Considerations on biologicals for patients with allergic disease in times of the COVID‐19 pandemic: An EAACI statement
Alessandra Vultaggio
(1)
,
Ioana Agache
(2)
,
Cezmi Akdis
(3)
,
Mubeccel Akdis
(3)
,
Sevim Bavbek
(4)
,
Apostolos Bossios
(5, 6)
,
Jean Bousquet
(7, 8, 9, 10)
,
Onur Boyman
(11)
,
Adam Chaker
(12)
,
Susan Chan
(13)
,
Alexia Chatzipetrou
(14)
,
Wojciech Feleszko
(15)
,
Davide Firinu
(16)
,
Marek Jutel
(17, 18)
,
Paula Kauppi
(19)
,
Ludger Klimek
(20)
,
Antonios Kolios
(9, 21, 11, 22)
,
Akash Kothari
(23)
,
Marek Kowalski
(24)
,
Andrea Matucci
(1)
,
Oscar Palomares
(25)
,
Oliver Pfaar
(26)
,
Barbara Rogala
(27)
,
Eva Untersmayr
(28)
,
Thomas Eiwegger
(23, 29)
1
AOUC -
Azienda Ospedaliero Universitaria Careggi [Firenze] = Careggi University Hospital [Florence, Italy]
2 Transylvania University of Brasov
3 SIAF - Swiss Institute of Allergy and Asthma Research
4 Ankara University School of Medicine [Turkey]
5 Karolinska University Hospital [Stockholm]
6 Karolinska Institutet [Stockholm]
7 Charité - UniversitätsMedizin = Berlin University Medicine
8 BIH - Berlin Institute of Health
9 MACVIA-LR - Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon
10 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
11 University hospital of Zurich [Zurich]
12 University Hospital of the Technical University Munich
13 Guy's and St Thomas' NHS Foundation Trust
14 “Attikon” University Hospital
15 Medical University of Warsaw - Poland
16 University of Cagliari
17 Wrocław Medical University
18 ALL-MED Medical Research Institute
19 HUS - Helsinki University Hospital [Finland]
20 Centre for Rhinology and Allergy
21 CHU Montpellier = Montpellier University Hospital
22 BIDMC - Beth Israel Deaconess Medical Center [Boston]
23 SickKids - The Hospital for sick children [Toronto]
24 MUL - Medical University of Łódź
25 UCM - Universidad Complutense de Madrid = Complutense University of Madrid [Madrid]
26 Philipps Universität Marburg = Philipps University of Marburg
27 SUM - Medical University of Silesia
28 Medizinische Universität Wien = Medical University of Vienna
29 University of Toronto
2 Transylvania University of Brasov
3 SIAF - Swiss Institute of Allergy and Asthma Research
4 Ankara University School of Medicine [Turkey]
5 Karolinska University Hospital [Stockholm]
6 Karolinska Institutet [Stockholm]
7 Charité - UniversitätsMedizin = Berlin University Medicine
8 BIH - Berlin Institute of Health
9 MACVIA-LR - Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon
10 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
11 University hospital of Zurich [Zurich]
12 University Hospital of the Technical University Munich
13 Guy's and St Thomas' NHS Foundation Trust
14 “Attikon” University Hospital
15 Medical University of Warsaw - Poland
16 University of Cagliari
17 Wrocław Medical University
18 ALL-MED Medical Research Institute
19 HUS - Helsinki University Hospital [Finland]
20 Centre for Rhinology and Allergy
21 CHU Montpellier = Montpellier University Hospital
22 BIDMC - Beth Israel Deaconess Medical Center [Boston]
23 SickKids - The Hospital for sick children [Toronto]
24 MUL - Medical University of Łódź
25 UCM - Universidad Complutense de Madrid = Complutense University of Madrid [Madrid]
26 Philipps Universität Marburg = Philipps University of Marburg
27 SUM - Medical University of Silesia
28 Medizinische Universität Wien = Medical University of Vienna
29 University of Toronto
Ioana Agache
- Fonction : Auteur
- PersonId : 767614
- ORCID : 0000-0001-7994-364X
Cezmi Akdis
- Fonction : Auteur
- PersonId : 797369
- ORCID : 0000-0001-8020-019X
Apostolos Bossios
- Fonction : Auteur
- PersonId : 763306
- ORCID : 0000-0002-0494-2690
Jean Bousquet
- Fonction : Auteur
- PersonId : 757330
- ORCID : 0000-0002-4061-4766
Adam Chaker
- Fonction : Auteur
- PersonId : 808727
- ORCID : 0000-0002-5117-4073
Susan Chan
- Fonction : Auteur
- PersonId : 758404
- ORCID : 0000-0001-5493-5985
Wojciech Feleszko
- Fonction : Auteur
- PersonId : 823306
- ORCID : 0000-0001-6613-2012
Davide Firinu
- Fonction : Auteur
- PersonId : 802274
- ORCID : 0000-0002-5768-391X
Marek Jutel
- Fonction : Auteur
- PersonId : 798508
- ORCID : 0000-0003-1555-9379
Ludger Klimek
- Fonction : Auteur
- PersonId : 791087
- ORCID : 0000-0002-2455-0192
Akash Kothari
- Fonction : Auteur
- PersonId : 802275
- ORCID : 0000-0003-1980-161X
Oscar Palomares
- Fonction : Auteur
- PersonId : 801559
- ORCID : 0000-0003-4516-0369
Oliver Pfaar
- Fonction : Auteur
- PersonId : 767433
- ORCID : 0000-0003-4374-9639
Eva Untersmayr
- Fonction : Auteur
- PersonId : 795378
- ORCID : 0000-0002-1963-499X
Thomas Eiwegger
- Fonction : Auteur
- PersonId : 802272
- ORCID : 0000-0002-2914-7829
Résumé
The outbreak of the SARS-CoV-2-induced coronavirus disease 2019 (COVID-19) pandemic re-shaped doctor-patient interaction and challenged capacities of healthcare systems. It created many issues around the optimal and safest way to treat complex patients with severe allergic disease. A significant number of the patients are on treatment with biologicals, and clinicians face the challenge to provide optimal care during the pandemic. Uncertainty of the potential risks for these patients is related to the fact that the exact sequence of immunological events during SARS-CoV-2 is not known. Severe COVID-19 patients may experience a "cytokine storm" and associated organ damage characterized by an exaggerated release of pro-inflammatory type 1 and type 3 cytokines. These inflammatory responses are potentially counteracted by anti-inflammatory cytokines and type 2 responses. This expert-based EAACI statement aims to provide guidance on the application of biologicals targeting type 2 inflammation in patients with allergic disease. Currently, there is very little evidence for an enhanced risk of patients with allergic diseases to develop severe COVID-19. Studies focusing on severe allergic phenotypes are lacking. At present, noninfected patients on biologicals for the treatment of asthma, atopic dermatitis, chronic rhinosinusitis with nasal polyps, or chronic spontaneous urticaria should continue their biologicals targeting type 2 inflammation via self-application. In case of an active SARS-CoV-2 infection, biological treatment needs to be stopped until clinical recovery and SARS-CoV-2 negativity is established and treatment with biologicals should be re-initiated. Maintenance of add-on therapy and a constant assessment of disease control, apart from acute management, are demanded.