Currently, there is no treatment approved for COVID-19. Numerous drugs are being used in an empirical manner according to experience and availability. Studies demonstrating their efficacy and safety are still to be published. Thus, it is of vital importance for healthcare workers to be well informed and updated regarding possible immunological and non-immunological adverse effects regarding such treatments. In this narrative revision, the rationale use of these treatments in the SARS-CoV-2 infection is emphasized as well as their most frequently described adverse drug reactions.
Drugs that are being essayed to counteract both clinical phases that are thought to take place in the severe stage of this disease are included; an initial phase where a viral infection prevails and a second phase where an inflammatory response takes over. Adverse reactions registered in the Pharmacovigilance Program of our hospital before the onset of this pandemic have also been included.
This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record.
RATIONALE: It is not clear if histaminergic angioedema is a form of chronic urticaria or is a different entity belonging to a subtype of acquired angioedema. METHODS: We performed a prospective study comparing clinical features, biomarkers and autoimmune mechanism of 70 patients with histaminergic angioedema without hives (IH-AAE) and 64 patients with chronic urticaria presenting hives and angioedema (CSU-AE). RESULTS: Men ratio in CSU-AE was 0.28 whereas was 0.44 in IH-AAE. We did find significant differences in angioedema location. Lips and eyelids angioedema was significantly more frequent in CSU-AE (95,2% lips, 73% eyelids)(p50.002) than in IH-AAE (78,9% lips, 53,5% eyelids); on the contrary, lingual angioedema was significantly more frequent in IH-AAE (57,7%) than in CSU-AE (30,2%). None of the patients had laryngeal edema nor needed intubation or tracheotomy. No significant differences in any sera CSU biomarker measured was found. IgE levels were similar in both entities within normal values. Basopenia was only found in CSU-AE with significantly lower basophil number (0,03160,031) than in IH-AAE (0,04660,03)(p50.001). Likewise, we found that 31,15% of CSU-AE patients' sera induced basophil activation, whereas none of the IH-AAE sera were able to. Only one patient inducing 6,88% of activation slightly over the 5% cutoff value. CONCLUSIONS: Although very similar, there are several features that distinguish IH-AAE from CSU-AE were identified. Apart from gender distribution and affected areas, two of the key CSU features which are basopenia and the sera ability to activate normal basophils were not present in IH-AAE, suggesting a different mechanism and cell implication.
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