Background Adherence to treatment and outcome monitoring remain major challenges in allergen immunotherapy. Objective This study evaluated a digital strategy for monitoring adherence and clinical outcomes of subcutaneous immunotherapy (SCIT) through the AllergyVax mobile and web platform. Methods This prospective observational study followed 83 patients receiving SCIT through the AllergyVax digital platform for 12 months. Patient-reported outcomes were assessed with the Rhinitis Control Assessment Test and the Asthma Control Test at baseline and predefined follow-up intervals. Both adherence and clinical outcomes were analyzed longitudinally in the same patient group. Methodologic limitations include absence of a control group and relatively short follow-up. Results The assessment of adherence to SCIT revealed that 84.3% of patients adhered to treatment, 7.2% were recovered adherent patients, and 8.4% dropped out after 12 months of treatment. We compared subgroups by analyzing adherence in patients with rhinitis alone versus those with rhinitis and asthma, as well as between male and female patients. None of the comparisons revealed statistically significant differences between the groups. Conclusions The digital platform facilitates SCIT management by improving adherence and strengthening patient engagement.

Allergen immunotherapy (AIT) is a key therapeutic approach for allergic rhinitis and asthma, demonstrating the ability to modify disease progression by targeting type 2 inflammation. This study evaluates the efficacy of a mobile application (app/web platform) AllergyVax®, designed to implement a patient-centered care (PCC) strategy to increase patient engagement in the treatment. A retrospective cross-sectional analysis was conducted with 482 patients diagnosed with respiratory allergic diseases who initiated sublingual immunotherapy (SLIT). Participants were divided into 2 groups: Group A received standard information, while Group B utilized the AllergyVax® app for managing treatment. This app provided daily reminders, evaluated symptom control through standardized questionnaires, and facilitated communication between patients and healthcare providers. Results indicated a significant increase in adherence rates among app users, with 92.11% adhering to SLIT compared to 46.32% in the non-app group. The app users exhibited a 2.42 times greater likelihood of maintaining adherence and reduced dropout rates by 82%. The AllergyVax® app improved adherence across all demographics, emphasizing the importance of innovative digital tools in enhancing patient engagement and treatment outcomes. In conclusion, this study highlights the critical role of mobile technology in promoting adherence to SLIT, suggesting that integrating digital solutions into AIT can lead to better management of allergic diseases and improved patient outcomes.

Objective: Bacterial extracts have been used for many years to prevent airway infections. Recent findings suggest that immunity can be trained by inducing an immunological memory in both the innate and acquired immune response. This real-life observational study investigated the potential of sublingual bacterial immunotherapy in the prevention of ear, nose, and throat infections. Methods: Patients received sublingual bacterial immunotherapy for 12 months and were followed for 24 months. The number of ear, nose, and throat infection episodes from the previous year was recorded during the initial visit based on the patient’s clinical history. Patients were then followed up with visits every 2 months, and the occurrence of ear, nose, and throat infection episodes was documented at 6, 12, 18, and 24 months after the start of the study. Results: The results demonstrated a strong potential for preventing ear, nose, and throat infections, with a reduction in the number of episodes by 75.68%, 82.27%, 82.78%, and 89.88% at 6, 12, 18, and 24 months, respectively. No adverse effects related to sublingual bacterial immunotherapy administration were reported. Conclusion: The results suggested that long-term sublingual bacterial immunotherapy is safe and effectively prevents ear, nose, and throat infections, even after treatment ends.

The use of allergen immunotherapy (AIT) in Brazil has specific regional conditions owing to the pattern of allergen sensitization, as well as to genetic, socioeconomic, and cultural characteristics. This review article aims to discuss the clinical practice of AIT by the subcutaneous or sublingual route in Brazil, addressing the possibilities of transition between these forms of administration. A systematic review using the PubMed and Cochrane databases was performed, and the websites of major allergy and immunology organizations were consulted. Knowledge of the mechanism of action of subcutaneous immunotherapy and sublingual immunotherapy, together with Brazilian real-life experience, allowed us to establish recommendations regarding switching routes of AIT administration in selected cases. Careful analysis of each clinical situation is necessary to perform the transition between subcutaneous and sublingual allergen immunotherapy.

PURPOSE OF REVIEW:To review recent evidence on allergen immunotherapy (AIT) as a model of personalized medicine in the treatment of children and adolescents with respiratory allergies. RECENT FINDINGS:Meta-analysis and systematic review studies continue to point out that AIT is an effective treatment for children with respiratory allergies. Molecular allergy allows the understanding of patient sensitization profiles that frequently change the prescription of AIT. There is still a lack of evidence showing that this personalized prescription of AIT is associated with better clinical outcomes. The nasal allergen challenge has extended the indications of AIT for a new group of subjects with local allergic rhinitis. Patient selection of allergens involved in the increasingly personalized composition of extracts to be used in AIT increasingly characterizes it as personalized medicine. SUMMARY:Despite the numerous studies carried out to identify the best biomarker to evaluate the response to AIT, there is still much disagreement, and clinical assessment (symptoms, quality of life, among others) continues to be the best way to evaluate the therapeutic success of AIT.

Since we published the “IV Brazilian Consensus on Rhinitis”, in 2017, several advances have been achieved and have enabled a further understanding of the different aspects of “Rhinitis”. This new guideline, developed jointly by ASBAI, SBP and SBORL, represents a relevant milestone in the updated and integrated management of the different forms of the disease, and it aims to unify evidence-based approaches to improve the diagnosis and treatment of this common and often underestimated condition. The document covers a wide range of topics, including clear definitions of the different phenotypes and endotypes of rhinitis, risk factors, updated diagnostic criteria, and recommended methods for clinical and laboratory investigation. We stress the importance of detailed clinical history and objective assessment, as well as tools for control and assessing severity tools an accurate diagnostic approach to the disease. Regarding treatment, it emphasizes the treatment customization, considering the severity of symptoms, the presence of comorbidities and the impact on the patient's quality of life. We discuss different drug treatment, in addition to non-pharmacological measures, such as environmental control and specific immunotherapy; and the possible role of immunobiological agents. Furthermore, the consensus addresses issues related to patient education, prevention and management of special situations, such as rhinitis in children, in pregnant women and in the elderly. In short, the “V Brazilian Consensus on Rhinitis” represents a comprehensive and updated guide for healthcare professionals involved in the diagnosis and management of rhinitis, aiming to improve patients' quality of life through an integrated and evidence-based approach.

INTRODUCTION Epidemiological studies show that allergic rhinitis (AR) is observed in 10–40% of the world’s population. This disease significantly compromises the quality of life, impairing development in children and professional activities in adults. AR is also frequently associated with allergic asthma (AA)1,2. It has been observed that 15–38% of patients with AR develop concomitant AA. This relationship between AR and AA is based on robust pathophysiological mechanisms, which are consistent with the united airways theory. This model states that environmental exposure to allergenic molecules in genetically predisposed individuals directs the production of specific cytokines responsible for the development of the allergic inflammatory process in the nasal mucosa and lungs1,3. The association between AR and AA or atopic dermatitis (AD) is very common, usually developing since childhood, representing a phenomenon called the atopic march. Therefore, patients with AR should be evaluated in a broad and systemic way due to the implications and interactions of this disease that is part of a broad allergic process that can affect the upper airways, lower airways, skin, and mucous membranes. These diseases, classified as atopic diseases, are characterized by the presence of a specific, genetically directed immune response after exposure to allergens1,2,4,5. In Brazil, the components derived from the house dust mites Dermatophagoides farinae (Df ), Dermatophagoides pteronyssinus (Dp), and Blomia tropicalis (Bt) are the main allergens associated with the etiology of AR. Particularly in southern Brazil and in rural areas, pollens are also allergens associated with the etiology of AR6. Knowledge of the pathophysiology of AR is important for understanding the diagnostic strategies and therapeutic possibilities. Sensitization in the nasal mucosa starts with the presentation of allergens by antigen-presenting cells, such as dendritic cells, macrophages, and Langerhans cells, to naive CD4+ T lymphocytes, which at the level of innate immunity may present themselves as dysfunctional, and individuals with genetic predisposition in the presence of allergens have a tendency to differentiate naive CD4+ T cells into Th2 cells, which are characterized by producing interleukin (IL)-4, IL-5, and IL-13. In addition, other important cytokines in this allergen-specific response or even in nonspecific triggers (irritants, pollutants, virus infection, etc.) are IL-25, IL-33, and thymic stromal lymphopoietin produced by respiratory mucosal epithelial cells. These cytokines (alarmins) can contribute to induce immunoglobulin E (IgE) production and the recruitment of eosinophils to the site of the inflammatory allergic process by stimulating, respectively, IL-4and IL-5-producing Th2 and ILC2 cells. This entire process is currently referred to as type 2 inflammation, characterizing the pathophysiological mechanisms of AR and AA5,6.

BACKGROUND:Concern about disease exacerbations and fear of reactions after coronavirus disease 2019 (COVID-19) vaccinations are common in chronic urticaria (CU) patients and may lead to vaccine hesitancy. OBJECTIVE:We assessed the frequency and risk factors of CU exacerbation and adverse reactions in CU patients after COVID-19 vaccination. METHODS:COVAC-CU is an international multicenter study of Urticaria Centers of Reference and Excellence (UCAREs) that retrospectively evaluated the effects of COVID-19 vaccination in CU patients aged ≥18 years and vaccinated with ≥1 dose of any COVID-19 vaccine. We evaluated CU exacerbations and severe allergic reactions as well as other adverse events associated with COVID-19 vaccinations and their association with various CU parameters. RESULTS:Across 2769 COVID-19-vaccinated CU patients, most (90%) received at least 2 COVID-19 vaccine doses, and most patients received CU treatment and had well-controlled disease. The rate of COVID-19 vaccination-induced CU exacerbation was 9%. Of 223 patients with CU exacerbation after the first dose, 53.4% experienced recurrence of CU exacerbation after the second dose. CU exacerbation most often started <48 hours after vaccination (59.2%), lasted for a few weeks or less (70%), and was treated mainly with antihistamines (70.3%). Factors that increased the risk for COVID-19 vaccination-induced CU exacerbation included female sex, disease duration shorter than 24 months, having chronic spontaneous versus inducible urticaria, receipt of adenovirus viral vector vaccine, having nonsteroidal anti-inflammatory drug/aspirin intolerance, and having concerns about getting vaccinated; receiving omalizumab treatment and Latino/Hispanic ethnicity lowered the risk. First-dose vaccine-related adverse effects, most commonly local reactions, fever, fatigue, and muscle pain, were reported by 43.5% of CU patients. Seven patients reported severe allergic reactions. CONCLUSIONS:COVID-19 vaccination leads to disease exacerbation in only a small number of CU patients and is generally well tolerated.

Introdução: Mutações do gene da filagrina vêm sendo associadas, classicamente, a alterações da barreira epitelial em doenças alérgicas com comprometimento da pele e das superfícies mucosas.Particularmente na dermatite atópica, a relação entre filagrina, mecanismo fisiopatológico e evolução clínica tem sido demonstrada.Recentemente, alterações da barreira epitelial com redução da expressão da filagrina, também têm sido associadas a mecanismos imunológicos envolvidos na patogênese da esofagite eosinofílica.Devido a disfunções na barreira epitelial, microrganismos e alérgenos são capazes de penetrarem no epitélio da mucosa esofágica, assim como na dermatite atópica

Objective The aim of the present study is to list the published clinical trials on coronavirus disease 2019 (COVID-19) vaccines, to describe the mechanism of action of the identified vaccines, and to identify protocols regarding safety, status, and prioritization of cancer patients for vaccination. Methods This is a systematic review with a limited literature search conducted by an information specialist; key resources such as PubMed and websites of major cancer organizations were searched. The main search terms were COVID-19 , vaccination , cancer , and breast and gynecological cancers . Results Cancer patients infected with the new coronavirus are at high risk of complications and death, but we still know little about the risks and benefits of vaccination for COVID-19 in these patients. In an ideal scenario, all cancer patients should have their immunization status updated before beginning treatment, but this is not always possible. Conclusion Patients with breast or gynecological cancers who are receiving treatment or are in the 5-year posttreatment period should be included in the priority group for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) vaccination.

and treated like other types of anaphylaxis. Less than 10% of patients with ColdA received adrenaline and less than 40% of them have an AAI. ColdU patients need to be screened by specialists and non- specialists to identify those with ColdA risk factors (Table 2), 3 which may also include underlying clonal mast cell disorder. 6 Prescribing an AAI to patients at risk of ColdA needs to be com-bined with advice on avoidance of relevant cold triggers, a written treatment plan, and training and re- training in the use of the AAI. Efforts should also be made for AAIs to become accessible at public beaches and addition of ColdA in the list of indications for AAI 1 shall be considered. for

Introduction: Bone healing depends on inflammation control and tissue repair time. Low-level laser therapy (LLLT) has been investigated to accelerate this process. Methylene blue (MB), together with LLLT, has been investigated for its antioxidant and anti-inflammatory potential; however, the effects of photosensitizers (photodynamic therapy, PDT) are controversial. This study aimed to verify whether the combination of MB and LLLT changes the course of the consolidation of experimental bone defects. Methods: Sixteen Wistar rats underwent femoral bone defects. In the control group (n=4), LLLT simulations were performed without MB. The MB group (n=4) received MB and simulation of LLLT. The LLLT group (n=4) was exposed to LLLT. The PDT+LLLT group (n=4) received MB and LLLT. At the end of 7 or 14 days, the animals were euthanized, and samples were collected. Results: PDT and LLLT induced osteogenic formation with cellularity (after seven days) and union of bony edges (14 days). On the seventh day, LLLT combined with PDT induced an increase (P<0.05) of 484% in the area of bone neoformation compared to the control. On the fourteenth day, LLLT combined with PDT or alone increased (P<0.05) the area of bone neoformation by 214% and 240% respectively, compared to the control group. The PDT/LLLT combination was associated with increased radiopacity (P<0.038). Conclusion: The combined use of MB with LLLT initiated during the transoperative phase may stimulate the bone repair process in rats.

Background: Allergen Immunotherapy (AIT) represents one of the pillars in the treatment of allergic diseases. AIT is the only therapeutic strategy with curative potential, promoting the reduc-tion of drug use and long-term symptom control even after the end of the treatment. The European Academy of Allergy, Asthma and Immunology (EAACI) guidelines, position papers of World Allergy Organization (WAO), and the US Practice Parameters are the leading official documents that set scientific standard for the use of AIT in the world. The use of AIT in Brazil has specific regional conditions due to the pattern of allergen sensitization, as well as genetic, socioeconomic, and cul-tural characteristics, climate conditions, and the availability of allergenic extracts. The most prevalent house dust mites are Dermatophagoides pteronyssinus, Dermatophagoides farinae and their aller-gens have the highest clinical relevance. Blomia tropicalis is also very frequent. This position paper has been prepared by the Brazilian Association of Allergy and Clinical Immunology (ASBAI) Task -force on AIT for respiratory allergy and Hymenoptera venom allergy.Objective: According to the current scientific literature adapted to the Brazilian reality, this po-sition paper aims to establish the main recommendations for the good clinical practice parameters for AIT in Brazil.Methods: A systematic review using the Pub Med and Cochrane databases was performed, and the websites of major allergy and immunology organizations were consulted. The research was limited to English language literature and was conducted between March 30, 2002, and March 30, 2022. The terms used for the research were: Allergen Immunotherapy, sublingual immunotherapy (SLIT), subcutaneous immunotherapy (SCIT), venom-specific immunotherapy (VIT), and allergen extract.Results: The several recommendations that establish the clinical practices for AIT recommended by the main Allergy, Asthma and Immunology world organizations were analyzed and adapted to the Brazilian situation.Conclusion: This position paper establishes the main recommendations for the effective clinical practice of AIT in Brazil, using current knowledge of evidence-based medicine and precision medicine.

ABSTRACT Introduction: Oral mucositis (OM) is considered the most frequent acute side effect of the antineoplasic treatment, with ulcerative lesions resulting from a painful symptomatology, affecting the oral cavity in response to the Antineoplastic treatment. In order to study these side effects, experiments in animal models are necessary, using antineoplastic drugs for the induction of OM and anesthetics, mainly Ketamine and Xylazine, to perform scarification of the cheeks. Objective: The goal is to report an experimental model of induced OM, without the use of anesthetics for the scarification stage of the animal cheeks. Methods: Fourty five male Wistar rats, 7 weeks old and weighting 220g, were used, divided into 2 groups; with OM induced by 5-Fluorouracil intraperitoneal administration. Two days later, Group I was physically contained, in contrast, Group II were anesthetized with Ketamine and Xylazine, focusing on irritating the cheek mucosa using the tip of a sterile needle, in order to potentialize the development of OM. The animals were euthanized with an anesthetic overdose. Results: Concerning the experiment of 5-Fluorouracil chemo-induced of OM, where the irritation was performed by physical containment, without the use of anesthetics (Ketamine and Xylazine), the animals had a longer survivability and a rapid improvement of the side effects induced by chemotherapy. Conclusion: This new model is promising, considering that the use of anesthetics (Ketamine and Xylazine) showed a high mortality rate. In the absence of anesthesia, all the animals survived until the end of the experiment involving chemotherapy model with 5-Fluorouracil and physical restraint.

A pandemia de COVID-19 representa um grande desafio para todas as especialidades médicas.A imunoterapia com alérgenos (ITA) é considerada o único procedimento terapêutico capaz de modificar a história natural das doenças alérgicas, e caracteriza o estado da arte na área de Alergia e Imunologia.Esta estratégia terapêutica de imunomodulação é capaz de promover a remissão e controle das doenças alérgicas por períodos prolongados, mesmo após o seu término.Existem poucos dados em relação ao emprego da ITA em pacientes vacinados contra COVID-19, e até o momento não há um posicionamento oficial das sociedades internacionais da área de Alergia e Imunologia Clínica.Este documento tem como objetivo estabelecer recomendações práticas para o manejo da ITA em pacientes que receberam a vacina contra COVID-19.Os fenômenos imunológicos envolvidos na imunoprofilaxia vacinal