reported pollen allergy symptoms and 127 reported an absence ofsymptoms. Specific immunoglobulin E levels were measured using the AlaSTAT3g Allergy method. Seventeen components, including four types ofcross-reactive carbohydrate determinant-specific immunoglobulin Eantibodies, were measured and evaluated comparatively.ResultsThe sensitivity and specificity of the tests in predicting the presence orabsence of pollen allergy were analyzed. The values of the areas under thecurves for immunoglobulin E antibody levels against cedar, cypress, orchardgrass, and ragweed pollen were 0.87, 0.82, 0.63, and 0.56, respectively. Across-reactive carbohydrate determinant-related false-positive effect on thepollen specific immunoglobulin E titer was noted in pollen screening.ConclusionCedar pollen-specific immunoglobulin E titers showed sufficient accuracy foruse in pollen allergy screening. The study of cross-reactive carbohydratedeterminants suggested that subjects who tested positive for pollen oftenhad false-positive results due to the impact of cross-reactive carbohydratedeterminants.

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.

ObjectivesTo 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.MethodsTo 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.ResultsWe 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).ConclusionLoss 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.

BackgroundThe coronavirus 2019 disease (COVID-19) has infected many individuals worldwide and continues to pose a significant threat to those with weakened immune systems. The data evaluating the clinical outcomes of patients with humoral immunodeficiencies that contract COVID-19 is limited and conflicting.ObjectiveTo describe the clinical outcomes of COVID-19 infections in patients with primary humoral immunodeficiency and compare results to current literature.MethodsWe conducted a retrospective cohort review on 15 patients with a humoral immunodeficiency defined as Common Variable Immunodeficiency, Specific Antibody Deficiency, or unspecified hypogammaglobulinemia, who contracted COVID-19. Severity scores were determined to evaluate the clinical outcomes of these patients.ResultsOf our 15-patient cohort, 33% of individuals with a humoral immunodeficiency infected with COVID-19 had moderate to severe disease, requiring hospitalization or resulting in death. COVID-19 mortality rate was found to be 7%. All 5 of our patients with severe COVID-19 infection had at least 1 comorbidity or risk factor.ConclusionWithin our cohort of humoral immunodeficient patients infected with COVID-19, we found a higher rate of moderate to severe COVID-19 infection and worse clinical outcomes, particularly in patients with comorbidities or risk factors.

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.

IntroductionLime 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 ReportA 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.DiscussionLime 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.ConclusionWe 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.

BackgroundChronic 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.MethodsWe discuss the therapeutic strategies employed among nine extremely resistant CSU cases and the heterogeneity between guidelines from different societies.ResultsPatients 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.ConclusionsThese 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.

ObjectiveSinusitis or rhinosinusitis is a very common disease worldwide, and in somecases, it leads to intracranial complications (ICS). These are more commonin immunocompromised patients or with underlying comorbidities, but evenhealthy individuals, can be affected. Nowadays, ICS have become less commonthanks to improved antibiotic therapies, radiological diagnostic methods,surgical techniques and skills. Nonetheless, they can still causesignificant morbidity and mortality. For this reason, management of thesecomplications requires a multidisciplinary approach to plan and customizetreatment options. This paper presents our strategy in the management of aseries of intracranial complications induced by acute sinusitis and comparesour experience and outcomes with the literature.Study designSingle institute experience, retrospective analysis of cases series andliterature review.MethodsAdult and child patients who were treated for ICS in the Department ofOtorhinolaryngology at Sion Hospital, in Switzerland from 2016 to 2020 wereincluded. Their symptoms, medical history, clinical and radiologicalfindings, treatment, and outcome were documented.ResultsEight 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 orother symptoms. Computed tomography (CT) and Magnetic Resonance Imaging(MRI) were used to confirm the diagnosis of all ICS. All types of knownintracranial complications were observed in our cohort with a wide range ofextension and severity of sinusitis. A multidisciplinary approach withindividual treatments was tailored to each patient. Outcomes were favorablein almost all patients with neither recurrence, nor neurological sequelsbeing observed in the follow-up. Only one patient was lost due to fatalcomplications of advanced lung cancer.ConclusionICS remain a challenging clinical problem due to substantial associatedmorbidity and mortality. The incidence of these complications is relativelylow. Therapeutical management guidelines are lacking. Early detection andmultidisciplinary approach are key to successful treatment.

ObjectiveDemonstrate feasibility, safety and outcome metrics of geriatric sinussurgery (GESS).Study DesignRetrospective review of patients undergoing sinus surgery for indication ofchronic rhinosinusitis with and without nasal polyposis.SettingTertiary referral center.ParticipantsPatients who underwent FESS from 2008–2017; excluding skull base,craniofacial, or oncologic surgery. Primary study group were patients aged65 years and older. Patients aged 40–64 years of age were included forcomparison.Main Outcomes and Measures: Multivariate analysis was performed to identifyindependently associated patient characteristics and perioperativevariables. Preoperative medical and treatment history, revision and primarysurgery, preoperative and post-operative SNOT-22 and NOSE scores, Lund-McKayscores were recorded when available. Post-operative data was assessed at aminimum of two months after the index procedure. Post-operativecomplications were included.ResultsNinety-one (91) patients met criteria. 21.2% of the geriatric patients weretaking systemic anticoagulation prior to surgery, and underwent treatmentwith nasal steroids (25.0%), oral antibiotics (67.7%), nasal irrigations(48.4%), and systemic steroids (37.5%) over an average of 7.3 months priorto surgery. There was an average post-operative reduction of 15.0 points(p < 0.0001) and 42.5 points (p = 0.0008) for SNOT-22 and NOSE scores,respectively. Average operative time was 117.4 minutes in geriatric patientscompared to 183.4 minutes in younger patients (p = 0.004), with an averageestimated blood loss of 55.6 milliliters (mL) compared to younger patients(111.8 mL) (p = 0.04). Linear regression identified revision surgery asassociated with reductions in Sinonasal Outcome Test (SNOT-22) scores(p = 0.011). Geriatric patients had a shorter operative time (p = 0.011)while male sex was associated with a longer operative time (p = 0.014).Patients over 65 had fewer minor complications (p = 0.01), and there were nomajor complications in either group.Conclusions and RelevanceGeriatric sinus surgery is effective and safe in this cohort of patients.

BackgroundPrimary ciliary dyskinesia (PCD) is characterised by an imbalance in mucociliary clearance leading to chronic respiratory infections. Cilia length is considered to be a contributing factor in cilia movement. Recently, IFT46 protein has been related to cilia length. Therefore, this work aims to study IFT46 expression in a PCD patients cohort and analyse its relationship with cilia length and function, as it was not previously described.Materials and methodsThe expression of one intraflagellar transport (IFT46) and two regulating ciliary architecture (FOXJ1 and DNAI2) genes, as well as cilia length of 27 PCD patients, were measured. PCD patients were diagnosed based on clinical data, and cilia function and ultrastructure. Gene expression was estimated by real-time RT-PCR and cilia length by electron microscopy in nasal epithelium biopsies.Results and conclusions: While IFT46 expression was only diminished in patients with short cilia, FOXJ1, and DNAI2 expression were reduced in all PCD patient groups compared to controls levels. Among the PCD patients, cilia were short in 44% (5.9 ± 0.70 µm); nine of these (33% from the total) patients’ cilia also had an abnormal ultrastructure. Cilia length was normal in 33% of patients (6.4 ± 0.39 µm), and only three patients’ biopsies indicated decreased expression of dynein.