Sönmez Sadi Can, Kısakürek Zeynep Büşra, Ozturk Ayse Bilge, Tekin Süda
School of Medicine, Koç University, Istanbul, Turkey.
Department of Allergy and Immunology, Koç University, School of Medicine, İstanbul, Turkey.
Turk Thorac J. 2021 Nov;22(6):501-506. doi: 10.5152/TurkThoracJ.2021.20329.
Recent developments in research have put forward claims on the protective effect of allergic diseases-especially allergic airway inflammation including allergic asthma-against the COVID-19 pandemic. This was first suggested by the underrepresentation of asthma patients in some cohorts and was later investigated by angiotensin-converting enzyme II (ACEII) receptor expression studies. Controversial data on this matter persists and continue to be a challenge for clinicians when it comes to managing allergic diseases during the pandemic. We present in this study a thorough review of related findings so far and our own experience with 2 severe asthma patients who presented with atypical symptoms. Interestingly, both patients were administered anti-IgE therapy prior to the initial positive polymerase chain reaction (PCR) results for COVID-19 and showed no symptoms of severe respiratory disease during the infection unlike what we know from other viral respiratory illnesses. Stemming from that, we wanted to combine the perspectives of allergists and infectious disease specialists to address certain concerns in the management of allergic diseases, such as biologicals, in the light of current guidelines. We have also pointed out certain gaps in clinical and molecular level research, such as the lack of phenotypicalsubgroup analysis among ill asthma patients and the lack of data concerning the molecular effects of biologicals on viral infection.
近期的研究进展提出了关于过敏性疾病——尤其是包括过敏性哮喘在内的过敏性气道炎症——对新冠疫情具有保护作用的说法。这一观点最初是由一些队列研究中哮喘患者比例过低所暗示的，随后通过血管紧张素转换酶II（ACEII）受体表达研究进行了调查。关于此事的有争议的数据仍然存在，并且在疫情期间管理过敏性疾病时，对临床医生来说仍然是一个挑战。在本研究中，我们全面回顾了迄今为止的相关研究结果以及我们对两名出现非典型症状的重度哮喘患者的治疗经验。有趣的是，两名患者在新冠病毒聚合酶链反应（PCR）首次检测呈阳性之前都接受了抗IgE治疗，并且在感染期间没有出现严重呼吸道疾病的症状，这与我们从其他病毒性呼吸道疾病中所了解的情况不同。基于此，我们希望结合过敏症专科医生和传染病专科医生的观点，根据当前指南解决过敏性疾病管理中的某些问题，例如生物制剂的使用。我们还指出了临床和分子水平研究中的某些差距，例如哮喘患者中缺乏表型亚组分析，以及缺乏关于生物制剂对病毒感染分子影响的数据。
