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Smolinska S, Popescu FD, Izquierdo E, Antolín-Amérigo D, Price OJ, Alvarez-Perea A, Eguíluz Gracia I, Papadopoulos NG, Pfaar O, Fassio F, Hoffmann-Sommergruber K, Dramburg S, Agache I, Jutel M, Brough HA, Fonseca JA, Angier E, Boccabella C, Bonini M, Dunn Galvin A, Gibson PG, Gawlik R, Hannachi F, Kalayci Ö, Klimek L, Knibb R, Matricardi P, Chivato T. Telemedicine with special focus on allergic diseases and asthma-Status 2022: An EAACI position paper. Allergy 2024; 79:777-792. [PMID: 38041429 DOI: 10.1111/all.15964] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/31/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
Efficacious, effective and efficient communication between healthcare professionals (HCP) and patients is essential to achieve a successful therapeutic alliance. Telemedicine (TM) has been used for decades but during the COVID-19 pandemic its use has become widespread. This position paper aims to describe the terminology and most important forms of TM among HCP and patients and review the existing studies on the uses of TM for asthma and allergy. Besides, the advantages and risks of TM are discussed, concluding that TM application reduces costs and time for both, HCP and patients, but cannot completely replace face-to-face visits for physical examinations and certain tests that are critical in asthma and allergy. From an ethical point of view, it is important to identify those involved in the TM process, ensure confidentiality and use communication channels that fully guarantee the security of the information. Unmet needs and directions for the future regarding implementation, data protection, privacy regulations, methodology and efficacy are described.
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Affiliation(s)
- Sylwia Smolinska
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
| | - Florin-Dan Popescu
- Department of Allergology, Nicolae Malaxa Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Elena Izquierdo
- Department of Basic Medical Sciences, Facultad de Medicina, Institute of Applied Molecular Medicine Instituto de Medicina Molecular Aplicada Nemesio Díez (IMMA), Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Madrid, Spain
| | - Darío Antolín-Amérigo
- Servicio de Alergia, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Oliver J Price
- School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Alberto Alvarez-Perea
- Allergy Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
| | - Ibon Eguíluz Gracia
- Allergy Department, Hospital Regional Universitario de Malaga and Allergy Research Group, Instituto de Investigacion Biomedica de Malaga (IBIMA-Plataforma BIONAND). RICORS "Inflammatory Diseases", Malaga, Spain
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National Kapodistrian University of Athens, Athens, Greece
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | | | | | - Stephanie Dramburg
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - Ioana Agache
- Allergy and Clinical Immunology at Transylvania University, Brasov, Romania
| | - Marek Jutel
- Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
- "ALL-MED" Medical Research Institute, Wroclaw, Poland
| | - Helen A Brough
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital, London, UK
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - João A Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Elizabeth Angier
- Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Cristina Boccabella
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Bonini
- Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Clinical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
- National Heart and Lung Institute (NHLI), Imperial College London, London, UK
| | | | - Peter G Gibson
- John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
| | - Radoslaw Gawlik
- Department of Internal Medicine, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland
| | - Farah Hannachi
- Immuno-Allergology Unit, Hospital Centre of Luxembourg, Luxembourg City, Luxembourg
| | - Ömer Kalayci
- Hacettepe University School of Medicine, Ankara, Turkey
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Rebecca Knibb
- School of Psychology, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Paolo Matricardi
- Department of Pediatric Respiratory Care, Immunology and Intensive Care Medicine, Charité Universitätsmedizin, Berlin, Germany
| | - Tomás Chivato
- Department of Clinical Medical Sciences, Facultad de Medicina, Universidad San Pablo-CEU, CEU Universities, Urbanización Montepríncipe, Madrid, Spain
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Wypych-Ślusarska A, Krupa-Kotara K, Oleksiuk K, Głogowska-Ligus J, Słowiński J, Niewiadomska E. Socioeconomic and Health Determinants of the Prevalence of COVID-19 in a Population of Children with Respiratory Diseases and Symptoms. CHILDREN (BASEL, SWITZERLAND) 2024; 11:88. [PMID: 38255401 PMCID: PMC10814875 DOI: 10.3390/children11010088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Most epidemiological studies indicate that bronchial asthma is not a risk factor for COVID-19, but previous analyses have not additionally focused on the socioeconomic determinants of SARS-CoV-2 infection in children with asthma, bronchitis, and respiratory symptoms. AIMS This research aimed to investigate the correlation between the socioeconomic status of families and the prevalence of respiratory conditions such as asthma, bronchitis, and respiratory symptoms in children, in addition to exploring their association with the prevalence of COVID-19. The study involved a cross-sectional epidemiological investigation conducted in 2022, encompassing 2454 students from elementary schools in Poland. The parents of the students completed a questionnaire modeled after the International Study on Asthma and Allergies in Childhood (ISAAC). Socioeconomic status (SES) indicators were determined based on parental education, self-reported economic status, and housing conditions. To assess the impact of social factors and health on the occurrence of COVID-19, odds ratios (ORs) were calculated. The findings revealed several COVID-19 risk factors, including higher maternal (OR 2.2; 95%CI: 1.3-3.0) and paternal education (OR 1.9; 95%CI: 1.3-2.4), urban residence (OR 1.7; 95%CI: 1.3-2.1), the presence of mold in residences (OR 1.7; 95%CI: 1.0-2.3), bronchitis (OR 1.5; 95%CI: 1.2-2.0), and chronic cough (OR 1.8; 95%CI: 1.3-2.4). Further analysis, stratifying children based on their baseline health status (i.e., presence or absence of asthma, bronchitis, and chronic cough), indicated that higher parental education increased the risk of COVID-19 solely for children without pre-existing conditions. The occurrence of SARS-CoV-2 infections was found to be notably associated with mold exposure in children who did not have bronchial asthma. Rigorous multivariate analyses substantiated the collective impact of factors such as residential environment, the existence of mold and moisture, and a history of bronchitis. This study's conclusions highlight a higher frequency of SARS-CoV-2 infections in cases where bronchitis had been diagnosed previously and chronic cough was prevalent. Interestingly, the initially hypothesized higher prevalence of COVID-19 among children with bronchial asthma did not receive confirmation in our findings. This study highlights the importance of urban residence, exposure to mold or dampness, and higher parental education in the incidence of COVID-19. Higher parental education was a significant factor in increasing the risk of COVID-19 among children without bronchitis, chronic cough, and asthma.
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Affiliation(s)
- Agata Wypych-Ślusarska
- Department of Epidemiology, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, 41-902 Katowice, Poland; (A.W.-Ś.); (K.O.); (J.G.-L.); (J.S.)
| | - Karolina Krupa-Kotara
- Department of Biostatistics, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, 41-902 Katowice, Poland;
| | - Klaudia Oleksiuk
- Department of Epidemiology, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, 41-902 Katowice, Poland; (A.W.-Ś.); (K.O.); (J.G.-L.); (J.S.)
| | - Joanna Głogowska-Ligus
- Department of Epidemiology, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, 41-902 Katowice, Poland; (A.W.-Ś.); (K.O.); (J.G.-L.); (J.S.)
| | - Jerzy Słowiński
- Department of Epidemiology, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, 41-902 Katowice, Poland; (A.W.-Ś.); (K.O.); (J.G.-L.); (J.S.)
| | - Ewa Niewiadomska
- Department of Biostatistics, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, 41-902 Katowice, Poland;
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3
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Avdeev SN, Chulanov VP, Alexeeva EI, Aleshina OA, Bereznikov AV, Kotenko ON, Lila AM, Mutovina ZY, Parovichnikova EN, Fomina DS, Frolova NF, Shevchenko AO. [The burden of COVID-19 in a heterogeneous population of immunocompromised patients - realities of the postpandemic]. TERAPEVT ARKH 2023; 95:722-729. [PMID: 38158913 DOI: 10.26442/00403660.2023.08.202391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 01/03/2024]
Abstract
On July 3, 2023, an interdisciplinary Council of Experts "The burden of COVID-19 in a heterogeneous population of immunocompromised patients - post-pandemic realities" was held in Moscow with leading experts in pulmonology, rheumatology, hematology, oncology, nephrology, allergology-immunology, transplantation, and infectious diseases. The aim of the meeting was to discuss the current clinical and epidemiologic situation related to COVID-19, the relevance of disease prevention strategies for high-risk patients. The experts addressed the following issues: 1) the disease burden of COVID-19 in 2023 for patients with immunodeficiency in different therapeutic areas; 2) the place of passive immunization with monoclonal antibodies as a method of COVID-19 prophylaxis among immunocompromised patients; 3) prerequisites for the inclusion of passive immunization of immunocompromised patients into routine clinical practice.
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Affiliation(s)
- S N Avdeev
- Sechenov First Moscow State Medical University (Sechenov University)
| | - V P Chulanov
- Sechenov First Moscow State Medical University (Sechenov University)
- National Medical Research Center for Phthisiopulmonology and Infectious Diseases
| | - E I Alexeeva
- Sechenov First Moscow State Medical University (Sechenov University)
- National Medical Research Center for Children's Health
| | | | | | - O N Kotenko
- City Clinical Hospital №52
- Pirogov Russian National Research Medical University
| | - A M Lila
- Nasonova Research Institute of Rheumatology
- Russian Medical Academy of Continuous Professional Education
| | - Z Y Mutovina
- City Clinical Hospital №52
- Central State Medical Academy of the Administrative Department of the President of the Russian Federation
| | | | - D S Fomina
- Sechenov First Moscow State Medical University (Sechenov University)
- City Clinical Hospital №52
| | - N F Frolova
- City Clinical Hospital №52
- Yevdokimov Moscow State University of Medicine and Dentistry
| | - A O Shevchenko
- Sechenov First Moscow State Medical University (Sechenov University)
- Pirogov Russian National Research Medical University
- Shumakov National Medical Research Center for Transplantology and Artificial Organs
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4
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Mancino E, Nenna R, Matera L, La Regina DP, Petrarca L, Iovine E, Di Mattia G, Frassanito A, Conti MG, Bonci E, Spatuzzo M, Ialongo S, Zicari AM, Spalice A, Midulla F. A Single Center Observational Study on Clinical Manifestations and Associated Factors of Pediatric Long COVID. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6799. [PMID: 37754658 PMCID: PMC10531477 DOI: 10.3390/ijerph20186799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/10/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023]
Abstract
Children with SARS-CoV-2 are mostly mild symptomatic, but they may develop conditions, such as persisting symptoms, that may put them at greater risk of complications. Our aim was to evaluate the frequency and the presence of risk factors for persisting COVID-19 symptoms in children. We carried out a prospective observational study of the clinical manifestation of Long COVID at the Department of Maternal Infantile Science of a tertiary University hospital in Rome. We included 697 children (0-18 years), with previous SARS-CoV-2 infection. Children and parents were asked questions regarding persistent symptoms of COVID-19. Children with symptoms 30 days after initial diagnosis were 185/697 (26.4%). Moreover, 81/697 (11.6%) patients presented symptoms 90 days after the diagnosis. Thirty-day-persisting symptoms were mostly present in children with anosmia, atopy, asthenia, and cough in the acute phase compared with the asymptomatic children 30 days after infection. After 90 days, symptoms described were mainly neurological (47/697 children, 6.7%), and headache (19/697; 2.7%) was the most frequent manifestation. In conclusion, a relatively large proportion of the patients reported persisting symptoms that seem to be related to the symptom burden and to the atopy. Ninety days after the infection, most of the children had recovered, showing that long-term effects are not frequent. Limitations of the study include the single-center design and the lack of a control group.
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Affiliation(s)
- Enrica Mancino
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy
- Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Raffaella Nenna
- Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Luigi Matera
- Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Domenico Paolo La Regina
- Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Laura Petrarca
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00161 Rome, Italy
- Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Elio Iovine
- Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Greta Di Mattia
- Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Antonella Frassanito
- Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Maria Giulia Conti
- Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Enea Bonci
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Mattia Spatuzzo
- Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Sara Ialongo
- Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Anna Maria Zicari
- Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Alberto Spalice
- Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Fabio Midulla
- Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, 00161 Rome, Italy
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5
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Jugulete G, Luminos M, Pavelescu C, Merișescu MM. Remdesivir Efficacy and Tolerability in Children with COVID-19-Associated Allergic Comorbidities such as Asthma, Allergic Rhinitis, and Atopic Dermatitis. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050810. [PMID: 37238359 DOI: 10.3390/children10050810] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/24/2023] [Accepted: 04/17/2023] [Indexed: 05/28/2023]
Abstract
In children, coronavirus disease 2019 (COVID-19) starts as a minor illness compared to adults, but during the ongoing COVID-19 pandemic, distinct SARS-CoV-2 variants and subvariants have changed options for therapies in both adults and children, especially for those with comorbidities such as allergies. On 25 April 2022, Remdesivir (RDV), a viral RNA-dependent RNA polymerase inhibitor, was approved by the Food and Drug Administration (FDA) for the treatment of pediatric patients 28 days and older, weighing ≥3 kg, hospitalized or non-hospitalized, who are at high risk of progression to severe forms of COVID-19. While RDV has been shown to have favorable effects in numerous types of research conducted on adults, such as shortening hospital stays, and has shown it has antiviral effects on various RNA viruses, there is a lack of findings regarding safety, tolerability, and efficacy of RDV in allergic pediatric patients since its initial FDA approval. This study aims to assess RDV's efficacy and tolerability in treating pediatric patients with mild and severe forms of COVID-19-associated allergies such as asthma, allergic rhinitis, and atopic dermatitis and how RDV affects the duration of hospitalization, especially for these comorbidities. The most recent pandemic wave among children rose due to the high transmissibility of the Omicron variant, and this study analyzed changes between July 2020 and September 2022 at the National Institute of Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania. Our retrospective study included 250 children <18 years old, 42 (16.8%) had allergies, 132 were males (52.8%), age group 0-5 years old (80%), with a positive viral test for SARS-CoV-2. Severity was categorized as mild (43.6%), moderate (53.2%), and severe (1.6%) COVID-19, and treatment with RDV was administered in 50.4% (126/250) of children included in the study. The presence of comorbidities, asthma (7.2%), allergic rhinitis (4.4%), and atopic dermatitis (4.4%), was associated with an increased risk of developing severe COVID-19 infection in children, p < 0.05. We did not register deaths and severe complications; all cases evolved favorably under the instituted treatment. Laboratory abnormalities in transaminase levels 53.97% (ALT) and 61.9% (AST) were grades 1 or 2 and did not require discontinuation of the antiviral treatment, p < 0.05. RDV in children reduced the duration and evolution of COVID-19 and decreased the length of hospitalization in group-associated allergies; p < 0.05. This article summarizes RDV's efficacy among children with COVID-19 and allergies when the clinical result was improved and reports positive effects on tolerability and reduced duration of hospitalization, especially in children with asthma, atopic dermatitis, and allergic rhinitis. More studies are needed to confirm our findings.
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Affiliation(s)
- Gheorghiță Jugulete
- Faculty of Medicine, University of Medicine and Pharmacy, "Carol Davila", No. 37, Dionisie Lupu Street, 2nd District, 020021 Bucharest, Romania
- "Matei Balş" National Institute for Infectious Diseases, No. 1, Calistrat Grozovici Street, 2nd District, 021105 Bucharest, Romania
| | - Monica Luminos
- Faculty of Medicine, University of Medicine and Pharmacy, "Carol Davila", No. 37, Dionisie Lupu Street, 2nd District, 020021 Bucharest, Romania
- "Matei Balş" National Institute for Infectious Diseases, No. 1, Calistrat Grozovici Street, 2nd District, 021105 Bucharest, Romania
| | - Carmen Pavelescu
- Faculty of Medicine, University of Medicine and Pharmacy, "Carol Davila", No. 37, Dionisie Lupu Street, 2nd District, 020021 Bucharest, Romania
| | - Mădălina Maria Merișescu
- Faculty of Medicine, University of Medicine and Pharmacy, "Carol Davila", No. 37, Dionisie Lupu Street, 2nd District, 020021 Bucharest, Romania
- "Matei Balş" National Institute for Infectious Diseases, No. 1, Calistrat Grozovici Street, 2nd District, 021105 Bucharest, Romania
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6
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Votto M, Castagnoli R, Marseglia GL, Licari A, Brambilla I. COVID-19 and autoimmune diseases: is there a connection? Curr Opin Allergy Clin Immunol 2023; 23:185-192. [PMID: 36728317 DOI: 10.1097/aci.0000000000000888] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE OF REVIEW This review summarizes current evidence on the potential link between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and autoimmunity. RECENT FINDINGS Several viral infections are potential triggers of reactive and autoimmune diseases by inducing type II and type IV hypersensitivity reactions. Recent evidence demonstrated that SARS-CoV-2 infection is not an exception, triggering the production of tissue-specific autoantibodies during the acute phase of coronavirus disease 2019 (COVID-19) and leading to autoimmune diseases development as long-term complication. The significant immune dysregulation with cytokine storm and organ damage observed in patients with severe to critical COVID-19 is considered the main mechanism explaining the high levels of autoantibodies, which are also implicated in disease severity and the need for an intensive care assessment. Multisystem inflammatory syndrome in children (MIS-C) is an immune-mediated disease where the recent viral infection leads to systemic inflammation, as already observed in other reactive and autoimmune diseases. SUMMARY Autoimmunity may be a complication of SAR-CoV-2 infection. Understanding the pathogenesis of autoimmune manifestations in COVID-19 might help prevent the incidence or exacerbation of autoimmune disorders and design better and more efficient treatment strategies in children and adult populations.
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Affiliation(s)
- Martina Votto
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia
| | - Riccardo Castagnoli
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Amelia Licari
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ilaria Brambilla
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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7
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Comorbid Asthma Increased the Risk for COVID-19 Mortality in Asia: A Meta-Analysis. Vaccines (Basel) 2022; 11:vaccines11010089. [PMID: 36679934 PMCID: PMC9862735 DOI: 10.3390/vaccines11010089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/03/2023] Open
Abstract
We aimed to explore the influence of comorbid asthma on the risk for mortality among patients with coronavirus disease 2019 (COVID-19) in Asia by using a meta-analysis. Electronic databases were systematically searched for eligible studies. The pooled odds ratio (OR) with 95% confidence interval (CI) was estimated by using a random-effect model. An inconsistency index (I2) was utilized to assess the statistical heterogeneity. A total of 103 eligible studies with 198,078 COVID-19 patients were enrolled in the meta-analysis; our results demonstrated that comorbid asthma was significantly related to an increased risk for COVID-19 mortality in Asia (pooled OR = 1.42, 95% CI: 1.20−1.68; I2 = 70%, p < 0.01). Subgroup analyses by the proportion of males, setting, and sample sizes generated consistent findings. Meta-regression indicated that male proportion might be the possible sources of heterogeneity. A sensitivity analysis exhibited the reliability and stability of the overall results. Both Begg’s analysis (p = 0.835) and Egger’s analysis (p = 0.847) revealed that publication bias might not exist. In conclusion, COVID-19 patients with comorbid asthma might bear a higher risk for mortality in Asia, at least among non-elderly individuals.
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8
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Munblit D, Greenhawt M, Brough HA, Pushkareva A, Karimova D, Demidova A, Warner JO, Kalayci O, Sediva A, Untersmayr E, Rodriguez Del Rio P, Vazquez-Ortiz M, Arasi S, Alvaro-Lozano M, Tsabouri S, Galli E, Beken B, Eigenmann PA. Allergic diseases and immunodeficiencies in children, lessons learnt from COVID-19 pandemic by 2022: A statement from the EAACI-section on pediatrics. Pediatr Allergy Immunol 2022; 33:e13851. [PMID: 36282136 PMCID: PMC9538373 DOI: 10.1111/pai.13851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022]
Abstract
By the April 12, 2022, the COVID-19 pandemic had resulted in over half a billion people being infected worldwide. There have been 6.1 million deaths directly due to the infection, but the pandemic has had many more short- and long-term pervasive effects on the physical and mental health of the population. Allergic diseases are among the most prevalent noncommunicable chronic diseases in the pediatric population, and health-care professionals and researchers were seeking answers since the beginning of pandemic. Children are at lower risk of developing severe COVID-19 or dying from infection. Allergic diseases are not associated with a higher COVID-19 severity and mortality, apart from severe/poorly controlled asthma. The pandemic disrupted routine health care, but many mitigation strategies, including but not limited to telemedicine, were successfully implemented to continue delivery of high-standard care. Although children faced a multitude of pandemic-related issues, allergic conditions were effectively treated remotely while reduction in air pollution and lack of contact with outdoor allergens resulted in improvement, particularly respiratory allergies. There is no evidence to recommend substantial changes to usual management modalities of allergic conditions in children, including allergen immunotherapy and use of biologicals. Allergic children are not at greater risk of multisystem inflammatory syndrome development, but some associations with Long COVID were reported, although the data are limited, and further research is needed. This statement of the EAACI Section on Pediatrics provides recommendations based on the lessons learnt from the pandemic, as available evidence.
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Affiliation(s)
- Daniel Munblit
- Inflammation, Repair and Development Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Helen A Brough
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital, London, UK.,Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Anna Pushkareva
- European Academy of Allergy and Clinical Immunology (EAACI), Zurich, Switzerland
| | - Diana Karimova
- European Academy of Allergy and Clinical Immunology (EAACI), Zurich, Switzerland
| | - Anastasia Demidova
- European Academy of Allergy and Clinical Immunology (EAACI), Zurich, Switzerland
| | - John O Warner
- Inflammation, Repair and Development Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Omer Kalayci
- Pediatric Allergy and Asthma, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Anna Sediva
- Department of Immunology, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | | | - Marta Vazquez-Ortiz
- Inflammation, Repair and Development Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Stefania Arasi
- Translational Research in Pediatric Specialities Area, Division of Allergy, IRCCS, Bambino Gesù Children's Hospital, Rome, Italy
| | - Montserrat Alvaro-Lozano
- Allergology and Clinical Immunology Department, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Sophia Tsabouri
- Child Health Department, University of Ioannina School of Medicine, Ioannina, Greece
| | - Elena Galli
- Pediatric Allergology Unit, Department of Pediatric Medicine, S.Pietro Hospital Fatebenefratelli, Rome, Italy
| | - Burcin Beken
- Department of Pediatric Allergy and Immunology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Philippe A Eigenmann
- Pediatric Allergy Unit, Department of Woman, Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
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9
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Khemiri H, Ayouni K, Triki H, Haddad-Boubaker S. SARS-CoV-2 infection in pediatric population before and during the Delta (B.1.617.2) and Omicron (B.1.1.529) variants era. Virol J 2022; 19:144. [PMID: 36076271 PMCID: PMC9452867 DOI: 10.1186/s12985-022-01873-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/27/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19, the coronavirus disease that emerged in December 2019, caused drastic damage worldwide. At the beginning of the pandemic, available data suggested that the infection occurs more frequently in adults than in infants. In this review, we aim to provide an overview of SARS-CoV-2 infection in children before and after B.1.617.2 Delta and B.1.1.529 Omicron variants emergence in terms of prevalence, transmission dynamics, clinical manifestations, complications and risk factors. METHODS Our method is based on the literature search on PubMed, Science Direct and Google Scholar. From January 2020 to July 2022, a total of 229 references, relevant for the purpose of this review, were considered. RESULTS The incidence of SARS-CoV-2 infection in infants was underestimated. Up to the first half of May, most of the infected children presented asymptomatic or mild manifestations. The prevalence of COVID-19 varied from country to another: the highest was reported in the United States (22.5%). COVID-19 can progress and become more severe, especially with the presence of underlying health conditions. It can also progress into Kawasaki or Multisystem Inflammatory Syndrome (MIS) manifestations, as a consequence of exacerbating immune response. With the emergence of the B.1.617.2 Delta and B.1.1.529 Omicron variants, it seems that these variants affect a large proportion of the younger population with the appearance of clinical manifestations similar to those presented by adults with important hospitalization rates. CONCLUSION The pediatric population constitutes a vulnerable group that requires particular attention, especially with the emergence of more virulent variants. The increase of symptomatic SARS-CoV-2 infection and hospitalization rate among children highlights the need to extend vaccination to the pediatric population.
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Affiliation(s)
- Haifa Khemiri
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institut Pasteur de Tunis, University of Tunis El Manar, 13 place Pasteur, BP74 1002 le Belvédère, Tunis, Tunisia
- LR 20 IPT 02 Laboratory of Virus, Host and Vectors, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Kaouther Ayouni
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institut Pasteur de Tunis, University of Tunis El Manar, 13 place Pasteur, BP74 1002 le Belvédère, Tunis, Tunisia
- LR 20 IPT 02 Laboratory of Virus, Host and Vectors, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Henda Triki
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institut Pasteur de Tunis, University of Tunis El Manar, 13 place Pasteur, BP74 1002 le Belvédère, Tunis, Tunisia
| | - Sondes Haddad-Boubaker
- Laboratory of Clinical Virology, WHO Regional Reference Laboratory for Poliomyelitis and Measles for the EMR, Institut Pasteur de Tunis, University of Tunis El Manar, 13 place Pasteur, BP74 1002 le Belvédère, Tunis, Tunisia.
- LR 20 IPT 02 Laboratory of Virus, Host and Vectors, Institut Pasteur de Tunis, University of Tunis El Manar, Tunis, Tunisia.
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10
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Brindisi G, Spalice A, Anania C, Bonci F, Gori A, Capponi M, Cinicola B, De Castro G, Martinelli I, Pulvirenti F, Matera L, Mancino E, Guido CA, Zicari AM. COVID-19, Anosmia, and Allergies: Is There a Relationship? A Pediatric Perspective. J Clin Med 2022; 11:jcm11175019. [PMID: 36078947 PMCID: PMC9457095 DOI: 10.3390/jcm11175019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/06/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Between June and July 2020, we evaluated children and adolescents concerning post-infection surveillance after a COVID-19 positivity during the lockdown. We aimed to assess whether the anamnestic presence of allergies could correlate with the presence of SARS-CoV-2 symptoms, and in particular with anosmia. Material and methods: For each patient, we collected anamnestic data, the presence of allergies documented by performing skin prick tests, and COVID-19 symptoms. Then, if over six years of age, each patient underwent an active anterior rhinomanometry. Results: A total of 296 patients were enrolled, of whom 105 (35.4%) reported allergies. Considering COVID-19 symptoms, 74 subjects (25%) presented an asymptomatic form, 222 (75%) reported symptoms, and anosmia recurred in 60 subjects (27.03%). A statistically significant relationship was found between allergies and symptomatic COVID-19 (p = 0.042), allergies, and anosmia (p = 0.05), and allergies and anosmia in males (p = 0.007). Moreover, anosmic patients presented a higher body mass index, older age, and a longer COVID-19 duration with statistical significance (p = 0.001, 0.001, 0.006, respectively). Conclusions: Allergic subjects seem to develop symptomatic COVID-19 more frequently and allergies appear to be a protective factor from anosmia’s onset in males.
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Affiliation(s)
- Giulia Brindisi
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence: ; Tel.: +39-06-49979333
| | - Alberto Spalice
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Caterina Anania
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Flaminia Bonci
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Alessandra Gori
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Martina Capponi
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Bianca Cinicola
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy
| | - Giovanna De Castro
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Ivana Martinelli
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Federica Pulvirenti
- Primary Immune Deficiencies Unit, Department of Internal Medicine and Infectious Diseases, Azienda Ospedaliera Universitaria Policlinico Umberto I, 00185 Rome, Italy
| | - Luigi Matera
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Enrica Mancino
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Cristiana Alessia Guido
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
| | - Anna Maria Zicari
- Department of Mother-Child, Urological Science, Sapienza University of Rome, 00161 Rome, Italy
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11
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Varela-Trinidad GU, Domínguez-Díaz C, Solórzano-Castanedo K, Íñiguez-Gutiérrez L, Hernández-Flores TDJ, Fafutis-Morris M. Probiotics: Protecting Our Health from the Gut. Microorganisms 2022; 10:1428. [PMID: 35889147 PMCID: PMC9316266 DOI: 10.3390/microorganisms10071428] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 02/07/2023] Open
Abstract
The gut microbiota (GM) comprises billions of microorganisms in the human gastrointestinal tract. This microbial community exerts numerous physiological functions. Prominent among these functions is the effect on host immunity through the uptake of nutrients that strengthen intestinal cells and cells involved in the immune response. The physiological functions of the GM are not limited to the gut, but bidirectional interactions between the gut microbiota and various extraintestinal organs have been identified. These interactions have been termed interorganic axes by several authors, among which the gut-brain, gut-skin, gut-lung, gut-heart, and gut-metabolism axes stand out. It has been shown that an organism is healthy or in homeostasis when the GM is in balance. However, altered GM or dysbiosis represents a critical factor in the pathogenesis of many local and systemic diseases. Therefore, probiotics intervene in this context, which, according to various published studies, allows balance to be maintained in the GM, leading to an individual's good health.
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Affiliation(s)
- Gael Urait Varela-Trinidad
- Doctorado en Ciencias Biomédicas, Con Orientaciones en Inmunología y Neurociencias, Universidad de Guadalajara, Sierra Mojada 950, Guadalajara 44340, Mexico; (G.U.V.-T.); (C.D.-D.)
- Centro de Investigación en Inmunología y Dermatología (CIINDE), Calzada del Federalismo Nte 3102, Zapopan 45190, Mexico
| | - Carolina Domínguez-Díaz
- Doctorado en Ciencias Biomédicas, Con Orientaciones en Inmunología y Neurociencias, Universidad de Guadalajara, Sierra Mojada 950, Guadalajara 44340, Mexico; (G.U.V.-T.); (C.D.-D.)
- Centro de Investigación en Inmunología y Dermatología (CIINDE), Calzada del Federalismo Nte 3102, Zapopan 45190, Mexico
| | - Karla Solórzano-Castanedo
- Doctorado en Ciencias de la Nutrición Traslacional, Universidad de Guadalajara, Sierra Mojada 950, Guadalajara 44340, Mexico;
| | - Liliana Íñiguez-Gutiérrez
- Instituto de Investigación de Inmunodeficiencias y VIH, Hospital Civil de Guadalajara, Coronel Calderón 777, Guadalajara 44280, Mexico; (L.Í.-G.); (T.d.J.H.-F.)
| | - Teresita de Jesús Hernández-Flores
- Instituto de Investigación de Inmunodeficiencias y VIH, Hospital Civil de Guadalajara, Coronel Calderón 777, Guadalajara 44280, Mexico; (L.Í.-G.); (T.d.J.H.-F.)
- Departamento de Disciplinas Filosóficas Metodológicas e Intrumentales, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Sierra Mojada 950, Guadalajara 44340, Mexico
| | - Mary Fafutis-Morris
- Centro de Investigación en Inmunología y Dermatología (CIINDE), Calzada del Federalismo Nte 3102, Zapopan 45190, Mexico
- Departamento de Fisiología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Sierra Mojada 950, Guadalajara 44340, Mexico
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12
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Özer M, Başkaya N, Bostancı İ. Attitudes towards influenza and pneumococcal vaccines in parents of asthmatic children during the COVID-19 pandemic. Pediatr Pulmonol 2022; 57:871-877. [PMID: 34997997 DOI: 10.1002/ppul.25818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/11/2021] [Accepted: 01/01/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study aimed to determine the differences in attitudes and views towards influenza and pneumococcal vaccines in parents of children with asthma during the COVID-19 pandemic. MATERIALS AND METHODS Asthmatic children in the 6-18 age group who were admitted to the pediatric allergy clinic of our hospital between October 1, 2020 and February 31, 2021 were included in the study. The parents were given a questionnaire asking about their demographics and medical history. Their attitudes and thoughts towards these two vaccines, both before and during the pandemic, and their COVID-19 stories were questioned. RESULTS A total of 78 patients diagnosed with asthma were included in this study. While the rate of influenza vaccination before the pandemic was 29.5%, the rate of those who received or wanted to receive influenza vaccine during the pandemic was 71.8% (p = 0.001). It was observed that the rate of influenza vaccination during the pandemic increased with the regular use of asthma medication, the presence of atopy, and a history of COVID-19 infection in the family/close environment. In total, 69.2% of the parents stated that their child's pneumococcal vaccination was incomplete or they were unaware of their child's vaccination status. CONCLUSION This study demonstrated that there was an increase in the rate and willingness of parents of asthmatic children to have their children vaccinated against influenza during the COVID-19 pandemic. As for the pneumococcal vaccine, the majority of the parents did not have enough information or they were unaware of the vaccination status of their children.
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Affiliation(s)
- Murat Özer
- Department of Pediatric Immunology and Allergy, Dr. Sami Ulus, Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Nevzat Başkaya
- Department of Pediatric Immunology and Allergy, Dr. Sami Ulus, Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - İlknur Bostancı
- Department of Pediatric Immunology and Allergy, Dr. Sami Ulus, Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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13
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Abstract
PURPOSE OF REVIEW The interplay of asthma and coronavirus disease 2019 (COVID-19) in children is yet unknown. The purpose of this review is to determine the interplay of asthma and asthma therapeutics and COVID-19. RECENT FINDINGS There is no evidence to date that asthma is a risk factor for more severe COVID-19 outcomes, especially in children. There is actually some basis to suggest that children with atopic asthma may be at reduced risk of asthma exacerbations during COVID-19. The impact of asthma therapeutics on COVID-19 outcomes is unclear, but guidance is relatively uniform in recommending that those with asthma remain on current asthma medications. A focus on social determinants of health may be increasingly important during the pandemic and beyond. SUMMARY Asthma in children appears to be more friend, than foe, during COVID-19.
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Affiliation(s)
- Elissa M Abrams
- Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
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14
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Kimiya T, Shinjoh M, Asanuma H, Inoguchi T, Takahashi T. High success rate of nocturnal enuresis treatment during the stay-home period for COVID-19. Int J Urol 2022; 29:617-622. [PMID: 35240721 PMCID: PMC9111710 DOI: 10.1111/iju.14852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/20/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To clarify whether enuresis treatment was more effective during the stay-home period for the coronavirus disease 2019 pandemic, when restrictions on activities enabled patients to concentrate on treatment. METHODS We performed a retrospective, nonrandomized cohort study for monosymptomatic enuresis during the coronavirus disease 2019 pandemic (March-June 2020) and a 2-year comparator period (March-June 2018 and March-June 2019). Primary outcome was treatment response, defined as a change in the number of wet nights per week within 6 months following enrollment. The time-dependent occurrence of treatment response was evaluated with the Kaplan-Meier method and the log-rank test. The Cox proportional hazards regression model was used to identify risk factors for treatment response. The range of appropriate sample sizes for this primary outcome was 39-48. RESULTS Of our 41 enrolled patients, 28 (68%) were male and mean age was 8.8 years. The complete response rate was 73% during the coronavirus disease 2019 pandemic period and 27% during the comparator period. Log-rank tests showed a higher cumulative incidence of complete response in the pandemic period (P = 0.020). Cox regression analysis identified treatment during the coronavirus disease 2019 pandemic (hazard ratio 2.533; 95% confidence interval 1.069-6.006) and dinner before 19:00 (hazard ratio 4.184; 95% confidence interval 1.56-11.252) as significantly associated with treatment response. CONCLUSIONS The rate of enuresis treatment response was uncommonly high during the stay-home period for the coronavirus disease 2019 pandemic. Restrictions on daily life may provide opportunities to concentrate on treatments for chronic illnesses, leading to more success.
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Affiliation(s)
- Takahisa Kimiya
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Masayoshi Shinjoh
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Asanuma
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Tomohiro Inoguchi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Takao Takahashi
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
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15
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Bartha I, Bernaola M, Escudero C, Rodríguez Del Río P, Bazire R, Ibáñez Sandín MD. COVID-19 and childhood asthma: Analysis of a pediatric referral hospital. Pediatr Allergy Immunol 2022; 33:e13757. [PMID: 35338727 PMCID: PMC9115475 DOI: 10.1111/pai.13757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Irene Bartha
- Allergy Derpartment, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Marta Bernaola
- Allergy Derpartment, Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Carmelo Escudero
- Allergy Derpartment, Hospital Infantil Universitario Niño Jesús, Madrid, España.,FibHNJ, ARADyAL-RETICs RD16/RD16/0006/0026 Instituto de Salud Carlos III, Madrid, España.,IIS La Princesa, Madrid, España
| | - Pablo Rodríguez Del Río
- Allergy Derpartment, Hospital Infantil Universitario Niño Jesús, Madrid, España.,FibHNJ, ARADyAL-RETICs RD16/RD16/0006/0026 Instituto de Salud Carlos III, Madrid, España.,IIS La Princesa, Madrid, España
| | - Raphaëlle Bazire
- Allergy Derpartment, Hospital Infantil Universitario Niño Jesús, Madrid, España.,FibHNJ, ARADyAL-RETICs RD16/RD16/0006/0026 Instituto de Salud Carlos III, Madrid, España.,IIS La Princesa, Madrid, España.,Contrato Río Hortega CM20/00253, Instituto de Salud Carlos III, Fondo Social Europeo, Madrid, Spain
| | - Maria Dolores Ibáñez Sandín
- Allergy Derpartment, Hospital Infantil Universitario Niño Jesús, Madrid, España.,FibHNJ, ARADyAL-RETICs RD16/RD16/0006/0026 Instituto de Salud Carlos III, Madrid, España.,IIS La Princesa, Madrid, España
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16
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Qiu LJ, Yin KJ, Pan GX, Ni J, Wang B. Non-Causal Effects of Asthma on COVID-19 Susceptibility and Severity. Front Genet 2022; 12:762697. [PMID: 35082829 PMCID: PMC8784851 DOI: 10.3389/fgene.2021.762697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/08/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Asthma is observationally associated with an increased risk of COVID-19, but the causality remains unclear. We aim to determine whether there is a casual role of asthma in susceptibility to SARS-CoV-2 infection or COVID-19 severity. Methods: Instrumental variables (IVs) for asthma and moderate-to-severe asthma were obtained from publicly available summary statistics from the most recent and largest genome-wide association study (GWAS), including 394 283 and 57 695 participants of European ancestry, respectively. The corresponding data for COVID-19 susceptibility, hospitalization and severe-disease were derived from the COVID-19 Host Genetics Initiative GWAS meta-analysis of up to 1 683 768 individuals of European descent. Causality was inferred between correlated traits by Mendelian Randomization analyses. Inverse-variance weighted method was used as the primary MR estimates and multiple alternate approaches and several sensitivity analyses were also conducted. Results: Our MR analysis revealed no causal effects of asthma on COVID-19 susceptibility, hospitalization or severe disease, with odds ratio (OR) of 0.994 (95% CI: 0.962-1.027), 1.020 (95% CI: 0.955-1.089), and 0.929 (95% CI: 0.836-1.032), respectively. Furthermore, using genetic variants for moderate-to-severe asthma, a similar pattern of results was observed for COVID-19 susceptibility (OR: 0.988, 95% CI: 0.946-1.031), hospitalization (OR: 0.967, 95% CI: 0.906-1.031), and severe disease (OR: 0.911, 95% CI: 0.823-1.009). The association of asthma and moderate-to-severe asthma with COVID-19 was overall robust to sensitivity analyses. Conclusion: Genetically predicted asthma was not associated with susceptibility to, or severity of, COVID-19 disease, indicating that asthma is unlikely to be a causal factor in the development of COVID-19.
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Affiliation(s)
- Li-Juan Qiu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
- Medical Insurance Office, The Fourth Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Kang-Jia Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Gui-Xia Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
| | - Jing Ni
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
| | - Bin Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, China
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17
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Prevalence of COVID-19 in children affected by allergic rhinoconjunctivitis and asthma: results from the second "SIAIP rhinosinusitis and conjunctivitis committee" survey. Ital J Pediatr 2022; 48:1. [PMID: 34991654 PMCID: PMC8733922 DOI: 10.1186/s13052-021-01198-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 12/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The role of allergic sensitization seems to be protective against SARS CoV2 infection. The aim of this study was to evaluate, using online surveys, the impact of COVID-19 on Italian allergic children, comparing the prevalence of AR and asthma symptoms between the first and second pandemic wave. METHODS Both surveys were emailed to Italian pediatricians in April 2020 (first survey) and in March 2021 (second survey). The first one was related to the impact of COVID-19 and the most frequently reported symptoms. The second one was superimposed on the previous one, taking into account some additional aspects in the management of disease. RESULTS A total of 99 pediatricians participated in the first survey and 267 in the second one. The first survey showed that, asthma and allergic rhinoconjunctivitis prevalence was mostly between 0 and 20% throughout the country. The second survey showed a lower prevalence of both diseases nationwide in comparison to the first one. Comparing the two surveys, statistically significant differences were reported only in the distribution of asthma prevalence in Southern Italy while no differences were highlighted in the North and in the Center. Finally regarding allergic rhinoconjunctivitis prevalence, no differences were noticed nationwide. CONCLUSIONS Allergic rhinoconjunctivitis and asthma, if under control, did not represent risk factors for the susceptibility to SARS CoV2. Therefore, it is strongly recommended to continue therapies during COVID-19 outbreak, according to the international guidelines. However, being COVID-19 a new disease, actual knowledge will undergo continuous improvements over time.
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18
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Gatti E, Piotto M, Lelii M, Pensabene M, Madini B, Cerrato L, Hassan V, Aliberti S, Bosis S, Marchisio P, Patria MF. Therapeutic Strategies for COVID-19 Lung Disease in Children. Front Pediatr 2022; 10:829521. [PMID: 35321012 PMCID: PMC8936419 DOI: 10.3389/fped.2022.829521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/20/2022] [Indexed: 12/15/2022] Open
Abstract
The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has milder presentation in children than in adults, mostly requiring only supportive therapy. The immunopathogenic course of COVID-19 can be divided in two distinct but overlapping phases: the first triggered by the virus itself and the second one by the host immune response (cytokine storm). Respiratory failure or systemic involvement as Multisystem Inflammatory Syndrome in Children (MIS-C) requiring intensive care are described only in a small portion of infected children. Less severe lung injury in children could be explained by qualitative and quantitative differences in age-related immune response. Evidence on the best therapeutic approach for COVID-19 lung disease in children is lacking. Currently, the approach is mainly conservative and based on supportive therapy. However, in hospitalized children with critical illness and worsening lung function, antiviral therapy with remdesivir and immunomodulant treatment could be considered the "therapeutic pillars."
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Affiliation(s)
| | | | - Mara Lelii
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | | | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, Italy.,Respiratory Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Milan, Italy
| | - Samantha Bosis
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Marchisio
- Università Degli Studi di Milano, Milan, Italy.,Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
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19
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Zhang D, Zheng J. The Burden of Childhood Asthma by Age Group, 1990-2019: A Systematic Analysis of Global Burden of Disease 2019 Data. Front Pediatr 2022; 10:823399. [PMID: 35252064 PMCID: PMC8888872 DOI: 10.3389/fped.2022.823399] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 01/21/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Asthma is a common respiratory disease in children. We aimed to update information about the incidence and mortality and disability-adjusted life years (DALYs) of childhood asthma and provide evidence-based recommendations for childhood asthma prevention. METHODS Data were obtained from the Global Burden of Disease (GBD) study, which was conducted from 1990 to 2019 in 204 countries. First, we estimated incidence, mortality and DALY rates of childhood asthma using a Bayesian meta-regression model. Second, we analyzed the relationship between the sociodemographic index (SDI) and DALYs in different age groups. Third, we studied changes in trends of the age-standardized DALY rate between 1990 and 2019 based on age group, SDI, and risk factors. RESULTS Globally, the number of deaths due to childhood asthma and the incidence and DALY rates were 12.9 thousand (95% UI 10.6 to 15.7), 22 million (95% UI 15 to 31), and 5.1 million (95% UI 3.4 to 7.5) in 2019, decreasing by 65.1% (95% UI 47.6 to 72.4), 5.3% (95% UI 2.6 to 8.8) and 30% (95% UI 18 to 41) from those in 1990, respectively. With the exception of high-SDI regions, the age-standardized DALY rate in all age groups in all SDI regions declined. In 2019, the age-standardized DALY rate in 1- to 4-year-old individuals was highest in low-SDI regions and that of 5- to 19-year-old individuals was highest in high-SDI regions. In contrast to low-SDI regions, individuals in high-SDI regions had a higher risk of DALYs due to asthma, except in those aged 1 to 4 years. A high body mass index (BMI) was a stronger risk factor than occupational asthmagens for childhood asthma. CONCLUSION Our findings provide insight into asthma prevention and treatment through the identification of key factors related to childhood asthma. Based on the data available, different risk factors according to age group and region/country suggest different prevention strategies, which is key for preventing childhood asthma.
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Affiliation(s)
- Daoqi Zhang
- Department of Internal Medicine Teaching and Research Section, Xuancheng Vocational and Technical College, Xuancheng, China
| | - Jinxin Zheng
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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20
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Alvaro‐Lozano M, Sandoval‐Ruballos M, Giovannini M, Jensen‐Jarolim E, Sahiner U, Tomic Spiric V, Quecchia C, Chaker A, Heffler E, Klimek L, Brough H, Sturm G, Untersmayr E, Bonini M, Pfaar O. Allergic patients during the COVID-19 pandemic-Clinical practical considerations: An European Academy of Allergy and Clinical Immunology survey. Clin Transl Allergy 2022; 12:e12097. [PMID: 35070270 PMCID: PMC8762981 DOI: 10.1002/clt2.12097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 12/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has affected health care systems unexpectedly. However, data focusing on practical considerations experienced by health care professionals (HCPs) providing care to allergic patients is scarce. METHODS Under the framework of the European Academy of Allergy and Clinical Immunology (EAACI), a panel of experts in the field of immunotherapy developed a 42-question online survey, to evaluate real-life consequences of the COVID-19 pandemic in allergy practice. RESULTS The respondents in the survey were 618. About 80% of HCPs indicated being significantly affected in their allergy practice. A face-to-face visit reduction was reported by 93% of HCPs and about a quarter completely interrupted diagnostic challenges. Patients with severe uncontrolled asthma (59%) and anaphylaxis (47%) were prioritized for in-person care. About 81% maintained an unaltered prescription of inhaled corticosteroids (ICS) in asthmatics. About 90% did not modify intranasal corticosteroids (INCS) in patients with allergic rhinitis. Nearly half of respondents kept biological prescriptions unmodified for asthma. About 50% of respondents kept their allergen immunotherapy (AIT) prescription patterns unchanged for respiratory allergies; 60% for insect venom allergies. Oral immunotherapy (OIT) for food allergies was initiated by 27%. About 20% kept carrying out up-dosing without modifications and 14% changed to more prolonged intervals. Telemedicine practice was increased. CONCLUSIONS HCPs providing care to allergic patients were affected during the pandemic in diagnostic, management, and therapeutic approaches, including AIT for respiratory, insect-venom, and food allergies. Most HCPs maintained controller treatments for both asthma, and allergic rhinitis consistent with international recommendations, as well as biological agents in asthma. Remote tools are valuable in delivering allergy care.
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Affiliation(s)
- Montserrat Alvaro‐Lozano
- Pediatric Allergology and Clinical ImmunologyHospital Sant Joan de DéuBarcelonaSpain
- Childhood and Adolescence Allergic Illness GroupInstitut de Recerca Sant Joan de DéuBarcelonaSpain
- Facultat de Medicina i Ciències de la SalutUniversitat de BarcelonaBarcelonaSpain
| | - Mónica Sandoval‐Ruballos
- Pediatric Allergology and Clinical ImmunologyHospital Sant Joan de DéuBarcelonaSpain
- Childhood and Adolescence Allergic Illness GroupInstitut de Recerca Sant Joan de DéuBarcelonaSpain
| | - Mattia Giovannini
- Allergy UnitDepartment of PediatricsMeyer Children's University HospitalFlorenceItaly
| | - Erika Jensen‐Jarolim
- Institute of Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University ViennaViennaAustria
- The Interuniversity Messerli Research Institute, Medical University Vienna, Veterinary University Vienna, and University ViennaViennaAustria
| | - Umit Sahiner
- Department of Pediatric Allergy and AsthmaHacettepe University School of MedicineAnkaraTurkey
| | - Vesna Tomic Spiric
- Faculty of MedicineUniversity of BelgradeBelgradeSerbia
- Clinic of Allergology and ImmunologyClinical Centre of SerbiaBelgradeSerbia
| | - Cristina Quecchia
- “Io e l’Asma” CenterChildren's HospitalASST Spedali CiviliBresciaItaly
| | - Adam Chaker
- Department of Otolaryngology and Center of Allergy and EnvironmentTUM School of MedicineTechnical University of MunichMunichGermany
| | - Enrico Heffler
- Personalized Medicine, Asthma and AllergyHumanitas Clinical and Research Hospital IRCCSRozzanoItaly
- Department of Biomedical SciencesHumanitas UniversityMilanItaly
| | - Ludger Klimek
- Center for Rhinology and AllergologyWiesbadenGermany
| | - Helen Brough
- Children's Allergy ServiceEvelina Children's HospitalGuy's and St. Thomas' HospitalLondonUK
- Paediatric Allergy GroupDepartment of Women and Children's HealthSchool of Life Course SciencesKing's College LondonLondonUK
| | - Gunter Sturm
- Department of Dermatology and VenerologyMedical University of GrazGrazAustria
- Allergy Outpatient Clinic ReummanplatzViennaAustria
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy ResearchCenter for Pathophysiology, Infectiology and ImmunologyMedical University ViennaViennaAustria
| | - Mateo Bonini
- Department of Cardiovascular and Thoracic SciencesFondazione Policlinico Universitario A. Gemelli – IRCCSUniversità Cattolica del Sacro CuoreRomeItaly
- National Heart and Lung Institute (NHLI)Imperial College LondonLondonUK
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity Hospital MarburgPhilipps‐Universität MarburgMarburgGermany
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21
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Gao YD, Agache I, Akdis M, Nadeau K, Klimek L, Jutel M, Akdis CA. The effect of allergy and asthma as a comorbidity on the susceptibility and outcomes of COVID-19. Int Immunol 2021; 34:177-188. [PMID: 34788827 PMCID: PMC8689956 DOI: 10.1093/intimm/dxab107] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/10/2021] [Indexed: 12/12/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic causes an overwhelming number of hospitalization and deaths with a significant socioeconomic impact. The vast majority of studies indicate that asthma and allergic diseases do not represent a risk factor for COVID-19 susceptibility nor cause a more severe course of disease. This raises the opportunity to investigate the underlying mechanisms of the interaction between an allergic background and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The majority of patients with asthma, atopic dermatitis, allergic rhinitis, chronic rhinosinusitis, food allergies and drug allergies exhibit an over-expression of type 2 immune and inflammatory pathways with the contribution of epithelial cells, innate lymphoid cells, dendritic cells, T cells, eosinophils, mast cells, basophils, and the type 2 cytokines interleukin (IL)-4, IL-5, IL-9, IL-13, and IL-31. The potential impact of type 2 inflammation-related allergic diseases on susceptibility to COVID-19 and severity of its course have been reported. In this review, the prevalence of asthma and other common allergic diseases in COVID-19 patients is addressed. Moreover, the impact of allergic and non-allergic asthma with different severity and control status, currently available asthma treatments such as inhaled and oral corticosteroids, short- and long-acting β2 agonists, leukotriene receptor antagonists and biologicals on the outcome of COVID-19 patients is reviewed. In addition, possible protective mechanisms of asthma and type 2 inflammation on COVID-19 infection, such as the expression of SARS-CoV-2 entry receptors, antiviral activity of eosinophils and cross-reactive T-cell epitopes, are discussed. Potential interactions of other allergic diseases with COVID-19 are postulated, including recommendations for their management.
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Affiliation(s)
- Ya-Dong Gao
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.,Hubei Province Key Laboratory of Allergy and Immunology, Wuhan University, Wuhan, Hubei, China
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Herman-Burchard Strasse, Davos, Switzerland
| | - Kari Nadeau
- Sean N. Parker Center for Allergy and Asthma Research, Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Ludger Klimek
- Center for Rhinology and Allergology, An den Quellen, Wiesbaden, Germany
| | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University.,All-MED Medical Research Institute, Wrocław, Poland
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Herman-Burchard Strasse, Davos, Switzerland
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22
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Eigenmann P. Comments on metabolomics in asthma and atopic dermatitis, and patient care during the COVID-19 pandemic. Pediatr Allergy Immunol 2021; 32:1597-1600. [PMID: 34719820 PMCID: PMC8646783 DOI: 10.1111/pai.13664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Philippe Eigenmann
- Department of Pediatrics, Gynecology and Obstetrics, University Hospital of Geneva, Geneva, Switzerland
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23
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Shen K, Hong J, El Beleidy A, Furman E, Liu H, Yin Y, Cano-Salas MDC, AlJassim FM, Al-Shammari N, Lochindarat S, Dieu Thuy NT. International expert opinion on the use of nebulization for pediatric asthma therapy during the COVID-19 pandemic. J Thorac Dis 2021; 13:3934-3947. [PMID: 34422324 PMCID: PMC8339766 DOI: 10.21037/jtd-21-841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/16/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Kunling Shen
- China National Clinical Research Center for Respiratory Diseases, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jianguo Hong
- Department of Pediatrics, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Ahmed El Beleidy
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Evgeny Furman
- Department of Pediatrics, E. A. Vagner Perm State Medical University, Perm, Russia
| | - Hanmin Liu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yong Yin
- Department of Respiratory, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Fatma Mohammed AlJassim
- Pediatric Pulmonology Section, Dubai Health Authority, Latifa Women and Children Hospital, Dubai, UAE
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24
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Angiotensin-Converting Enzyme 2 (ACE2) as a Potential Diagnostic and Prognostic Biomarker for Chronic Inflammatory Lung Diseases. Genes (Basel) 2021; 12:genes12071054. [PMID: 34356070 PMCID: PMC8306334 DOI: 10.3390/genes12071054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/30/2021] [Accepted: 07/07/2021] [Indexed: 01/08/2023] Open
Abstract
Chronic inflammatory lung diseases are characterized by uncontrolled immune response in the airways as their main pathophysiological manifestation. The lack of specific diagnostic and therapeutic biomarkers for many pulmonary diseases represents a major challenge for pulmonologists. The majority of the currently approved therapeutic approaches are focused on achieving disease remission, although there is no guarantee of complete recovery. It is known that angiotensin-converting enzyme 2 (ACE2), an important counter-regulatory component of the renin–angiotensin–aldosterone system (RAAS), is expressed in the airways. It has been shown that ACE2 plays a role in systemic regulation of the cardiovascular and renal systems, lungs and liver by acting on blood pressure, electrolyte balance control mechanisms and inflammation. Its protective role in the lungs has also been presented, but the exact pathophysiological mechanism of action is still elusive. The aim of this study is to review and discuss recent findings about ACE2, including its potential role in the pathophysiology of chronic inflammatory lung diseases:, i.e., chronic obstructive pulmonary disease, asthma, and pulmonary hypertension. Additionally, in the light of the coronavirus 2019 disease (COVID-19), we will discuss the role of ACE2 in the pathophysiology of this disease, mainly represented by different grades of pulmonary problems. We believe that these insights will open up new perspectives for the future use of ACE2 as a potential biomarker for early diagnosis and monitoring of chronic inflammatory lung diseases.
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25
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Ravindra K, Goyal A, Mor S. Does airborne pollen influence COVID-19 outbreak? SUSTAINABLE CITIES AND SOCIETY 2021; 70:102887. [PMID: 33816082 PMCID: PMC7999829 DOI: 10.1016/j.scs.2021.102887] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/04/2021] [Accepted: 03/23/2021] [Indexed: 05/09/2023]
Abstract
The fast spread of SARS-CoV-2 presented a worldwide challenge to public health, economy, and educational system, affecting wellbeing of human society. With high transmission rates, there are increasing evidences of COVID-19 spread via bioaerosols from an infected person. The current review was conducted to examine airborne pollen impact on COVID-19 transmission and to identify the major gaps for post-pandemic research. The study used all key terms to identify revenant literature and observation were collated for the current research. Based on existing literature, there is a potential association between pollen bioaerosols and COVID-19. There are few studies focusing the impact of airborne pollen on SARS-CoV-2, which could be useful to advance future research. Allergic rhinitis and asthma patients were found to have pre-modified immune activation, which could help to provide protection against COVID-19. However, does airborne pollen acts as a potent carrier for SARS-CoV-2 transport, dispersal and its proliferation still require multidisciplinary research. Further, a clear conclusion cannot be drawn due to limited evidence and hence more research is needed to show how pollen bioaerosols could affect virus survivals. The small but growing literature review focuses on searching for every possible answer to provide additional security layers to overcome near future corona-like infectious diseases.
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Key Words
- AAAAI, American Academy of Allergy, Asthma & Immunology
- ACE-2, angiotensin-converting enzyme 2
- ARDS, acute respiratory distress syndrome
- Airborne pollen
- Allergic rhinitis
- Asthma
- Bioaerosols
- CCDC, Chinese Centre for Disease Control and Prevention
- CDC, Centers for Disease Control and Prevention
- CESM, Community Earth System Model
- CMAQ, Community Multiscale Air Quality
- COPD, chronic obstructive pulmonary diseases
- COVID-19
- ERS, European Respiratory Society
- FLI, flu-like illnesses
- GINA, Global Initiative for Asthma
- H1N1, Influenza A virus subtype H1N1
- H5N1, avian influenza virus
- IgE, Immunoglobulin E
- LDT, long-distance transport
- MERS, Middle East respiratory syndrome
- NHC, National Health Commission
- RSV, Respiratory Syncytial Virus infection
- SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus-2
- STaMPS, Simulator of Timing and Magnitude of Pollen Season
- Virus
- WAO, World Allergy Organisation
- WHO, World Health Organization
- WRF, Weather Research Forecasting
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Affiliation(s)
- Khaiwal Ravindra
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Akshi Goyal
- Department of Environment Studies, Panjab University, Chandigarh, 160014, India
| | - Suman Mor
- Department of Environment Studies, Panjab University, Chandigarh, 160014, India
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26
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Lin NY, Roach DJ, Willmering MM, Walkup LL, Hossain MM, Desirazu P, Cleveland ZI, Guilbert TW, Woods JC. 129Xe MRI as a measure of clinical disease severity for pediatric asthma. J Allergy Clin Immunol 2021; 147:2146-2153.e1. [PMID: 33227317 DOI: 10.1016/j.jaci.2020.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Measurement of regional lung ventilation with hyperpolarized 129Xe magnetic resonance imaging (129Xe MRI) in pediatric asthma is poised to advance our understanding of disease mechanisms and pathophysiology in a disorder with diverse clinical phenotypes. 129Xe MRI has not been investigated in a pediatric asthma cohort. OBJECTIVE We hypothesized that 129Xe MRI is feasible and can demonstrate ventilation defects that relate to and predict clinical severity in a pediatric asthma cohort. METHODS Thirty-seven children (13 with severe asthma, 8 with mild/moderate asthma, 16 age-matched healthy controls) aged 6 to 17 years old were imaged with 129Xe MRI. Ventilation defect percentage (VDP) and image reader score were calculated and compared with clinical measures at baseline and at follow-up. RESULTS Children with asthma had higher VDP (P = .002) and number of defects per image slice (defects/slice) (P = .0001) than children without asthma. Children with clinically severe asthma had significantly higher VDP and number of defects/slice than healthy controls. Children with asthma who had a higher number of defects/slice had a higher rate of health care utilization (r = 0.48; P = .03) and oral corticosteroid use (r = 0.43; P = .05) at baseline. Receiver-operating characteristic analysis demonstrated that the VDP and number of defects/slice were predictive of increased health care utilization, asthma, and severe asthma. VDP correlated with FEV1 (r = -0.35; P = .04) and FEV1/forced vital capacity ratio (r = -0.41; P = .01). CONCLUSIONS 129Xe MRI correlates with asthma severity, health care utilization, and oral corticosteroid use. Because delineation of clinical severity is often difficult in children, 129Xe MRI may be an important biomarker for severity, with potential to identify children at higher risk for exacerbations and improve outcomes.
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Affiliation(s)
- Nancy Y Lin
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David J Roach
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Matthew M Willmering
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Laura L Walkup
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio; Department of Biomedical Engineering, University of Cincinnati College of Engineering and Applied Science, Cincinnati, Ohio
| | - Md Monir Hossain
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio; Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Priyanka Desirazu
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Zackary I Cleveland
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio; Department of Biomedical Engineering, University of Cincinnati College of Engineering and Applied Science, Cincinnati, Ohio
| | - Theresa W Guilbert
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | - Jason C Woods
- Center for Pulmonary Imaging Research, Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio.
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27
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Updates on Children with Allergic Rhinitis and Asthma during the COVID-19 Outbreak. J Clin Med 2021; 10:jcm10112278. [PMID: 34073986 PMCID: PMC8197398 DOI: 10.3390/jcm10112278] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND During the lockdown period caused by the SARS-CoV-2 pandemic, we monitored via online survey the trend of allergic symptoms and the therapeutic compliance in patients followed at our center. MATERIAL AND METHODS In June 2020, we selected children followed at the Allergy and Immunology Service of Umberto I Hospital, aged between 6 and 16 years old, diagnosed with asthma and/or rhinitis and sensitized to grass pollen or dust mite. We sent an email with 12 multiple-choice questions investigating several areas: type of disease and sensitization, recurrence of symptoms, medication use during lockdown compared to the same period of the previous year. RESULTS The results of 82 questionnaires showed that 17.8% of patients suffered from asthma, 24.4% from rhinitis, and 57.8% from both. Within the group of asthmatic children, most of them presented an improvement of their symptoms. Likewise, with regard to allergic rhinitis, most of them reported better clinical conditions. Regarding treatment, we observed a global decrease in the use of on-demand therapies (salbutamol, nasal corticosteroid, and antihistamine) for both pathologies. In addition, there was a reduction in the use of basal therapy for asthma and rhinitis from 2019 (23.3%) to 2020 (15.5%). CONCLUSIONS Our data show a general trend of clinical improvement and a reduction in the use of on-demand and basal therapy in allergic children during the lockdown.
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28
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Aizawa Y, Katsuta T, Sakiyama H, Tanaka-Taya K, Moriuchi H, Saitoh A. Changes in childhood vaccination during the coronavirus disease 2019 pandemic in Japan. Vaccine 2021; 39:4006-4012. [PMID: 34059371 PMCID: PMC8139263 DOI: 10.1016/j.vaccine.2021.05.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 12/17/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has greatly affected daily life. COVID-19 often causes asymptomatic or mild disease in children; however, delayed routine childhood immunization is a concern, as it could increase the risk of vaccine-preventable disease. No study has evaluated the status of childhood vaccinations in Japan during the COVID-19 pandemic. Methods This retrospective observational study evaluated the number of vaccine doses administered to children in 4 Japanese cities (2 cities in the Tokyo metropolitan area and 2 cities far from Tokyo) during the period from 2016 to 2020. Vaccine doses administered between January and September 2020 during the COVID-19 pandemic were compared, by month, with those given during 2016–2019. Age-stratified demographic data were collected to determine whether factors other than change in the child population over time affected vaccination trends. Results In all cities the decrease in vaccine doses administered was most apparent in March and April 2020, i.e., just before or coincident with the declaration of a nationwide COVID-19 emergency on April 7, 2020. The decrease started as early as February in the Tokyo metropolitan area. As child age increased, the decrease became more apparent. Before the lift of national emergency on May 25, catch-up of the vaccination was observed in all age groups in all cities. Vaccine doses persistently increased in older age groups but not in infants. The overall vaccination trends did not differ significantly among the 4 cities. Conclusions The COVID-19 pandemic significantly affected routine childhood immunization in Japan. Thus, a nationwide electronic surveillance system and announcements for guardians to encourage timely routine immunization are warranted.
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Affiliation(s)
- Yuta Aizawa
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; The Committee on Immunization, Medical Association of Niigata City, Niigata, Japan
| | - Tomohiro Katsuta
- Department of Pediatrics, St. Marianna University School of Medicine, Kanagawa, Japan; The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan
| | - Hiroshi Sakiyama
- Department of Pediatrics, Sakiyama Children's Clinic, Tokyo, Japan
| | - Keiko Tanaka-Taya
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan; The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan
| | - Hiroyuki Moriuchi
- Department of Pediatrics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan
| | - Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; The Committee on Immunization and Infectious Diseases, Japan Pediatric Society, Japan.
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29
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Mardani M, Hakamifard A. COVID-19 and immunocompromised conditions: Ongoing challenging issue. EUR J INFLAMM 2021. [DOI: 10.1177/20587392211016114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
One of the most serious complications of COVID-19 is the development of uncontrolled production of cytokines that poses a major factor contributing to COVID-19 morbidity and mortality. The exact effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on clinical and biochemical course of in patients with underlying immune compromised conditions is not well known with recent available data. The present letter aimed to draw attention to COVID-19 in immune deficiency.
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Affiliation(s)
- Masoud Mardani
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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30
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Eigenmann P. Comments on nitric oxide in children with asthma, low-dose oral immunotherapy for cow's milk allergy, and SARS-Cov-2 testing in school children. Pediatr Allergy Immunol 2021; 32:631-634. [PMID: 33932041 PMCID: PMC8207058 DOI: 10.1111/pai.13499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Philippe Eigenmann
- Department of Women-Children-Teenagers, University Hospital of Geneva, Geneva, Switzerland
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31
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Marko M, Pawliczak R. Can we safely use systemic treatment in atopic dermatitis during the COVID-19 pandemic? Overview of selected conventional and biologic systemic therapies. Expert Rev Clin Immunol 2021; 17:619-627. [PMID: 33866905 DOI: 10.1080/1744666x.2021.1919511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Introduction: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, the medical community has faced major challenges that affect disease management in all areas. Dermatologists and immunologists have to choose appropriate treatment strategy taking into consideration the risk of infection and possible exacerbation of the course of the disease in patients with confirmed infection. Management of atopic dermatitis (AD) in moderate to severe cases is based on systemic therapy such as cyclosporine, azathioprine, methotrexate and dupilumab.Areas covered: A literature search in PubMed database was performed until 6 March 2021. In this review, the authors discuss non-biologic and biologic systemic medications for AD and provide an overview of therapeutic recommendations during COVID-19 pandemic.Expert opinion: In case of an active COVID-19 infection, conventional systemic treatment and biological treatment needs to be stopped until clinical recovery. Noninfected patients with systemic treatment of AD should continue their therapy via self-application. The authors can conclude that understanding of dupilumab therapy is better recognized in context AD treatment during COVID-19 pandemic in comparison to cyclosporine, azathioprine and methotrexate. However, this systemic immunosuppressants still require further investigation and literature complementation.
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Affiliation(s)
- Monika Marko
- Department of Immunopathology, Faculty of Medicine, Division of Biomedical Science, Medical University of Lodz, Lodz, Poland
| | - Rafał Pawliczak
- Department of Immunopathology, Faculty of Medicine, Division of Biomedical Science, Medical University of Lodz, Lodz, Poland
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Wu T, Yu P, Li Y, Wang J, Li Z, Qiu J, Cui L, Mou Y, Sun Y. Asthma does not influence the severity of COVID-19: a meta-analysis. J Asthma 2021; 59:1188-1194. [PMID: 33863266 PMCID: PMC8074647 DOI: 10.1080/02770903.2021.1917603] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Previous studies have reported a correlation between coronavirus disease-2019 (COVID-19) and asthma. However, data on whether asthma constitutes a risk factor for COVID-19 and the prevalence of asthma in COVID-19 cases still remain scant. Here, we interrogated and analyzed the association between COVID-19 and asthma. METHODS In this study, we systematically searched PubMed, Embase, and Web of Science databases for studies published between January 1 and August 28, 2020. We included studies that reported the epidemiological and clinical features of COVID-19 and its prevalence in asthma patients. We excluded reviews, animal trials, single case reports, small case series and studies evaluating other coronavirus-related illnesses. Raw data from the studies were pooled into a meta-analysis. RESULTS We analyzed findings from 18 studies, including asthma patients with COVID-19. The pooled prevalence of asthma in COVID-19 cases was 0.08 (95% CI, 0.06-0.11), with an overall I2 of 99.07%, p < 0.005. The data indicated that asthma did not increase the risk of developing severe COVID-19 (odds ratio [OR] 1.04 (95% CI, 0.75-1.46) p = 0.28; I2=20%). In addition, there was no significant difference in the incidence of asthma with age in COVID-19 infections [OR] 0.77(95% CI, 0.59-1.00) p = 0.24; I2=29%). CONCLUSION Taken together, our data suggested that asthma is not a significant risk factor for the development of severe COVID-19.
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Affiliation(s)
- Ting Wu
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Pengyi Yu
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Yuanxia Li
- Department of Otolaryngology, The People's Hospital of Zhaoyuan City, Yantai, Shandong, China
| | - Junxin Wang
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China.,Weifang Medical University, Weifang, Shandong, China
| | - Zhen Li
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China.,Binzhou Medical University, Yantai, Shandong, China
| | - Jingjing Qiu
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Limei Cui
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Yakui Mou
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Yan Sun
- Department of Otorhinolaryngology Head and Neck Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
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Eigenmann P. Comments on vitamin D in asthma, milk allergy diagnosis, and stem cell transplantation in chronic granulomatous disease. Pediatr Allergy Immunol 2021; 32:401-404. [PMID: 33792989 DOI: 10.1111/pai.13468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Philippe Eigenmann
- Department of Women-Children-Teenagers, University Hospital of Geneva, Geneva, Switzerland
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Fung M, Otani I, Pham M, Babik J. Zoonotic coronavirus epidemics: Severe acute respiratory syndrome, Middle East respiratory syndrome, and coronavirus disease 2019. Ann Allergy Asthma Immunol 2021; 126:321-337. [PMID: 33310180 PMCID: PMC7834857 DOI: 10.1016/j.anai.2020.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To review the virology, immunology, epidemiology, clinical manifestations, and treatment of the following 3 major zoonotic coronavirus epidemics: severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and coronavirus disease 2019 (COVID-19). DATA SOURCES Published literature obtained through PubMed database searches and reports from national and international public health agencies. STUDY SELECTIONS Studies relevant to the basic science, epidemiology, clinical characteristics, and treatment of SARS, MERS, and COVID-19, with a focus on patients with asthma, allergy, and primary immunodeficiency. RESULTS Although SARS and MERS each caused less than a thousand deaths, COVID-19 has caused a worldwide pandemic with nearly 1 million deaths. Diagnosing COVID-19 relies on nucleic acid amplification tests, and infection has broad clinical manifestations that can affect almost every organ system. Asthma and atopy do not seem to predispose patients to COVID-19 infection, but their effects on COVID-19 clinical outcomes remain mixed and inconclusive. It is recommended that effective therapies, including inhaled corticosteroids and biologic therapy, be continued to maintain disease control. There are no reports of COVID-19 among patients with primary innate and T-cell deficiencies. The presentation of COVID-19 among patients with primary antibody deficiencies is variable, with some experiencing mild clinical courses, whereas others experiencing a fatal disease. The landscape of treatment for COVID-19 is rapidly evolving, with both antivirals and immunomodulators demonstrating efficacy. CONCLUSION Further data are needed to better understand the role of asthma, allergy, and primary immunodeficiency on COVID-19 infection and outcomes.
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Affiliation(s)
- Monica Fung
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco, San Francisco, California.
| | - Iris Otani
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Michele Pham
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Jennifer Babik
- Division of Infectious Diseases, Department of Medicine, University of California San Francisco, San Francisco, California
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Mustafa SS, Shaker MS, Munblit D, Greenhawt M. Paediatric allergy practice in the era of coronavirus disease 2019. Curr Opin Allergy Clin Immunol 2021; 21:159-165. [PMID: 33534416 DOI: 10.1097/aci.0000000000000727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW To summarize the impact of the COVID-19 pandemic on the practice of paediatric allergy. RECENT FINDINGS Given significant overlap in symptoms, care must be taken to differentiate routine allergic conditions from COVID-19 infection but it appears that most allergic diseases are not risk factors for a severe COVID-19 course. The full impact of restricted allergy/immunology ambulatory services will take months to years to fully understand. One benefit of having to adapt practice style is greater awareness and acceptance of shared decision-making and recognition of preference-sensitive care options in food allergy, in particular for approaches towards allergy prevention, treatment, and anaphylaxis care. Social distancing and masks have helped reduce spread of common respiratory viruses, which may be helping to lower the incidence of viral-associated wheezing episodes, enhancing evidence of the effects of preventing exposure of young children to respiratory viruses on asthma pathogenesis, as well as on allergic rhinitis. There has been a revolution in the rise of telemedicine to increase access to high-quality allergy/immunology specialty care. SUMMARY Although the field has adapted to remain operational in the face of a significant challenge, it is important to apply lessons learned to evolve patient care and optimize treatment in the aftermath of the pandemic.
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Affiliation(s)
- S Shahzad Mustafa
- Department of Allergy, Immunology, & Rheumatology, Rochester Regional Health, University of Rochester School of Medicine and Dentistry
| | - Marcus S Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Daniel Munblit
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
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School Attendance, Asthma Risk, and COVID-19 in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2145-2150. [PMID: 33744475 PMCID: PMC8770849 DOI: 10.1016/j.jaip.2021.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 12/11/2022]
Abstract
In the face of tremendous uncertainty during the current pandemic, there is a need for clear and consistent recommendations and an understanding of the evidence in general, and for families of children with allergic conditions. A common concern of parents of children with asthma is the risk that in-person learning poses during the pandemic. This Rostrum examines the actual risk of in-person learning among children with asthma during novel coronavirus disease 2019 (COVID-19), the discrepancy between perceived and actual risk, the contributing factors to this discrepancy, and possible solutions to narrow this divide. Overall, the evidence does not support that children with asthma are at an increased risk of COVID-19 morbidity or mortality compared with children without asthma. Asthma medications do not appear to contribute to incidence or severity of COVID-19 disease. However, there is a high perceived risk of in-person learning that is partially related to how it is portrayed in the media. There is little guidance regarding transitioning asthmatic children back to school and how to properly counsel on mediation of risk. There are differences regionally and locally around school reopening, exemptions, and their implementation. To narrow the divide between perceived and actual risk, clear consistent and ongoing communication will be necessary.
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Pfaar O, Torres MJ, Akdis CA. COVID-19: A series of important recent clinical and laboratory reports in immunology and pathogenesis of SARS-CoV-2 infection and care of allergy patients. Allergy 2021; 76:622-625. [PMID: 32589296 PMCID: PMC7361446 DOI: 10.1111/all.14472] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Maria J. Torres
- Allergy Clinical Unit Hospital Regional Universitario de Málaga‐UMA‐ARADyAL Málaga Spain
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
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Shah AC, Badawy SM. Telemedicine in Pediatrics: Systematic Review of Randomized Controlled Trials. JMIR Pediatr Parent 2021; 4:e22696. [PMID: 33556030 PMCID: PMC8078694 DOI: 10.2196/22696] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/07/2021] [Accepted: 02/01/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Telemedicine modalities, such as videoconferencing, are used by health care providers to remotely deliver health care to patients. Telemedicine use in pediatrics has increased in recent years. This has resulted in improved health care access, optimized disease management, progress in the monitoring of health conditions, and fewer exposures to patients with illnesses during pandemics (eg, the COVID-19 pandemic). OBJECTIVE We aimed to systematically evaluate the most recent evidence on the feasibility and accessibility of telemedicine services, patients' and care providers' satisfaction with these services, and treatment outcomes related to telemedicine service use among pediatric populations with different health conditions. METHODS Studies were obtained from the PubMed database on May 10, 2020. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In this review, we included randomized controlled trials from the last 10 years that used a telemedicine approach as a study intervention or assessed telemedicine as a subspecialty of pediatric care. Titles and abstracts were independently screened based on the eligibility criteria. Afterward, full texts were retrieved and independently screened based on the eligibility criteria. A standardized form was used to extract the following data: publication title, first author's name, publication year, participants' characteristics, study design, the technology-based approach that was used, intervention characteristics, study goals, and study findings. RESULTS In total, 11 articles met the inclusion criteria and were included in this review. All studies were categorized as randomized controlled trials (8/11, 73%) or cluster randomized trials (3/11, 27%). The number of participants in each study ranged from 22 to 400. The health conditions that were assessed included obesity (3/11, 27%), asthma (2/11, 18%), mental health conditions (1/11, 9%), otitis media (1/11, 9%), skin conditions (1/11, 9%), type 1 diabetes (1/11, 9%), attention deficit hyperactivity disorder (1/11, 9%), and cystic fibrosis-related pancreatic insufficiency (1/11). The telemedicine approaches that were used included patient and doctor videoconferencing visits (5/11, 45%), smartphone-based interventions (3/11, 27%), telephone counseling (2/11, 18%), and telemedicine-based screening visits (1/11, 9%). The telemedicine interventions in all included studies resulted in outcomes that were comparable to or better than the outcomes of control groups. These outcomes were related to symptom management, quality of life, satisfaction, medication adherence, visit completion rates, and disease progression. CONCLUSIONS Although more research is needed, the evidence from this review suggests that telemedicine services for the general public and pediatric care are comparable to or better than in-person services. Patients, health care professionals, and caregivers may benefit from using both telemedicine services and traditional, in-person health care services. To maximize the potential of telemedicine, future research should focus on improving patients' access to care, increasing the cost-effectiveness of telemedicine services, and eliminating barriers to telemedicine use.
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Affiliation(s)
- Aashaka C Shah
- University of Illinois College of Medicine, Chicago, IL, United States
| | - Sherif M Badawy
- Division of Hematology, Oncology, Neuro-Oncology and Stem Cell Transplant, Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Eigenmann P. Risk factors for bronchiolitis and asthma, and COVID-19 symptoms in young children. Pediatr Allergy Immunol 2021; 32:215-218. [PMID: 33522012 PMCID: PMC8014648 DOI: 10.1111/pai.13436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/04/2022]
Affiliation(s)
- Philippe Eigenmann
- Department of Women-Children-Teenagers, University Hospital of Geneva, Geneva, Switzerland
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40
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Cardenas MC, Bustos SS, Enninga EAL, Mofenson L, Chakraborty R. Characterising and managing paediatric SARSCoV-2 infection: Learning about the virus in a global classroom. Acta Paediatr 2021; 110:409-422. [PMID: 33175403 DOI: 10.1111/apa.15662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/26/2020] [Accepted: 11/06/2020] [Indexed: 01/08/2023]
Abstract
AIM This study is a comprehensive review with the purpose of collecting the most relevant data in several sections including current treatment guidelines in the paediatric population. METHODS Literature was systematically searched in different databases. Results were limited to 2019+ and English, French and Spanish language. RESULTS Children can exhibit mild and less severe COVID-19 disease than adults and also have asymptomatic carriage of SARS-CoV-2, while severe disease is more frequently noted during infancy (<1 year). SARS-CoV-2 binds the angiotensin-converting enzyme 2 (ACE-2) receptor; age-, racial-, and gender-specific differences in ACE-2 expression need to be elucidated in order to explain the differential clinical profiles between children and adults. Multisystem inflammatory syndrome in children (MIS-C) is an important condition to recognise in children. The decision to use antiviral or immunomodulatory therapy in a child or adolescent should be individualised based on the clinical scenario. Remdesivir is the only FDA-approved therapy available for children older than 12 years old who require hospitalisation for COVID-19. CONCLUSION Further studies are urgently required to address prevention and treatment in at-risk and infected children, especially with underlying comorbidities. The chapter on the overall impact of COVID-19 in children has not yet been written. Nevertheless, SARS-CoV-2 has now joined a long list of human pandemics, which may forever change the world's history.
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Affiliation(s)
- Maria C. Cardenas
- Division of Pediatric Infectious Diseases Department of Mayo Clinic Rochester Minnesota USA
| | - Samyd S. Bustos
- Department of Surgery Mayo Clinic Rochester Minnesota USA
- Center for Regenerative Medicine Mayo Clinic Rochester Minnesota USA
| | | | - Lynne Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation Washington District of Columbia USA
| | - Rana Chakraborty
- Division of Pediatric Infectious Diseases Department of Mayo Clinic Rochester Minnesota USA
- Department of Obstetrics and Gynecology Mayo Clinic Rochester Minnesota USA
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Boechat JL, Wandalsen GF, Kuschnir FC, Delgado L. COVID-19 and Pediatric Asthma: Clinical and Management Challenges. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031093. [PMID: 33530624 PMCID: PMC7908623 DOI: 10.3390/ijerph18031093] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/15/2021] [Accepted: 01/23/2021] [Indexed: 12/15/2022]
Abstract
Asthma is the most frequent chronic condition in childhood and a current concern exists about asthma in the pediatric population and its risk for severe SARS-CoV-2 infection. Although all ages can be affected, SARS-CoV-2 infection has lower clinical impact on children and adolescents than on adults. Fever, cough and shortness of breath are the most common symptoms and signs in children; wheezing has not been frequently reported. Published studies suggest that children with asthma do not appear to be disproportionately more affected by COVID-19. This hypothesis raises two issues: is asthma (and/or atopy) an independent protective factor for COVID-19? If yes, why? Explanations for this could include the lower IFN-α production, protective role of eosinophils in the airway, and antiviral and immunomodulatory proprieties of inhaled steroids. Additionally, recent evidence supports that allergic sensitization is inversely related to ACE2 expression. Obesity is a known risk factor for COVID-19 in adults. However, in the childhood asthma–obesity phenotype, the classic atopic Th2 pattern seems to predominate, which could hypothetically be a protective factor for severe SARS-CoV-2 infection in children with both conditions. Finally, the return to school activities raises concerns, as asymptomatic children could act as vectors for the spread of the disease. Although this is still a controversial topic, the identification and management of asymptomatic children is an important approach during the SARS-CoV-2 epidemic. Focus on asthma control, risk stratification, and medication adherence will be essential to allow children with asthma to return safely to school.
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Affiliation(s)
- José Laerte Boechat
- Clinical Immunology Service, Internal Medicine Department, Faculty of Medicine, Universidade Federal Fluminense, Niterói 24070-035, Brazil
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto 4200-319, Portugal;
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
- Correspondence:
| | - Gustavo Falbo Wandalsen
- Department of Pediatrics, Faculty of Medicine, Universidade Federal de Sao Paulo, São Paulo 04025-002, Brazil;
| | - Fabio Chigres Kuschnir
- Department of Pediatrics, Faculty of Medicine, Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20943-000, Brazil;
| | - Luís Delgado
- Basic and Clinical Immunology Unit, Department of Pathology, Faculty of Medicine, University of Porto, Porto 4200-319, Portugal;
- Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto 4200-319, Portugal
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Beken B, Ozturk GK, Aygun FD, Aydogmus C, Akar HH. Asthma and allergic diseases are not risk factors for hospitalization in children with coronavirus disease 2019. Ann Allergy Asthma Immunol 2021; 126:569-575. [PMID: 33493639 PMCID: PMC7825986 DOI: 10.1016/j.anai.2021.01.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/02/2021] [Accepted: 01/19/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) emerged as a pandemic toward the end of 2019, causing large numbers of people to become infected and die. OBJECTIVE To determine whether allergic diseases are a risk factor for hospitalization in COVID-19. METHODS We conducted a study including 107 pediatric patients after COVID-19 recovery. The International Study of Asthma and Allergies in Childhood Phase 3 questionnaires were distributed together with a detailed history of environmental factors and an allergic evaluation including skin prick tests, specific immunoglobulin E tests, and spirometry. We investigated the prevalence of allergic diseases and evaluated the factors associated with hospitalization in COVID-19. RESULTS A total of 61 (57%) patients were hospitalized and 46 (43%) patients were followed closely in the outpatient clinic. The prevalences of allergic rhinitis, asthma, atopic dermatitis, and episodic wheezing were 10.3%, 6,5%, 4.7%, and 3.7%, respectively, within the whole study population. Although having asthma with or without allergic rhinitis, atopic dermatitis, and passive tobacco exposure were not found to be related to hospitalization because of COVID-19, having a pet at home was found to decrease the risk of hospitalization (odds ratio, 0.191; 95% confidence interval, 0.047-0.779; P = .02). Spirometry tests revealed a higher forced expiratory volume in one second to forced vital capacity ratio and a peak expiratory flow reversibility in hospitalized patients than in nonhospitalized ones (P = .02 and P = .003, respectively). CONCLUSION Asthma and allergic diseases do not seem to be risk factors for hospitalization in children because of COVID-19, and having a pet at home can be a protective effect. Pulmonary function testing seems to be important for monitoring lung damage after COVID-19.
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Affiliation(s)
- Burcin Beken
- Department of Pediatric Allergy and Immunology, Kanuni Sultan Suleyman Training, and Research Hospital, Istanbul, Turkey.
| | - Gokcen Kartal Ozturk
- Department of Pediatric Pulmonology, Kanuni Sultan Suleyman Training, and Research Hospital, Istanbul, Turkey
| | - Fatma Deniz Aygun
- Department of Pediatric Infectious Diseases, Kanuni Sultan Suleyman Training, and Research Hospital, Istanbul, Turkey
| | - Cigdem Aydogmus
- Department of Pediatric Allergy and Immunology, Kanuni Sultan Suleyman Training, and Research Hospital, Istanbul, Turkey
| | - Himmet Haluk Akar
- Department of Pediatric Allergy and Immunology, Kanuni Sultan Suleyman Training, and Research Hospital, Istanbul, Turkey
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Quinti I, Mezzaroma I, Milito C. Clinical management of patients with primary immunodeficiencies during the COVID-19 pandemic. Expert Rev Clin Immunol 2021; 17:163-168. [PMID: 33412960 DOI: 10.1080/1744666x.2021.1873767] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Introduction: Patients affected by Inborn Errors of Immunity (IEI) represent a potential group-at-risk in the current COVID-19 pandemic. Studies on large and small cohorts of IEI reported a huge variability clinical manifestations associated to SARS-Cov-2, ranging from asymptomatic, mild, moderate/severe to death. A great impulse to improve remote assistance programs and to switch to home-based treatment to reduce mobility and face to face contacts has been implemented.Areas covered: The authors completed a comprehensive review of the literature by searching the PubMed database for studies on large and small cohorts and case reports of IEI patients with COVID-19, with the aim to provide useful information for their clinical management during the COVID-19 pandemic.Expert opinion: Surprisingly, a low number of IEI patients affected by SARS-Cov-2 were reported with a risk to die for COVID-19 overlapping that of the general population. The low number might be explained by the choice of most physicians to inform early in the pandemic about safety measures, to switch most of the IEI patients to home therapy and to remote assistance. The guidelines issued by the scientific societies and periodically updated, represent the best tool for the clinical management of IEI patients.
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Affiliation(s)
- Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Ivano Mezzaroma
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
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Bitar H, Alismail S. The role of eHealth, telehealth, and telemedicine for chronic disease patients during COVID-19 pandemic: A rapid systematic review. Digit Health 2021; 7:20552076211009396. [PMID: 33959378 PMCID: PMC8060773 DOI: 10.1177/20552076211009396] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 03/20/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To summarize the current status of, and the current expert opinions, recommendation and evidence associated with the use and implementation of electronic health (eHealth), telemedicine, and/or telehealth to provide healthcare services for chronic disease patients during the COVID-19 pandemic. MATERIALS AND METHODS We searched four electronic databases (PubMed, Google Scholar, Science Direct, and Web of Science Core Collection) to identify relevant articles published between 2019 and 2020. Searches were restricted to English language articles only. Two independent reviewers screened the titles, abstracts, and keywords for relevance. The potential eligible articles, papers with no abstract, and those that fall into the uncertain category were read in full text independently. The reviewers met and discussed which articles to include in the final review and reached a consensus. RESULTS We identified 51 articles of which 25 articles met the inclusion criteria. All included articles indicated the promising potential of eHealth, telehealth, and/or telemedicine solutions in delivering healthcare services to patients living with chronic diseases/conditions during the COVID-19 pandemic. We synthesized the main findings into ten usages and eight recommendations concerning the different activities for delivering healthcare services remotely for those living with chronic diseases/conditions in the era of COVID-19. DISCUSSION AND CONCLUSIONS There is limited evidence available about the effectiveness of such solutions. Further research is required during this pandemic to improve the credibility of evidence on telemedicine, telehealth, and/or eHealth-related outcomes for those living with chronic diseases.
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Affiliation(s)
- Hind Bitar
- Department of Information Systems, King Abdulaziz University,
Jeddah, Saudi Arabia
| | - Sarah Alismail
- Center for Information Systems & Technology, Claremont
Graduate University, Claremont, USA
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Ferrante G, Licari A, Marseglia GL, La Grutta S. Digital health interventions in children with asthma. Clin Exp Allergy 2020; 51:212-220. [PMID: 33238032 PMCID: PMC7753570 DOI: 10.1111/cea.13793] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 11/13/2020] [Accepted: 11/22/2020] [Indexed: 12/20/2022]
Abstract
Although healthcare providers are actively involved in offering education, information and interventions for asthmatic patients, medication and therapeutic adherence remain low in the paediatric population, with estimates suggesting that adherence rates hover below 50%. A range of available digital health interventions has been explored in paediatric asthma with promising but variable results, limiting their widespread adoption in clinical practice. They include emerging technologies that yield the advantage of tracking asthma symptoms and medications, setting drug reminders, improving inhaler technique and delivering asthma education, such as serious games (video games designed for medical‐ or health‐related purposes), electronic monitoring devices, speech recognition calls, text messaging, mobile apps and interactive websites. Some of the proposed digital interventions have used multiple components, including educational and behavioural strategies and interactions with medical professionals. Overall, the implementation of such interventions may offer the opportunity to improve adherence and asthma control. In a state of emergency as the COVID‐19 pandemic, telemedicine can also play a central role in supporting physicians in managing children with asthma. This review evaluates the published literature examining digital health interventions for paediatric asthma and explores the most relevant issues affecting their implementation in practice and the associated evidence gaps, research limitations and future research perspectives.
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Affiliation(s)
- Giuliana Ferrante
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy
| | - Amelia Licari
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Gian Luigi Marseglia
- Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Stefania La Grutta
- Institute for Research and Biomedical Innovation (IRIB), National Research Council (CNR), Palermo, Italy
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The Impact of COVID-19 Pandemic on Adult and Pediatric Allergy & Immunology Services in the UK National Health Service. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:709-722.e2. [PMID: 33271350 PMCID: PMC7703386 DOI: 10.1016/j.jaip.2020.11.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/28/2020] [Accepted: 11/14/2020] [Indexed: 01/18/2023]
Abstract
Background The coronavirus disease 2019 pandemic imposed multiple restrictions on health care services. Objective To investigate the impact of the pandemic on Allergy & Immunology (A&I) services in the United Kingdom. Methods A national survey of all A&I services registered with the Royal College of Physicians and/or the British Society for Allergy and Clinical Immunology was carried out. The survey covered staffing, facilities, personal protective equipment, appointments & patient review, investigations, treatments, and research activity. Weeks commencing February 3, 2020 (pre–coronavirus disease), April 6, 2020, and May 8, 2020, were used as reference points for the data set. Results A total of 99 services participated. There was a reduction in nursing, medical, administrative, and allied health professional staff during the pandemic; 86% and 92% of A&I services continued to accept nonurgent and urgent referrals, respectively, during the pandemic. There were changes in immunoglobulin dose and infusion regimen in 67% and 14% of adult and pediatric services, respectively; 30% discontinued immunoglobulin replacement in some patients. There was a significant (all variables, P ≤ .0001) reduction in the following: face-to-face consultations (increase in telephone consultations), initiation of venom immunotherapy, sublingual and subcutaneous injection immunotherapy, anesthetic allergy testing, and hospital procedures (food challenges, immunoglobulin and omalizumab administration); and a significant increase (P ≤ .0001) in home therapy for immunoglobulin and omalizumab. Adverse clinical outcomes were reported, but none were serious. Conclusions The pandemic had a significant impact on A&I services, leading to multiple unplanned pragmatic amendments in service delivery. There is an urgent need for prospective audits and strategic planning in the medium and long-term to achieve equitable, safe, and standardized health care.
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Abstract
Many research teams all over the world focus their research on the SARS-CoV-2, the new coronavirus that causes the so-called COVID-19 disease. Most of the studies identify the main protease or 3C-like protease (Mpro/3CLpro) as a valid target for large-spectrum inhibitors. Also, the interaction of the human receptor angiotensin-converting enzyme 2 (ACE2) with the viral surface glycoprotein (S) is studied in depth. Structural studies tried to identify the residues responsible for enhancement/weaken virus-ACE2 interactions or the cross-reactivity of the neutralizing antibodies. Although the understanding of the immune system and the hyper-inflammatory process in COVID-19 are crucial for managing the immediate and the long-term consequences of the disease, not many X-ray/NMR/cryo-EM crystals are available. In addition to 3CLpro, the crystal structures of other nonstructural proteins offer valuable information for elucidating some aspects of the SARS-CoV-2 infection. Thus, the structural analysis of the SARS-CoV-2 is currently mainly focused on three directions-finding Mpro/3CLpro inhibitors, the virus-host cell invasion, and the virus-neutralizing antibody interaction.
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Affiliation(s)
- Mihaela Ileana Ionescu
- Department of Microbiology, Iuliu Hațieganu University of Medicine and Pharmacy, 6 Louis Pasteur, 400349, Cluj-Napoca, Romania.
- Department of Microbiology, County Emergency Clinical Hospital, 400006, Cluj-Napoca, Romania.
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Abrams EM, Sinha I, Fernandes RM, Hawcutt DB. Pediatric asthma and COVID-19: The known, the unknown, and the controversial. Pediatr Pulmonol 2020; 55:3573-3578. [PMID: 33058493 PMCID: PMC7675412 DOI: 10.1002/ppul.25117] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 12/21/2022]
Abstract
The novel coronavirus disease-2019 (COVID-19), caused by the pathogen severe acute respiratory syndrome-CoV-2, is causing a global pandemic, with over 26.9 million cases and 880,000 deaths as of September 6, 2020. While there has been speculation and observational research about the impact of COVID-19 on asthma, much remains unknown. The goal of this article is to provide a scoping review on pediatric asthma and COVID-19 and summarize what we do and do not know from the first wave of the pandemic.
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Affiliation(s)
- Elissa M. Abrams
- Department of Pediatrics, Section of Allergy and Clinical ImmunologyUniversity of ManitobaWinnipegManitobaCanada
- Division of Allergy and Immunology, Department of PediatricsUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Ian Sinha
- Pediatric RespirologyAlder Hey Children's HospitalLiverpoolUK
- Division of Child HealthUniversity of LiverpoolLiverpoolUK
| | - Ricardo M. Fernandes
- Clinical Pharmacology Unit, Faculty of Medicine, Instituto de Medicina MolecularUniversity of LisbonLisbonPortugal
- Department of Pediatrics, Santa Maria HospitalCentro Hospitalar Universitário Lisboa NorteLisbonPortugal
| | - Daniel B. Hawcutt
- Pediatric RespirologyAlder Hey Children's HospitalLiverpoolUK
- Paediatric Clinical PharmacologyUniversity of LiverpoolLiverpoolUK
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Sánchez-García S, Ruiz-Hornillos J, Escudero C. Pediatric Asthma Management During the COVID-19 Pandemic: Results of a National Survey. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2020; 33:199-203. [PMID: 35921568 PMCID: PMC9353999 DOI: 10.1089/ped.2020.1250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/06/2020] [Indexed: 06/15/2023]
Abstract
Background: During the COVID-19 pandemic specialists were concerned about how to achieve the best control of pediatric asthmatic patients. Methods: A national survey was performed. Analysis of the mean of follow-up, complementary tests, health system (public/private/both), availability of severe asthma units, and geographic location (cities with high COVID-19 prevalence vs. other cities with low prevalence). Differences were analyzed using contingency tables and Pearson's chi-squared test. Results: We obtained 95 responses, mostly from cities with a high disease prevalence (39; 52%). Only 29 (38.6%) of respondents provided care in a severe asthma unit. Severe asthmatic children were followed up mainly by telephone (68; 90.7%) and by in-person visits (32; 42.7%). Face-to-face care was less frequent in cities with a high prevalence of COVID-19 when compared with smaller cities (P = 0.044). Some of the surveyed physicians had discontinued patient follow-up as they were caring for patients with COVID-19 (7; 9.3%). Of all specialists surveyed, 45.3% did not evaluate severe asthmatic children with any means of testing. Pulmonary function tests were scarcely implemented. Blood tests were the most common test performed (45.3%). Specialists working in a severe asthma unit carried out more pulmonary function tests (P = 0.019). Peculiarly, moderate persistent asthmatics underwent more spirometries in cities with a high prevalence rate (P = 0.03). Follow-up of asthmatic children during the pandemic was perceived to be reduced or altogether inexistent by 42.7% of respondents when compared with a similar season outside of this emergency situation. Remarkably, the perception that better management of asthma was delivered during the pandemic by those working in cities with a high prevalence of COVID-19 versus other regions. Conclusions: Pediatric asthma control is crucial to decrease the future risk presented by the condition. New technologies and severe asthma units may become key tools in global health emergencies such as the COVID-19 pandemic.
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Affiliation(s)
- Silvia Sánchez-García
- Allergy Department, Hospital Infantil Universitario Niño Jesús and ARADyAL-RETICs Network, Instituto de Salud Carlos III, Madrid, Spain
| | - Javier Ruiz-Hornillos
- Allergy Department, Hospital Infanta Elena, Valdemoro, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
- Health Research Institute-Fundación Jiménez Díaz University Hospital (IIS-FJD), Madrid, Spain
| | - Carmelo Escudero
- Allergy Department, Hospital Infantil Universitario Niño Jesús and ARADyAL-RETICs Network, Instituto de Salud Carlos III, Madrid, Spain
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Perikleous E, Tsalkidis A, Bush A, Paraskakis E. Coronavirus global pandemic: An overview of current findings among pediatric patients. Pediatr Pulmonol 2020; 55:3252-3267. [PMID: 32965785 PMCID: PMC7646267 DOI: 10.1002/ppul.25087] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic has been emerged as a cardinal public health problem. Children have their own specific clinical features; notably, they seem to be escaping the severe respiratory adverse effects. The international scientific community is rapidly carrying out studies, driving to the need to reassess knowledge of the disease and therapeutic strategies. AIM To assess the characteristics of COVID-19 infected children worldwide of all ages, from neonates to children and adolescents, and how they differ from their adult counterparts. SEARCH STRATEGY An electronic search in PubMed was conducted, using combinations of the following keywords: coronavirus, SARS-CoV-2, COVID-19, children. The search included all types of articles written in English between January 1, 2019 until August 15, 2020. RESULTS The search identified 266 relevant articles. Children were mainly within family clusters of cases and have relatively milder clinical presentation compared with adults; children were reported to have better outcomes with a significantly lower mortality rate. Cough and fever were the most common symptoms while pneumonia was the cardinal respiratory manifestation of infected children. Laboratory results and thoracic imaging give varying results. CONCLUSIONS Children were mainly family cluster cases and usually presented with a mild infection, although cases presented with the multisystem inflammatory syndrome are becoming more apparent. Studies determining why the manifestations of SARS-CoV-2 infection are so variable may help to gain a better understanding of the disease and accelerate the development of vaccines and therapies.
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Affiliation(s)
| | - Aggelos Tsalkidis
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Department of Pediatrics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Andrew Bush
- Departments of Pediatrics and Pediatric Respiratory Medicine, Royal Brompton Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Emmanouil Paraskakis
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Department of Pediatrics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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