Aeroallergen immunotherapy associated with reduced risk of severe COVID-19 in 1095 allergic patients

Allergen immunotherapy (AIT) brings along changes in the immune system, restoring dendritic cell function, reducing T2 inflammation and augmenting the regulatory cell activation. Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, interf...

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Published in:	The World Allergy Organization journal Vol. 16; no. 5; p. 100779
Main Authors:	Larenas-Linnemann, Désirée, Morfin-Maciel, Blanca María, Bedolla-Barajas, Martín, López-Bago, Ana, Navarrete Rodríguez, Elsy Maureen, Mogica-Martínez, María Dolores, Gereda, José E., Sarrazola Sanjuan, Mauricio, Cano Pedroza, Rosa Yazmín, Cavallo, María Cecilia, Romero Tapia, Sergio de Jesús, Jossen, Roberto A., Fuentes Pérez, José Miguel, Del Rio Navarro, Blanca E., Rodríguez Zagal, Erendira, Piraino Sosa, Pedro A., Huerta Villalobos, Yunuen Rocío, Chavez-Vereau, Pierre, García Imperial, Daniel Alberto, Olivares Gómez, Margarita, Valle Rodríguez, Francisco, Zuñiga Reyes, Carlos Omar, Rodríguez-González, Mónica, Gallego Corella, Claudia Ivonne, Ivancevich, Juan Carlos, García Cruz, María de la Luz Hortencia, Repka-Ramirez, María Susana, Flores Morales, Mauricio Ernesto, Fernández De Córdova Aguirre, Juan Carlos, Luna-Pech, Jorge A., Rivero Yeverino, Daniela, Martínez Guzmán, Edgar, Pérez Ortiz, Cinthia Elizabeth, Villa Médica, Leonor
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-05-2023 Elsevier BV Published by Elsevier Inc. on behalf of World Allergy Organization Elsevier
Subjects:	Age Allergen immunotherapy Allergens Allergic asthma Allergies Asthma COVID-19 COVID-19 vaccines Datasets Disease Dyspnea Fatalities Immunotherapy Infections Olfaction disorders Oxygen therapy Pandemics Patients Physicians Registry Rhinitis Severe acute respiratory syndrome coronavirus 2 Severe COVID-19 Taste disorders Urticaria Viral infections COVID-19 Allergic asthma Severe COVID-19 Registry Oxygen therapy Allergen immunotherapy
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Summary:	Allergen immunotherapy (AIT) brings along changes in the immune system, restoring dendritic cell function, reducing T2 inflammation and augmenting the regulatory cell activation. Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, interferes with the immune system causing immune suppression during the first phase and over-activation in more advanced disease. We decided to explore the interaction of both in a real-world observational trial. We registered COVID-19 outcomes in patients with allergic disorders in Latin America, treated with and without AIT. The registry was conducted during the first 1.3 years of the pandemic, with most of the data collected before COVID-19 vaccination was concluded in most countries. Data collection was anonymous via a web-based instrument. Ten countries participated. 630/1095 (57.6%) of the included patients received AIT. Compared to patients without AIT, those treated with AIT had a reduced risk ratio (RR) for COVID-19 lower respiratory symptoms (RR 0.78, 95% CI: 0.6703–0.9024; p = 0.001662) and need for oxygen therapy (RR 0.65, 95% CI: 0.4217–0.9992; p = 0.048). In adherent patients on maintenance sublingual immunotherapy/subcutaneous immunotherapy (SLIT/SCIT) the RR reduction was larger [RR = 0.6136 (95% CI 0.4623–0.8143; p < 0.001) and RR: 0.3495 (95% CI 0.1822–0.6701; p < 0.005), respectively]. SLIT was slightly more effective (NS). We excluded age, comorbidities, level of health care attendance, and type of allergic disorder as confounders, although asthma was related to a higher frequency of severe disease. When analyzing patients with allergic asthma (n = 503) the RR reduction favoring AIT was more pronounced with 30% for lower respiratory symptoms or worse (RR 0.6914, 95% CI 0.5264 to 0.9081, p = 0.0087) and 51% for need of oxygen therapy or worse (RR 0.4868, 95% CI 0.2829–0.8376, p = 0.0082). Among severe allergic patients treated with biologics (n = 24) only 2/24 needed oxygen therapy. There were no critical cases among them. In our registry AIT was associated with reduced COVID-19 severity.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1939-4551 1939-4551
DOI:	10.1016/j.waojou.2023.100779