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Medical Journal Review

September 2020

WAO Reviews – Editors' Choice

The Editors’ Choice comes to you from Juan Carlos Ivancevich, MD, and John J. Oppenheimer, MD, FACAAI, FAAAAI. They select articles for their importance to clinicians who care for patients with asthma and allergic/immunologic diseases, and whenever possible, for their accessibility to everyone.

Asthma in COVID-19 hospitalizations: An overestimated risk factor?
Broadhurst R, Peterson R, Wisnivesky JP, Federman A, Zimmer SM et al.
Annals of the American Thoracic Society 2020; Published online ahead of print (31 August)
https://doi.org/10.1513/AnnalsATS.202006-613RL

In this study, the authors performed a focused literature review to identify studies reporting asthma prevalence among patients hospitalized for COVID-19 infection, which had published prior to May 7, 2020. They found that asthma prevalence among those hospitalized with COVID-19 appears to be similar to population asthma prevalence and significantly lower than asthma prevalence among patients hospitalized for influenza. Furthermore, they found that asthma did not appear to be an independent risk factor for intubation among hospitalized COVID-19 patients, even after adjusting for the well-known risk factors, body mass index, and age.

The role of the allergist/immunologist in the COVID-19 pandemic: A Janus-faced presentation
Bellanti JA
Allergy & Asthma Proceedings 2020; Published online ahead of print (14 August)
https://doi.org/10.2500/aap.2020.41.200072

In this article, Dr Bellanti examines the current body of evidence supporting the two phases of infection and inflammation that influence the pathogenesis of COVID-19. Numerous clinical trials are being performed in attempt to identify the most effective treatments for COVID-19. As noted by the author, every specialty of medicine has been affected by COVID-19, but the allergy/immunology specialty holds a special place in the battle against this pandemic. We are uniquely poised to play a major role both in the delivery of specialized therapeutic procedures and practices that can improve the health of patients with COVID-19 as well as in the use of hopeful newly developed vaccines for the prevention of its spread.

Deep immune profiling of COVID-19 patients reveals distinct immunotypes with therapeutic implications
Mathew D, Giles JR, Baster AE, Oldridge DA, Greenplate ER et al.
Science 2020;369(6508):eabc8511
https://doi.org/10.1126/science.abc8511

Analysis of 125 hospitalized COVID-19 patients revealed that while CD4 and CD8T cells were activated in some patients, T cell responses were limited in others. In many patients, CD4 and CD8 T cell proliferation (measured by KI67 increase) and activation (detected by CD38 and HLA-DR coexpression) were consistent with antiviral responses observed in other infections. Plasmablast (PB) responses were present in many patients, reaching >30% of total B-cells, and most patients made SARS-CoV-2–specific antibodies. However, ~20% of patients had little T cell activation or PB response compared with controls. In some patients, responses declined over time, resembling typical kinetics of antiviral response, while in others, robust T cell and PB responses remained stable or actually increased over time. Not surprisingly, these disparate patterns were associated with specific clinical features. The authors were able to distill ~200 immune parameters into 3 immunotypes of COVID-19: (1) Immunotype 1 was associated with disease severity and showed robust activated CD4 T cells, a paucity of circulating follicular helper cells, activated CD8 “EMRAs”, hyperactivated or exhausted CD8 T cells, and PBs. (2) Immunotype 2 was characterized by less CD4 T cell activation, Tbet+ effector CD4 and CD8T cells, and proliferating memory B cells and was not associated with disease severity. (3) Immunotype 3, which negatively correlated with disease severity and lacked obvious activated T and B cell responses, was also identified. Mortality occurred for patients with all three immunotypes, illustrating a complex relationship between immune response and COVID-19.

Clinical presentation at the onset of COVID-19 and allergic rhinoconjunctivitis
Ferreli F, Gaino F, Russo E, Di Bari M, Pirola F et al
Journal of Allergy and Clinical Immunology: In Practice 2020; Published online ahead of print (18 August)
https://doi.org/10.1016/j.jaip.2020.08.009

In this letter to the editor, the authors examined nasal and ocular manifestations and their impact on quality of life at the onset of COVID-19 among 204 patients who also suffer from allergic rhinoconjunctivitis (ARC), demonstrating that COVID-19 manifestations at the onset were clearly different from ARC. Specifically, patients with allergy are very familiar with ARC symptoms and are able to distinguish them from COVID-19 rhinoconjunctival manifestations in most cases.

Association of maternal prepregnancy weight and gestational weight gain with children’s allergic diseases
Chen Y, Zhu J, Lyu J, Xia Y, Ying Y et al
JAMA Network Open 2020;3(9):e2015643 (2 September)
https://doi.org/10.1001/jamanetworkopen.2020.15643

In this cross-sectional study of 8877 children, Chen and colleagues examined whether maternal pre-pregnancy weight and gestational weight gain were associated with the development of childhood allergic illnesses, finding that excessive gestational weight gain was associated with a risk of asthma and/or wheezing, allergic rhinitis, eczema, and food and/or drug allergy. Moreover, this risk appeared to be higher when coexisting with maternal pre-pregnancy overweight or obesity. Low gestational weight gain was associated with a reduced risk of allergies in children of women with low or normal pre-pregnancy weight, while there was no association in women who were overweight or obese. The authors suggest that to meet the challenge of increasing childhood allergies, the management of pre-pregnancy weight control and gestational weight gain must be addressed.

 

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