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Untersmayr E, Venter C, Smith P, Rohrhofer J, Ndwandwe C, Schwarze J, Shannon E, Sokolowska M, Sadlier C, O'Mahony L. Immune Mechanisms Underpinning Long COVID: Collegium Internationale Allergologicum Update 2024. Int Arch Allergy Immunol 2024; 185:489-502. [PMID: 38253027 DOI: 10.1159/000535736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/07/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can result in a prolonged multisystem disorder termed long COVID, which may affect up to 10% of people following coronavirus disease 2019 (COVID-19). It is currently unclear why certain individuals do not fully recover following SARS-CoV-2 infection. SUMMARY In this review, we examine immunological mechanisms that may underpin the pathophysiology of long COVID. These mechanisms include an inappropriate immune response to acute SARS-CoV-2 infection, immune cell exhaustion, immune cell metabolic reprogramming, a persistent SARS-CoV-2 reservoir, reactivation of other viruses, inflammatory responses impacting the central nervous system, autoimmunity, microbiome dysbiosis, and dietary factors. KEY MESSAGES Unfortunately, the currently available diagnostic and treatment options for long COVID are inadequate, and more clinical trials are needed that match experimental interventions to underlying immunological mechanisms.
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Affiliation(s)
- Eva Untersmayr
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Immunology and Infectiology, Medical University Vienna, Vienna, Austria
| | - Carina Venter
- Section of Allergy and Immunology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Peter Smith
- Department of Clinical Medicine, Griffiths University, Southport, Queensland, Australia
| | - Johanna Rohrhofer
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Immunology and Infectiology, Medical University Vienna, Vienna, Austria
| | - Cebile Ndwandwe
- School of Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Jurgen Schwarze
- Centre for Inflammation Research, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK
| | - Emer Shannon
- School of Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Milena Sokolowska
- Swiss Institute of Allergy and Asthma Research, University of Zurich, Zurich, Switzerland
| | - Corinna Sadlier
- Department of Infectious Diseases, Cork University Hospital, Cork, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
| | - Liam O'Mahony
- School of Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland
- Department of Medicine, University College Cork, Cork, Ireland
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