Immunological Aspects Related to Viral Infections in Severe Asthma and the Role of Omalizumab

Menzella, Francesco; Ghidoni, Giulia; Galeone, Carla; Capobelli, Silvia; Scelfo, Chiara; Facciolongo, Nicola

doi:10.3390/biomedicines9040348

Cited by 10 publications

(21 citation statements)

References 54 publications

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“…Notably, plasmacytoid dendritic cells (pDCs) are the primary blood source of IFN-α/β. 45 , 46 A reduction in the production of these cytokines by pDCs has been observed in atopic patients, and this impairment resulted to correlate with serum IgE levels in one study. This finding suggested that pDCs antiviral responses may be suppressed in atopic patients, and this may represent one of the mechanisms by which atopy is supposed to increase the susceptibility to respiratory viral infections.…”

Section: Impact Of Anti-th2 Therapy On Covid-19: Potential Mechanismsmentioning

confidence: 89%

Impact of Anti-Type 2 Inflammation Biologic Therapy on COVID-19 Clinical Course and Outcome

Poddighe¹,

Kovzel²

2021

JIR

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SARS-CoV-2 pandemic had a general and deep impact on the clinical management of chronic diseases, including respiratory and allergic disorders. At the beginning of the pandemic, one of the main concerns was the potential impact of immunosuppressive/immunomodulatory drugs on COVID-19 clinical course. In this review, we aim to summarize and analyze the available clinical evidence from patients treated with anti-type 2 inflammation biologics (including anti-IgE, anti-IL-5 and anti-IL-4 agents), who developed COVID-19. Overall, the treatment with anti-Th2 biologics can be considered safe during COVID-19. It does not worsen the clinical course and outcome of COVID-19, and it may be actually protective somehow from developing severe forms. Moreover, patients treated with these biological agents do not seem to be more prone to get infected by SARS-CoV-2.

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Section: Impact Of Anti-th2 Therapy On Covid-19: Potential Mechanismsmentioning

confidence: 89%

Impact of Anti-Type 2 Inflammation Biologic Therapy on COVID-19 Clinical Course and Outcome

Poddighe¹,

Kovzel²

2021

JIR

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“… 102 Omalizumab reduces dendritic cell receptors high‐affinity IgE receptor (FcεRI) by blocking free IgE, which is fundamental in allergic asthma, restoring the ability to produce IFN‐α, which translates into a greater antiviral response. 103 Combined blockade of multiple Th2‐associated cytokines (IL‐13, IL‐4 and IL‐5) may be a better approach to overcome cytokine redundancy and gain full control of asthma symptoms, including exacerbations, lung function and quality of life, by simultaneous optimization of airway hyper‐reactivity, eosinophil and IgE targeting. 104 …”

Section: Immunological Mechanism Of Allergen Immunotherapy and Biolog...mentioning

confidence: 99%

COVID‐19 vaccination in patients receiving allergen immunotherapy (AIT) or biologicals—EAACI recommendations

Jutel

Torres

Palomares

et al. 2022

Allergy

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Immune modulation is a key therapeutic approach for allergic diseases, asthma and autoimmunity. It can be achieved in an antigen‐specific manner via allergen immunotherapy (AIT) or in an endotype‐driven approach using biologicals that target the major pathways of the type 2 (T2) immune response: immunoglobulin (Ig)E, interleukin (IL)‐5 and IL‐4/IL‐13 or non‐type 2 response: anti‐cytokine antibodies and B‐cell depletion via anti‐CD20. Coronavirus disease 2019 (COVID‐19) vaccination provides an excellent opportunity to tackle the global pandemics and is currently being applied in an accelerated rhythm worldwide. The vaccine exerts its effects through immune modulation, induces and amplifies the response against the severe acute respiratory syndrome coronavirus (SARS‐CoV‐2). Thus, as there may be a discernible interference between these treatment modalities, recommendations on how they should be applied in sequence are expected. The European Academy of Allergy and Clinical Immunology (EAACI) assembled an expert panel under its Research and Outreach Committee (ROC). This expert panel evaluated the evidence and have formulated recommendations on the administration of COVID‐19 vaccine in patients with allergic diseases and asthma receiving AIT or biologicals. The panel also formulated recommendations for COVID‐19 vaccine in association with biologicals targeting the type 1 or type 3 immune response. In formulating recommendations, the panel evaluated the mechanisms of COVID‐19 infection, of COVID‐19 vaccine, of AIT and of biologicals and considered the data published for other anti‐infectious vaccines administered concurrently with AIT or biologicals.

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“…In the majority of people infected with SARS-CoV-2, the infection follows a mild to moderate self-limiting course that is not much different from the typical course of common respiratory virus infections [92][93][94]. In a subset of patients, however, SARS-CoV-2 infection evokes a hyperinflammatory immune response characterized by an exaggerated increase in the release of cytokines (IL-2, IL-6, IL-7, IL-10, IL-12, TNF-α, CXCL10, CCL2, CCL3), aptly known as "cytokine storm", and the disproportionate inflammatory activation may lead to acute respiratory distress, multi-organ failure, and possible death [92,95]. Considering the well-established role of IgE in atopic diseases, airway hyperreactivity, and antiviral response, an investigation of anti-IgE as a potential treatment to COVID-19 is warranted.…”

Section: Anti-ige Biologic Agent As a Potential Treatment For Covid-19mentioning

confidence: 99%

“…Considering the well-established role of IgE in atopic diseases, airway hyperreactivity, and antiviral response, an investigation of anti-IgE as a potential treatment to COVID-19 is warranted. Among the currently available biologic treatments for severe asthma, omalizumab is the only agent with a documented effect in viral respiratory infections [95]. The protective action of omalizumab against viral infections is multifaceted.…”

Section: Anti-ige Biologic Agent As a Potential Treatment For Covid-19mentioning

confidence: 99%

“…Omalizumab directly reduces levels of free IgE, inhibits cross-linking of IgE-bound FcERI, and inhibits mast cell activation that can trigger and propagate the hyperinflammatory cascade (Figure 2) [89]. In addition, omalizumab indirectly reduces the number of FcERI on basophils, mast cells, and dendritic cells, which helps to prevent the hindrance of an IFN-α-mediated antiviral response [95].…”

Section: Anti-ige Biologic Agent As a Potential Treatment For Covid-19mentioning

confidence: 99%

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Asthma and COVID-19 Associations: Focus on IgE-Related Immune Pathology

Wang

Cheng

Kuo

2022

Life

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Management of patients with asthma during the coronavirus disease 2019 (COVID-19) pandemic is a concern, especially since asthma predisposes patients to respiratory problems. Interestingly, asthma characterized by type 2 inflammation, also known as T-helper type 2-high endotype, displays a cellular and molecular profile that may confer protective effects against COVID-19. The results of experimental and clinical studies have established the actions of immunoglobulin E (IgE) in inducing airway hyperreactivity and weakening an interferon-mediated antiviral response following respiratory viral infection. Robust evidence supports the beneficial effect of the anti-IgE biologic treatment omalizumab on reducing respiratory virus-induced asthma exacerbations and reducing the frequency, duration, and severity of respiratory viral illness in patients with asthma. Indeed, accumulating reports of patients with severe asthma treated with omalizumab during the pandemic have reassuringly shown that continuing omalizumab treatment during COVID-19 is safe, and in fact may help prevent the severe course of COVID-19. Accordingly, guidance issued by the Global Initiative for Asthma recommends that all patients with asthma continue taking their prescribed asthma medications, including biologic therapy, during the COVID-19 pandemic. The impact of biologic treatments on patients with asthma and COVID-19 will be better understood as more evidence emerges.

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Immunological Aspects Related to Viral Infections in Severe Asthma and the Role of Omalizumab

Cited by 10 publications

References 54 publications

Impact of Anti-Type 2 Inflammation Biologic Therapy on COVID-19 Clinical Course and Outcome

Impact of Anti-Type 2 Inflammation Biologic Therapy on COVID-19 Clinical Course and Outcome

COVID‐19 vaccination in patients receiving allergen immunotherapy (AIT) or biologicals—EAACI recommendations

Asthma and COVID-19 Associations: Focus on IgE-Related Immune Pathology

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