key: cord-336026-x02f7byo
authors: Lommatzsch, Marek; Stoll, Paul; Virchow, Johann Christian
title: COVID‐19 in a patient with severe asthma treated with Omalizumab
date: 2020-06-27
journal: Allergy
DOI: 10.1111/all.14456
sha: 
doc_id: 336026
cord_uid: x02f7byo

nan

To the Editor,

The novel coronavirus SARS-CoV-2 is currently spreading around the world, causing one of the largest pandemics in history. Infections with SARS-CoV-2 in at risk populations, especially patients with chronic diseases, represent a major healthcare challenge. 1 Of these, severe asthma is of special concern, not only because of the underlying airway disease, but also because of the use of immunomodulatory medications. Over the last years, several types of highly potent immunomodulatory antibodies (biologics) have been approved for the treatment of severe asthma which can improve asthma control and reduce exacerbations and the need for treatments with side effects prone systemic corticosteroids. 2 However, the impact and safety of a treatment with biologics during SARS-CoV-2 infections is currently unknown. Here, we report, for the first time, a case of COVID-19 during treatment with the anti-IgE antibody omalizumab. There is evidence that patients with asthma might generally be at a lower risk for severe forms of COVID-19. It has been reported that the proportion of patients with asthma among hospitalized patients with COVID-19 is low and that hospitalized patients with asthma are not at an increased risk for severe COVID-19 disease. 1, 3, 4 This is sup- with asthma following Omalizumab treatment is primarily mediated by a downregulation of the high-affinity IgE receptor on pDCs. 8, 9 Thus, we hypothesize that the patient described in this case report might have been protected from an asthma exacerbation or pneumonia during COVID-19, either because of the underlying disease (allergic asthma) or because of the antibody used for treatment (Omalizumab), or both. Therefore, studies are needed to characterize the precise interaction of chronic airway diseases (such as asthma) and of biologics (such as Omalizumab) with SARS-CoV-2 infections in humans.

Circumstantial evidence suggests that patients with allergic asthma might have a lower risk to develop severe forms of COVID-19. In addition, the anti-IgE antibody Omalizumab was shown to enhance anti-viral immunity. We report a case of a 52-year-old man with severe allergic asthma treated with Omalizumab with no evidence of an asthma exacerbation, loss of asthma control or pneumonia during symptomatic COVID-19 disease. We hypothesize that the underlying disease (allergic asthma) or the antibody used for treatment (Omalizumab), or both, might have exerted protective effects.

ML, PS, and JCV report no conflicts of interest regarding this case report.

University of Rostock, Germany. F I G U R E 1 Lung function (measured using body plethysmography), asthma control and biomarkers before and after the SARS-CoV-2 infection. The y-axis of the flow-volume curve shows the volume (in liters) and the x-axis the flow (in liters per second). ACT, Asthma Control Test, FeNO, Fraction of exhaled nitric oxide, ppb: parts per billion, Eos, Eosinophils in peripheral blood, FEV 1 , Forced expiratory volume in the first second of expiration, RV, Residual volume µL µL F I G U R E 2 Timeline of symptoms and events before and during the SARS-CoV-2 infection

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