The global impact of the COVID‐19 pandemic on the management and course of chronic urticaria

Abstract

Introduction The COVID‐19 pandemic dramatically disrupts health care around the globe. The impact of the pandemic on chronic urticaria (CU) and its management are largely unknown. Aim To understand how CU patients are affected by the COVID‐19 pandemic; how specialists alter CU patient management; and the course of CU in patients with COVID‐19. Materials and Methods Our cross‐sectional, international, questionnaire‐based, multicenter UCARE COVID‐CU study assessed the impact of the pandemic on patient consultations, remote treatment, changes in medications, and clinical consequences. Results The COVID‐19 pandemic severely impairs CU patient care, with less than 50% of the weekly numbers of patients treated as compared to before the pandemic. Reduced patient referrals and clinic hours were the major reasons. Almost half of responding UCARE physicians were involved in COVID‐19 patient care, which negatively impacted on the care of urticaria patients. The rate of face‐to‐face consultations decreased by 62%, from 90% to less than half, whereas the rate of remote consultations increased by more than 600%, from one in 10 to more than two thirds. Cyclosporine and systemic corticosteroids, but not antihistamines or omalizumab, are used less during the pandemic. CU does not affect the course of COVID‐19, but COVID‐19 results in CU exacerbation in one of three patients, with higher rates in patients with severe COVID‐19. Conclusions The COVID‐19 pandemic brings major changes and challenges for CU patients and their physicians. The long‐term consequences of these changes, especially the increased use of remote consultations, require careful evaluation.

Pre-existing asthma as a comorbidity does not modify cytokine responses and severity of COVID-19

“…Furthermore, no difference was found in the prevalence of asthma between severe (1.1%) and non-severe (0.7%) COVID-19 in a previous study [ 11 ]. It has also been reported that the percentage of severe COVID-19 cases in asthmatic patients (4.6%) was significantly lower than that in non-asthmatic patients (25.0%) [ 14 ]. In this Oxford cohort, a similar pattern was observed that the prevalence of asthma in COVID-19 patients was not significantly higher than that in general population, and there was no difference of prevalence of pre-existing asthma among different COVID-19 severities.…”

“…Some of these observations were consistent with the findings in the study by Song et al . [ 14 ]. Therefore, asthma comorbidity does not appear to modify the cytokine storm cascade after COVID-19 infection, and any difference in disease severity is unlikely to be explained on this basis.…”

“…Large cohort studies in different geographic regions found that the prevalence of asthma in COVID-19 was under-represented and lower than that in general populations [ 11 – 13 ]. A study of 961 hospitalized COVID-19 patients did not show an increase of severity and mortality in patients with asthma [ 14 ]. In addition, the Th2 cytokines and eosinophilic inflammation, hallmarks of asthma pathophysiology, have been demonstrated to be associated with decreased ACE2 expression in bronchial epithelium of asthmatic patients [ 14 – 17 ].…”

“…A study of 961 hospitalized COVID-19 patients did not show an increase of severity and mortality in patients with asthma [ 14 ]. In addition, the Th2 cytokines and eosinophilic inflammation, hallmarks of asthma pathophysiology, have been demonstrated to be associated with decreased ACE2 expression in bronchial epithelium of asthmatic patients [ 14 – 17 ]. Hence, asthma is unlikely to represent a risk factor of COVID-19 infection [ 9 ].…”

“…Cytokine “storm” has been recognised as an important driver of disease deterioration and severity in COVID-19 [ 18 , 20 ]. However, there is still limited understanding of the impact of asthma on COVID-19-derived cytokine storm, with only one study reporting no difference between patients with and without asthma in the levels of interleukin (IL)-2, IL-6, IL-10, IL-8 and tumor necrosis factor (TNF)-α [ 14 ]. Comparing the cytokine response to infection may provide an important mechanistic insight into any interaction between asthma and COVID-19.…”