Use of biologicals in allergic and type-2 inflammatory diseases during the current COVID-19 pandemic

Abstract

Background: Since the beginning of the COVID-19 pandemic, the treatment of patients with allergic and atopy-associated diseases has faced major challenges. Recommendations for “social distancing” and the fear of patients becoming infected during a visit to a medical facility have led to a drastic decrease in personal doctor-patient contacts. This affects both acute care and treatment of the chronically ill. The immune response after SARS-CoV-2 infection is so far only insufficiently understood and could be altered in a favorable or unfavorable way by therapy with monoclonal antibodies. There is currently no evidence for an increased risk of a severe COVID-19 course in allergic patients. Many patients are under ongoing therapy with biologicals that inhibit type 2 immune responses via various mechanisms. There is uncertainty about possible immunological interactions and potential risks of these biologicals in the case of an infection with SARS-CoV-2. Materials and methods: A selective literature search was carried out in PubMed, Livivo, and the internet to cover the past 10 years (May 2010 – April 2020). Additionally, the current German-language publications were analyzed. Based on these data, the present position paper provides recommendations for the biological treatment of patients with allergic and atopy-associated diseases during the COVID-19 pandemic. Results: In order to maintain in-office consultation services, a safe treatment environment must be created that is adapted to the pandemic situation. To date, there is a lack of reliable study data on the care for patients with complex respiratory, atopic, and allergic diseases in times of an imminent infection risk from SARS-CoV-2. Type-2-dominant immune reactions, as they are frequently seen in allergic patients, could influence various phases of COVID-19, e.g., by slowing down the immune reactions. Theoretically, this could have an unfavorable effect in the early phase of a SARS-Cov-2 infection, but also a positive effect during a cytokine storm in the later phase of severe courses. However, since there is currently no evidence for this, all data from patients treated with a biological directed against type 2 immune reactions who develop COVID-19 should be collected in registries, and their disease courses documented in order to be able to provide experience-based instructions in the future. Conclusion: The use of biologicals for the treatment of bronchial asthma, atopic dermatitis, chronic rhinosinusitis with nasal polyps, and spontaneous urticaria should be continued as usual in patients without suspected infection or proven SARS-CoV-2 infection. If available, it is recommended to prefer a formulation for self-application and to offer telemedical monitoring. Treatment should aim at the best possible control of difficult-to-control allergic and atopic diseases using adequate rescue and add-on therapy and should avoid the need for systemic glucocorticosteroids. If SARS-Co...

Anti-IL5 Drugs in COVID-19 Patients: Role of Eosinophils in SARS-CoV-2-Induced Immunopathology

“…This statement is particularly surprising as asthma exacerbations can usually be triggered by respiratory infections (Flores-Torres et al, 2019). This interesting fact has been confirmed in different countries such as China, the USA, South Korea, and Italy (Klimek et al, 2020;Zhu et al, 2020). In detail, in Wuhan, the percentage of seriously ill or deceased COVID-19 patients with known bronchial asthma was far below the prevalence of asthma .…”

“…Furthermore, a position paper from European Allergologists and Clinical Immunologists’ leading societies highlights that there is currently no evidence for an increased risk of a severe COVID-19 course in allergic patients ( Klimek et al, 2020 ). This statement is particularly surprising as asthma exacerbations can usually be triggered by respiratory infections ( Flores-Torres et al, 2019 ).…”

“…The first reports show that the disease course is not worse in COVID-19 patients with eosinophilic diseases under biological therapy, compared to those infected patients with eosinophilic disorder not treated with biologicals ( Heffler et al, 2020 ). The pharmacological blockade of type 2 inflammation by therapeutic antibodies against IgE, IL-5, or IL-5/IL-4/-13 receptors, so far has not been suspected to increase the risk of viral infections, also in the respective approving clinical trials ( Klimek et al, 2020 ). For example, in the Italian Severe Asthma Network (SANI) cohort, 26 patients received a confirmed (11) or a suspected diagnosis of COVID-19 (15).…”

Atopische Dermatitis: Dermatologische Systemtherapie in Zeiten der COVID-19-Pandemie

“…Zu ähnlichen Schlussfolgerungen kommen auch die Autoren eines Positionspapiers der Allergologischen Gesellschaften in Deutschland, Österreich und Luxemburg [ 1 ]. Die Verwendung von Biologika zur Therapie eines Asthmas bronchiale, einer atopischen Dermatitis, chronischen Rhinosinusitis mit nasalen Polypen und spontaner Urtikaria sollten bei Patienten ohne vermutete oder gesicherte SARS-COV-2 -Infektion wie gewohnt durchgeführt werden.…”

Severe acute respiratory syndrome coronavirus 2 infection in those on mepolizumab therapy

“…Coronavirus disease 2019 (COVID‐19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) 1 , continues to cause morbidity and mortality across the world. Expert recommendation is to continue biologic therapy unchanged in severe eosinophilic asthma 2 , 3 but concern has been expressed as eosinopenia may be a risk factor for worse disease outcomes 4 . Here we report the outcomes of four patients from centres in the UK, Italy and North America with COVID-19, whilst receiving treatment with mepolizumab, an anti IL-5 monoclonal antibody, which reduces eosinophils to within the normal range 5 .…”