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Morais-Almeida M, Aguiar R, Martin B, Ansotegui IJ, Ebisawa M, Arruda LK, Caminati M, Canonica GW, Carr T, Chupp G, Corren J, Dávila I, Park HS, Hanania NA, Rosenwasser L, Sánchez-Borges M, Virchow JC, Yáñez A, Bernstein JA, Caraballo L, Chang YS, Chikhladze M, Fiocchi A, González-Diaz SN, Tanno LK, Levin M, Ortega-Martell JA, Passalacqua G, Peden DB, Rouadi PW, Sublett JL, Wong GWK, Bleecker ER. COVID-19, asthma, and biological therapies: What we need to know. World Allergy Organ J 2020; 13:100126. [PMID: 32426090 PMCID: PMC7229954 DOI: 10.1016/j.waojou.2020.100126] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/19/2022] Open
Abstract
Managing patients with severe asthma during the coronavirus pandemic and COVID-19 is a challenge. Authorities and physicians are still learning how COVID-19 affects people with underlying diseases, and severe asthma is not an exception. Unless relevant data emerge that change our understanding of the relative safety of medications indicated in patients with asthma during this pandemic, clinicians must follow the recommendations of current evidence-based guidelines for preventing loss of control and exacerbations. Also, with the absence of data that would indicate any potential harm, current advice is to continue the administration of biological therapies during the COVID-19 pandemic in patients with asthma for whom such therapies are clearly indicated and have been effective. For patients with severe asthma infected by SARS-CoV-2, the decision to maintain or postpone biological therapy until the patient recovers should be a case-by-case based decision supported by a multidisciplinary team. A registry of cases of COVID-19 in patients with severe asthma, including those treated with biologics, will help to address a clinical challenge in which we have more questions than answers.
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Key Words
- AAAAI, American Academy of Allergy, Asthma and Immunology
- ACAAI, American College of Allergy, Asthma and Immunology
- ACE2, Angiotensin-converting enzyme 2
- ADCC, Antibody-Dependent Cell-mediated Cytotoxicity
- AEs, Adverse events
- Asthma
- BTS, British Thoracic Society
- Biologics
- COVID-19
- COVID-19, Coronavirus Disease 2019
- DNA, Deoxyribonucleic acid
- EBM, Evidence Based Medicine
- ELF, European Lung Foundation
- ERS, European Respiratory Society
- FDA, Food and Drug Administration
- GINA, Global Initiative for Asthma
- GSK, Glaxo Smith Kline
- ICS, inhaled corticosteroids
- ICU, Intensive Care Unit
- IL13, Interleukin 13
- IL4, Interleukin 4
- IL5, Interleukin 5
- IL5Ra, Interleukin 5 alfa receptor
- IL5r, Interleukin 5 receptor
- IL6, Interleukin 6
- IgE, Immunoglobulin E
- NHLBI, National Heart, Lung, and Blood Institute
- OCS, Oral corticosteroids
- PDGFRA, Platelet-Derived Growth Factor Receptor A
- PROSE study, Preventative Omalizumab or Step-up therapy for fall Exacerbations study
- Pandemic
- RCTs, Randomized Controlled Trials
- SAEs, Serious Adverse Events
- SARP, Severe Asthma Research Programme
- SARS-CoV-2
- SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2
- SC, Subcutaneous
- SIAAIC, Italian Society of Allergy, Asthma and Clinical Immunology
- Severe
- T2, Type 2 inflammation
- TMPRSS2, Transmembrane Protease Serine 2 Enzyme
- Treatment
- USA, United States of America
- mAb, Monoclonal antibody
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Affiliation(s)
| | - Rita Aguiar
- Allergy Centre, CUF Descobertas Hospital, Lisbon, Portugal
| | | | | | - Motohiro Ebisawa
- National Hospital Organization, Sagamihara National Hospital, Sagamihara, Kanagwa, Japan
| | - L Karla Arruda
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Marco Caminati
- Department of Internal Medicine, University of Verona, Allergy Unit and Asthma Center, Verona University Hospital, Verona, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine Asthma & Allergy Clinic, Humanitas University & Research Hospital IRCCS, Milano, Italy
| | - Tara Carr
- Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA
| | - Geoffrey Chupp
- Division of Pulmonary, Critical Care, and Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan Corren
- David Geffen School of Medicine, University of California at Los Angelas (UCLA), Los Angeles, CA, USA
| | - Ignacio Dávila
- University Hospital, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Nicola A Hanania
- Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, TX, USA
| | | | - Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela
| | - J Christian Virchow
- Department of Pneumology/Intensive Care Medicine, Universitätsmedizin, Rostock, Germany
| | - Anahí Yáñez
- INAER-Investigaciones en Alergia y Enfermedades Respiratorias, Buenos Aires, Argentina
| | - Jonathan A Bernstein
- University of Cincinnati, College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, Cincinnati, OH, USA
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Cartagena de Indias, Colombia
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Manana Chikhladze
- Medical Faculty at Akaki Tsereteli State University, KuTaisi, Tskaltubo, Georgia
| | | | | | - Luciana Kase Tanno
- Division of Allergy, Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, Montpellier, France
| | - Michael Levin
- Division Paediatric Allergology, University of Cape Town, Cape Town, South Africa
| | | | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - David B Peden
- Division of Allergy, Immunology & Rheumatology, Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Philip W Rouadi
- Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
| | - James L Sublett
- Pediatric Allergy & Immunology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Gary W K Wong
- Department of Paediatrics, Chinese University of Hong Kong, Hong Kong
| | - Eugene R Bleecker
- Division of Genetics, Genomics and Precision Medicine, Department of Medicine, University of Arizona Health Sciences, Tucson, AZ, USA
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