Current issue
Journal content
Articles in press
Archive
About the Journal
About the Polish Annals of Medicine
Editorial Board
Open Access policy
Abstracting & indexing
Affiliated institutions
Contact
Instructions
Peer review process
Guide for authors
Publication ethics
Ethics and Patient Consent
User License
Usage of third party materials
Disclaimer
Reviewers
Guide for reviewers
List of reviewers
Review Form
CASE REPORT
Impact of omalizumab therapy on the course of COVID-19 in a patient with severe asthma: A case report
| 1 | Department of Internal Medicine, Pneumonology and Allergology, Wroclaw Medical University, Poland |
CORRESPONDING AUTHOR
Anna Zaleska
Department of Internal Medicine, Pneumonology and Allergology, Wroclaw Medical University, Curie-Sklodowskiej 66, 50-369 Wroclaw, Poland.
Department of Internal Medicine, Pneumonology and Allergology, Wroclaw Medical University, Curie-Sklodowskiej 66, 50-369 Wroclaw, Poland.
Submission date: 2022-05-28
Final revision date: 2022-09-07
Acceptance date: 2022-09-07
Online publication date: 2023-02-06
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Various risk factors have been attributed to coronavirus disease 19 (COVID-19) severity. Omalizumab as an immunoglobulin E blocker that enhances anti-viral immunity might be a potential cytokine storm trigger.
Aim:
Our goal was to investigate if the treatment with omalizumab due to severe asthma is a risk factor of severe COVID-19 pneumonia and if severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can trigger asthma exacerbation.
Case study:
We report the case of a 65-year-old patient with severe allergic asthma receiving treatment with omalizumab for last 8 months with good results, who in December 2020 was infected with SARS-CoV-2. The patient was not vaccinated against COVID-19 (no vaccine was available at that time), and had comorbidities.
Results and discussion:
COVID-19 course of presented patient was asymptomatic and resolved quickly without the need for hospitalization or asthma exacerbation. There was a slightly worse score on the asthma control questionnaire after COVID-19 resolution (2.1 point vs. 1.5 points) and a threefold increase in eosinophil counts (660 cell/µL vs. 230 cell/µL). However, no wheezing or deterioration in pulmonary function tests were found. A computed tomography of the chest revealed only minor densities of pulmonary parenchyma and thickened walls of bronchi.
Conclusions:
Omalizumab used in the treatment of severe allergic asthma proved to be safe and beneficial for the course of COVID-19 in the case reported. Simultaneously, SARS-CoV-2 was not a factor for asthma exacerbation.
Various risk factors have been attributed to coronavirus disease 19 (COVID-19) severity. Omalizumab as an immunoglobulin E blocker that enhances anti-viral immunity might be a potential cytokine storm trigger.
Aim:
Our goal was to investigate if the treatment with omalizumab due to severe asthma is a risk factor of severe COVID-19 pneumonia and if severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can trigger asthma exacerbation.
Case study:
We report the case of a 65-year-old patient with severe allergic asthma receiving treatment with omalizumab for last 8 months with good results, who in December 2020 was infected with SARS-CoV-2. The patient was not vaccinated against COVID-19 (no vaccine was available at that time), and had comorbidities.
Results and discussion:
COVID-19 course of presented patient was asymptomatic and resolved quickly without the need for hospitalization or asthma exacerbation. There was a slightly worse score on the asthma control questionnaire after COVID-19 resolution (2.1 point vs. 1.5 points) and a threefold increase in eosinophil counts (660 cell/µL vs. 230 cell/µL). However, no wheezing or deterioration in pulmonary function tests were found. A computed tomography of the chest revealed only minor densities of pulmonary parenchyma and thickened walls of bronchi.
Conclusions:
Omalizumab used in the treatment of severe allergic asthma proved to be safe and beneficial for the course of COVID-19 in the case reported. Simultaneously, SARS-CoV-2 was not a factor for asthma exacerbation.
FUNDING
None declared.
CONFLICT OF INTEREST
None declared.
REFERENCES (32)
1.
Romaszko-Wojtowicz AM, Doboszyńska A. Pulmonary complications due to COVID-19 – a literature review. Pol Ann Med. 2021;28(2):244–249. https://doi.org/10.29089/2021.....
2.
Hu B, Guo H, Zhou P, Shi Z-L. Characteristics of SARS-CoV-2 and COVID-19. Nat Rev Microbiol. 2021;19(3):141–154. https://doi.org/10.1038/s41579....
3.
Azkur AK, Akdis M, Azkur D, et al. Immune response to SARS-CoV-2 and mechanisms of immunopathological changes in COVID-19. Allergy. 2020;75(7):1564–1581. https://doi.org/10.1111/all.14....
4.
Gonzales-van Horn SR, Farrar JD. Interferon at the crossroads of allergy and viral infections. J Leukoc Biol. 2015;98(2):185–194. https://doi.org/10.1189/jlb.3r....
5.
Gern JE. How rhinovirus infections cause exacerbations of asthma. Clin Exp Allergy. 2015;45(1):32–42. https://doi.org/10.1111/cea.12....
6.
Contoli M, Message SD, Laza-Stanca V, et al. Role of deficient type III interferon-lambda production in asthma exacerbations. Nat Med. 2006;12(9):1023–1026. https://doi.org/10.1038/nm1462.
7.
Gill MA, Liu AH, Calatroni A, et al. Enhanced plasmacytoid dendritic cell antiviral responses after omalizumab. J Allergy Clin Immunol. 2018;141(5):1735–1743.e9. https://doi.org/10.1016/j.jaci....
8.
Carli G, Cecchi L, Stebbing J, Parronchi P, Farsi A. Is asthma protective against COVID-19? Allergy. 2021;76(3):866–868. https://doi.org/10.1111/all.14....
9.
Gao Y-D, Agache I, Akdis M, et al. The effect of allergy and asthma as a comorbidity on the susceptibility and outcomes of COVID-19. Int Immunol. 2022;34(4):177–188. https://doi.org/10.1093/intimm....
10.
Liu S, Cao Y, Du T, Zhi Y. Prevalence of comorbid asthma and related outcomes in COVID-19: A Systematic Review and Meta-Analysis. J Allergy Clin Immunol Pract. 2021;9(2):693–701. https://doi.org/10.1016/j.jaip....
11.
Busse WW, Humbert M, Haselkorn T, et al. Effect of omalizumab on lung function and eosinophil levels in adolescents with moderate-to-severe allergic asthma. Ann Allergy Asthma Immunol. 2020;124(2):190–196. https://doi.org/10.1016/j.anai....
12.
Licari A, Castagnoli R, Votto M, Brambilla I, Ciprandi G, Marseglia GL. Biologic use in allergic and asthmatic children and adolescents during the COVID-19 pandemic. Pediatr Allergy Immunol Pulmonol. 2020;33(3):155–158. https://doi.org/10.1089/ped.20....
13.
Eger K, Hashimoto S, Braunstahl GJ, et al. Poor outcome of SARS-CoV-2 infection in patients with severe asthma on biologic therapy. Respir Med. 2020;177:106287. https://doi.org/10.1016/j.rmed....
14.
Klimek L, Pfaar O, Worm M, et al. Use of biologicals in allergic and type-2 inflammatory diseases during the current COVID-19 pandemic: Position paper of Ärzteverband Deutscher Allergologen (AeDA)A, Deutsche Gesellschaft für Allergologie und Klinische Immunologie (DGAKI)B, Gesellschaft für Pädiatrische Allergologie und Umweltmedizin (GPA)C, Österreichische Gesellschaft für Allergologie und Immunologie (ÖGAI)D, Luxemburgische Gesellschaft für Allergologie und Immunologie (LGAI)E, Österreichische Gesellschaft für Pneumologie (ÖGP)F in co-operation with the German, Austrian, and Swiss ARIA groupsG, and the European Academy of Allergy and Clinical Immunology (EAACI)H. Allergol Select. 2020;4:53–68. https://doi.org/10.5414/alx021....
15.
Vultaggio A, Agache I, Akdis CA, et al. Considerations on biologicals for patients with allergic disease in times of the COVID-19 pandemic: An EAACI statement. Allergy. 2020;75(11):2764–2774. https://doi.org/10.1111/all.14....
16.
Lommatzsch M, Stoll P, Virchow JC. COVID-19 in a patient with severe asthma treated with Omalizumab. Allergy. 2020;75(10):2705–2708. https://doi.org/10.1111/all.14....
17.
Aksu K, Demir Ş, Topel M, et al. COVID-19 in patients with severe asthma using biological agents. Tuberk Toraks. 2021;69(3):433–436. https://doi.org/10.5578/tt.202....
18.
Rial MJ, Valverde M, Del Pozo V, et al. Clinical characteristics in 545 patients with severe asthma on biological treatment during the COVID-19 outbreak. J Allergy Clin Immunol Pract. 2021;9(1):487–489.e1. https://doi.org/10.1016/j.jaip....
19.
Yamaya M, Nishimura H, Deng X, et al. Inhibitory effects of glycopyrronium, formoterol, and budesonide on coronavirus HCoV-229E replication and cytokine production by primary cultures of human nasal and tracheal epithelial cells. Respir Investig. 2020;58(3):155–168. https://doi.org/10.1016/j.resi....
20.
Matsuyama S, Kawase M, Nao N, et al. The inhaled steroid ciclesonide blocks SARS-CoV-2 RNA replication by targeting the viral replication-transcription complex in cultured cells. J Virol. 2020;95(1):e01648-20. https://doi.org/10.1128/jvi.01....
21.
Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181(2):271–280.e8. https://doi.org/10.1016/j.cell....
22.
Gao Y-D, Ding M, Dong X, et al. Risk factors for severe and critically ill COVID-19 patients: A review. Allergy. 2021;76(2):428–455. https://doi.org/10.1111/all.14....
23.
Shukla AK, Banerjee M. Angiotensin-converting-enzyme 2 and renin-angiotensin system inhibitors in COVID-19: An Update. High Blood Press Cardiovasc Prev. 2021;28(2):129–139. https://doi.org/10.1007/s40292....
24.
Criado PR, Pagliari C, Criado RFJ, Marques GF, Belda W. What the physicians should know about mast cells, dendritic cells, urticaria, and omalizumab during COVID-19 or asymptomatic infections due to SARS-CoV-2? Dermatol Ther. 2020;33(6):e14068. https://doi.org/10.1111/dth.14....
25.
Davoudi-Monfared E, Rahmani H, Khalili H, et al. A Randomized Clinical Trial of the Efficacy and Safety of Interferon β-1a in Treatment of Severe COVID-19. Antimicrob Agents Chemother. 2020;64(9):e01061-20. https://doi.org/10.1128/aac.01....
26.
Zhang J-J, Dong X, Cao Y-Y, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75(7):1730–1741. https://doi.org/10.1111/all.14....
27.
Bastard P, Rosen LB, Zhang Q, et al. Autoantibodies against type I IFNs in patients with life-threatening COVID-19. Science. 2020;370(6515). https://doi.org/10.1126/scienc....
28.
Abdelmaksoud A, Goldust M, Vestita M. Omalizumab and COVID-19 treatment: Could it help? Dermatol Ther. 2020;33(4):e13792. https://doi.org/10.1111/dth.13....
29.
Du Y, Tu L, Zhu P, et al. Clinical features of 85 fatal cases of COVID-19 from Wuhan. A retrospective observational study. Am J Respir Crit Care Med. 2020;201(11):1372–1379. https://doi.org/10.1164/rccm.2....
30.
Xie G, Ding F, Han L, Yin D, Lu H, Zhang M. The role of peripheral blood eosinophil counts in COVID-19 patients. Allergy. 2021;76(2):471–482. https://doi.org/10.1111/all.14....
31.
Lindsley AW, Schwartz JT, Rothenberg ME. Eosinophil responses during COVID-19 infections and coronavirus vaccination. J Allergy Clin Immunol. 2020;146(1):1–7. https://doi.org/10.1016/j.jaci....
32.
Ferastraoaru D, Hudes G, Jerschow E, et al. Eosinophilia in asthma patients is protective against severe COVID-19 illness. J Allergy Clin Immunol Pract. 2021;9(3):1152–1162.e3. https://doi.org/10.1016/j.jaip....
RELATED ARTICLE
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.