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.
Keywords: Allergic rhinitis; Sublingual immunotherapy; COVID-19.
