Safety of allergen immunotherapy in patients with SARS-CoV-2 infection

Year 2022, , 642 - 649, 04.09.2022

Emel Atayık , Gökhan Aytekin

https://doi.org/10.18621/eurj.1086549

Abstract

Objectives: The aims of presenting study were trying to expose the course of SARS-CoV-2 (severe acute respiratory syndrome–related coronavirus) in patients with allergic rhinitis (AR), to compare the prevalence of SARS-CoV-2 infection, hospitalization and pneumonia rates in patients with AR receiving allergen immunotherapy (AIT) and patients did not receiving AIT (non-receivers) and to define possible risk factors for SARS-CoV-2 positivity in patients with AR.

Methods: A total of 419 patients with AR who were being followed-up in a tertiary allergy clinic between June 1, 2020 and December 31, 2020, were selected for the study.

Results: Seventy-nine (18.9%) patients became infected with the SARS-CoV-2 [32 (19.6%) patients in AR patients with AIT and 47 (18.4%) patients in non-receivers] and the rate of pneumonia was 2.4% [12.7% of SARS-CoV-2 (+) patients]. There was no significant difference was determined between the AR patients with AIT and the non-receivers in regard of the rate of SARS-CoV-2 infection, pneumonia and hospitalization (p = 0.864, p = 0.055 and p = 0.075; respectively). There was a significant difference between the groups in terms of gender, duration of disease, sensitivity to allergens (atopy) and serum IgE levels (p = 0.009, p = 0.001, p = 0.001 and p = 0.001; respectively). The accompanying comorbidities, eosinophil cout, AIT and duration of AIT were not found to be associated with an increased risk SARS-CoV-2 PCR positivity. However, female gender was shown to be associated with an decreased risk for SARS-CoV-2 PCR positivity (OR, 0.571; 95% confidence interval, 0.330-0.987; p = 0.045).

Conclusions: The course of SARS-CoV-2 is similar in patients with AR who underwent AIT and patients with AR who did not undergo AIT, and AIT does not seem to increase the risk for SARS-CoV-2 infection.

Keywords

Allergic rhinitis, allergy immunotherapy, subcutaneous immunotherapy, therapeutics

Project Number

2021/027

References

• 1. Aboubakr HA, Sharafeldin TA, Goyal SM. Stability of SARS-CoV-2 and other coronaviruses in the environment and on common touch surfaces and the influence of climatic conditions: a review. Transbound Emerg Dis 2021;68:296-312.
• 2. Rostami A, Sepidarkish M, Leeflang MMG, Riahi SM, Nourollahpour Shiadeh M, Esfandyari S, et al. SARS-CoV-2 seroprevalence worldwide: a systematic review and meta-analysis. Clin Microbiol Infect 2021;27:331-40.
• 3. Settipane RA. Demographics and epidemiology of allergic and nonallergic rhinitis. Allergy Asthma Proc 2001;22:185-9.
• 4. Singh K, Axelrod S, Bielory L. The epidemiology of ocular and nasal allergy in the United States, 1988-1994. J Allergy Clin Immunol 2010;126:778-83 e6.
• 5. Durrani SR, Montville DJ, Pratt AS, Sahu S, DeVries MK, Rajamanickam V, et al. Innate immune responses to rhinovirus are reduced by the high-affinity IgE receptor in allergic asthmatic children. J Allergy Clin Immunol 2012;130:489-95.
• 6. Wark PA, Johnston SL, Bucchieri F, Powell R, Puddicombe S, Laza-Stanca V, et al. Asthmatic bronchial epithelial cells have a deficient innate immune response to infection with rhinovirus. J Exp Med 2005;201:937-47.
• 7. Novak N, Cabanillas B. Viruses and asthma: the role of common respiratory viruses in asthma and its potential meaning for SARS-CoV-2. Immunology 2020;161:83-93.
• 8. Gill MA, Bajwa G, George TA, Dong CC, Dougherty, II, Jiang N, et al. Counterregulation between the FcepsilonRI pathway and antiviral responses in human plasmacytoid dendritic cells. J Immunol 2010;184:5999-6006.
• 9. Blaser K, Akdis CA. Interleukin-10, T regulatory cells and specific allergy treatment. Clin Exp Allergy 2004;34:328-31.
• 10. van de Veen W, Stanic B, Yaman G, Wawrzyniak M, Sollner S, Akdis DG, et al. IgG4 production is confined to human IL-10-producing regulatory B cells that suppress antigen-specific immune responses. J Allergy Clin Immunol 2013;131:1204-12.
• 11. Ye Q, Wang B, Mao J. The pathogenesis and treatment of the `Cytokine Storm' in COVID-19. J Infect 2020;80:607-13.
• 12. Wang H, Song J, Yao Y, Deng YK, Wang ZC, Liao B, et al. Angiotensin-converting enzyme II expression and its implication in the association between COVID-19 and allergic rhinitis. Allergy 2021;76:906-10.
• 13. Ren J, Pang W, Luo Y, Cheng D, Qiu K, Rao Y, et al. Impact of allergic rhinitis and asthma on COVID-19 infection, hospitalization, and mortality. J Allergy Clin Immunol Pract 2022;10:124-33.
• 14. Guvey A. How does allergic rhinitis impact the severity of COVID-19?: a case-control study. Eur Arch Otorhinolaryngol 2021;278:4367-71.
• 15. Vezir E, Hizal M, Cura Yayla B, Aykac K, Yilmaz A, Kaya G, et al. Does aeroallergen sensitivity and allergic rhinitis in children cause milder COVID-19 infection? Allergy Asthma Proc 2021;42:522-9.
• 16. Bousquet J, Akdis CA, Jutel M, Bachert C, Klimek L, Agache I, et al. Intranasal corticosteroids in allergic rhinitis in COVID-19 infected patients: An ARIA-EAACI statement. Allergy 2020;75:2440-4.
• 17. Lipworth B, Chan R, RuiWen Kuo C. COVID-19: Start with the nose. J Allergy Clin Immunol 2020;146:1214.
• 18. Strauss R, Jawhari N, Attaway AH, Hu B, Jehi L, Milinovich A, et al. Intranasal corticosteroids are associated with better outcomes in coronavirus disease 2019. J Allergy Clin Immunol Pract 2021;9:3934-40 e9.
• 19. Rosenberg HF, Dyer KD, Domachowske JB. Respiratory viruses and eosinophils: exploring the connections. Antiviral Res 2009;83:1-9.
• 20. Chen Y, Yang M, Deng J, Wang K, Shi J, Sun Y. Elevated levels of activated and pathogenic eosinophils characterize moderate-severe house dust mite allergic rhinitis. J Immunol Res 2020;2020:8085615.
• 21. Carli G, Cecchi L, Stebbing J, Parronchi P, Farsi A. Is asthma protective against COVID-19? Allergy 2021;76:866-8.
• 22. Kimura H, Francisco D, Conway M, Martinez FD, Vercelli D, Polverino F, et al. Type 2 inflammation modulates ACE2 and TMPRSS2 in airway epithelial cells. J Allergy Clin Immunol 2020;146:80-8 e8.
• 23. Yang JM, Koh HY, Moon SY, Yoo IK, Ha EK, You S, et al. Allergic disorders and susceptibility to and severity of COVID-19: a nationwide cohort study. J Allergy Clin Immunol 2020;146:790-8.
• 24. Gao YD, Ding M, Dong X, Zhang JJ, Kursat Azkur A, Azkur D, et al. Risk factors for severe and critically ill COVID-19 patients: a review. Allergy 2021;76:428-55.
• 25. Rashedi J, Mahdavi Poor B, Asgharzadeh V, Pourostadi M, Samadi Kafil H, Vegari A, et al. Risk factors for COVID-19. Infez Med 2020;28:469-74.
• 26. Bienvenu LA, Noonan J, Wang X, Peter K. Higher mortality of COVID-19 in males: sex differences in immune response and cardiovascular comorbidities. Cardiovasc Res 2020;116:2197-206.
• 27. Liu J, Ji H, Zheng W, Wu X, Zhu JJ, Arnold AP, et al. Sex differences in renal angiotensin converting enzyme 2 (ACE2) activity are 17beta-oestradiol-dependent and sex chromosome-independent. Biol Sex Differ 2010;1:6.
• 28. Akdis M, Akdis CA. Mechanisms of allergen-specific immunotherapy: multiple suppressor factors at work in immune tolerance to allergens. J Allergy Clin Immunol 2014;133:621-31.
• 29. Palomares O, Akdis M, Martin-Fontecha M, Akdis CA. Mechanisms of immune regulation in allergic diseases: the role of regulatory T and B cells. Immunol Rev 2017;278:219-36.
• 30. Bellinghausen I, Metz G, Enk AH, Christmann S, Knop J, Saloga J. Insect venom immunotherapy induces interleukin-10 production and a Th2-to-Th1 shift, and changes surface marker expression in venom-allergic subjects. Eur J Immunol 1997;27:1131-9.
• 31. Francis JN, Till SJ, Durham SR. Induction of IL-10+CD4+CD25+ T cells by grass pollen immunotherapy. J Allergy Clin Immunol 2003;111:1255-61.