Incidence and gravity of COVID-19 in patients with allergic rhinitis under treatment with sublingual immunotherapy

Introduction: Coronavirus disease (COVID-19) is a systemic, immunological, contagious and lethal disorder, with predominantly respiratory manifestations, caused by human infection by the SARS-CoV-2 virus. Allergic rhinitis (AR), in turn, is an incurable and heterogeneous disease, characterized as an inflammation and/or dysfunction of the nasal lining mucosa. Immunotherapy is the only treatment that can lead to the cure of AR. It involves a programmed administration of allergen extract in effective doses, instituting a persistent immunological modification. It is necessary to know if the control of AR with immunotherapy causes any benefit in relation to COVID-19. Objective: To evaluate the incidence rate and severity of COVID-19 in patients with AR treated with sublingual immunotherapy, compared to patients with AR who have not undergone this type of treatment. Methods: This was a retrospective, cross-sectional observational study, carried out by means of questionnaires sent by email to patients with AR undergoing treatment at the Rhinitis and Allergy Center of the Hospital Paranaense de Otorrinolaringologia, in Curitiba (Brazil), in the period from March 2020 to March 2021. The evaluation period for these questionnaires was the month of October 2021. The research project was approved by the Ethics Committee for Research in Human Beings of the Hospital Paranaense de Otorrinolaringologia. A Free and Informed Consent Term was obtained from all participants. The results obtained in the study were described as frequencies and percentages. To compare the groups defined by treatment with sublingual immunotherapy, in relation to the categorical variables, Fisher’s exact test or the chi-square test was used. Results: Twenty patients (36.4%) with confirmed COVID-19 have not undergone independent immunotherapy treatment, against eight patients (21.1%) in the immunotherapy group. However, the difference was not statistically significant. Regarding the severity of the condition, most of the patients in both groups reported symptoms, which was also not statistically significant. Conclusion: There was no statistically significant difference for the incidence rate of COVID-19 in patients with allergic rhinitis treated with sublingual immunotherapy, compared to patients with allergic rhinitis who have not undergone this type of treatment.

Objective: To assess the incidence rate and severity of the clinical picture of COVID-19 in RA patients treated with sublingual immunotherapy compared to RA patients who do not receive this type of treatment.
Methods: This is retrospective cross-sectional descriptive observational research carried out through questionnaires sent by e-mail to patients with allergic rhinitis undergoing treatment at the Rhinitis and Allergy Center of the Hospital Paranaense de Otorrinolaringologia, in Curitiba/Paraná, about the period from March 2020 to March 2021. The evaluation period for these questionnaires was in October 2021. The research project was approved by the Ethics Committee for Research on Human Beings of the Hospital Paranaense de Otorhinolaryngology through protocol no. 47179721.9.0000.5529. The Informed Consent Form was obtained from all participants. The results obtained in the study were described by frequency and percentage. To compare the groups defined by the treatment with sublingual immunotherapy about categorical variables, Fisher's exact test or the chi-square test was used.
Results: Questionnaires were sent to 1324 patients based on the attendance record of the Rhinitis and Allergy Center of the Hospital Paranaense de Otorhinolaryngology, which contained the word ''rhinitis'' in the diagnostic field of the Clinic software used at the institution. One hundred and one patients responded to the questionnaires. Four who had been using immunotherapy for less than 12 months were excluded, as were four health professionals. The analysis presented below was based on data from 93 patients who met the study's inclusion and exclusion criteria, 55 of whom were treated with sublingual immunotherapy and 38 were not treated with sublingual immunotherapy. The evaluation of the homogeneity of the groups defined by the treatment with sublingual immunotherapy (yes or no) in relation to demographic and clinical variables was performed as follows: for each of the variables analyzed, the null hypothesis was tested that the distributions over the classifications of the variable are the same for cases treated with sublingual immunotherapy and cases not treated with sublingual immunotherapy, versus the alternative hypothesis that the distributions are different. Twenty patients (36.4%) who are not undergoing immunotherapy treatment had confirmed COVID-19, against eight patients (21.1%) in the immunotherapy group. However, this data was not statistically significant. Regarding the severity of the condition, most patients in both groups reported having mild symptoms, which was also not significant.
Discussion: Allergic rhinitis is an inflammatory disease mediated by immunoglobulin E (IgE). Symptoms occur with patient exposure to the allergen. It is a widely prevalent condition that results in physical sequelae and recurrent morbidities (WISE et al., 2018;ARAUJO et al., 2016). The researched sample indicated a predominant age group between 18 and 44 years, since minors were not included in the study. Eifan et al. (2016) and Sakano et al. (2018) highlight a higher prevalence among children, due to a hyperactive response of T helper (Th) 2 lymphocytes, which initiate an IgE-induced systemic reaction, repressing the immune system until it is mature. Wise et al. (2018) demonstrate in their population-based studies increases in the prevalence of AR in adults in recent decades and that its prevalence in the United States is estimated between 11% (medical diagnosis) and 33% (self-report).
Conclusion: There was no statistically significant difference between the incidence rate and severity of COVID-19 in patients with allergic rhinitis treated with sublingual immunotherapy compared to patients with allergic rhinitis not receiving this type of treatment. Objectives: The aim of this research is to use 3D analysis of the facial surface of linear and angular measurements to correlate with the presence and degree of OSAS and its relationship with quality of life in patients undergoing polysomnography.
Methods: The study was approved by the Institution's Human Research Ethics Committee under number 47206821.3.0000.5529. This is a cross-sectional, comparative, analytical study. Patients were recruited from the Hospital Paranaense de Otorhinolaryngology with clinical suspicion of obstructive sleep apnea and who were referred for diagnostic polysomnography. Male and female patients aged at least 18 years, of all races/ethnicities, who underwent polysomnography, from August to October 2021, at Hospital Paranaense de Otorrinolaringologia and who agreed to participate in the study were included. study by signing the Free and Informed Consent Term (ICF). Participants who did not adequately answer the questionnaires and those who did not volunteer to carry out the questionnaire, in addition to those under 18 years of age, were excluded.

Results:
The results showed that the 17 patients submitted to the polysomnography exam presented a mean FOSQ-10 equal to 14.82, 50% of the patients presented a score greater than 15. The Functional Capacity domain of the SF-36 presented the highest mean value ( = 80). The AHI presented an average equal to 19.46, 50% of the patients had an index greater than 16.20. The mean oxyhemoglobin saturation Nadir was equal to 84.47, 50% of the patients had an index greater than 87. It is verified that there is a significant difference (p > 0.05) in the FOSQ-10 score, for the different levels of AHI, patients with severe apnea have the lowest FOSQ-10 score ( = 11.33), while patients without apnea (AHI below 5) have the highest FOSQ-10 value ( = 17.83).
Discussion: Few studies in the world compare 3D photogrammetry with the degree of apnea and its repercussions on the patient's quality of life. The difficulty in capturing 3D images may be the main limiting factor for further studies, mainly due to its current cost. A consolidated tool called Vectra XT 3D for capturing 3D images costs around US$45,000, a considerable cost that prevents its dissemination. The approach for this study aimed at a practical and simpler methodology for evaluating the three-dimensional mesh of the face to study its relationship with sleep apnea. Additionally, a decrease in the quality of life of patients in the vitality domain was observed when compared to the FOSQ-10 questionnaire, showing less vitality in patients with greater functional limitation caused by apnea. As for the three-dimensional analysis of the face, it was found that the increase in the Zi-Sn/Go-Po index implies a decrease in the FOSQ-10 score, that is, the greater the impact of daytime sleepiness on the patient's activities of daily living, less vitality.
Conclusion: We showed that there is the possibility of acquiring a three-dimensional mesh from 2D facial images with low cost and easy access for the evaluation of facial patterns. More studies are needed to better understand the three-dimensional facial pattern and its correlation with sleep apnea. Since the beginning of studies to understand the pathophysiology of obstructive sleep apnea, retrognathism has been one of the preponderant factors. However, there is still a need for a better understanding of the anatomical relationships of the face with apnea. New studies are emerging to contribute to these answers. In this, it was possible to show that there is a more practical and lower cost method for the acquisition of three-dimensional mesh to be studied. However, it became clear that this analysis should not be for a simple mathematical analysis and more factors should be considered in more advanced studies.