Safety of biological therapy in children and adolescents with severe asthma during the COVID-19 pandemic: a case series.

Safety of biological therapy in children and adolescents with severe asthma during the COVID-19 pandemic: a case series.

Authors

Keywords:

Asthma, Biological therapy, Children, COVID-19, Mepolizumab, Omalizumab, SARS-CoV-2 infection

Abstract

Background and aim  It is still unclear whether patients with severe asthma are at greater risk of developing severe COVID-19, particularly pediatric allergic patients under biologic therapy. Studies targeting pediatric patients are currently limited; thus, this study aims to assess the clinical characteristics of young patients with severe asthma under biological therapies during the COVID-19 pandemic.

Methods We collected data from February 2020 to April 2021. Patients with severe asthma treated with biological therapies (omalizumab and mepolizumab) have been enrolled. We described demographic data, clinical features, therapies, comorbidities, and laboratory findings for each patient. For patients who got COVID-19, we also described the severity of the disease, the need for hospitalization, and specific therapy.

Results A total of 14 patients were included in the study, 11 (78.6%) of them under treatment with omalizumab and 3 (21.6%) with mepolizumab. We identified four patients (28.6%) who tested positive for SARS-CoV-2. Two patients treated with mepolizumab had an asymptomatic disease, and two patients treated with omalizumab had mild disease. Only one patient with mild COVID-19 required hospitalization and specific therapy because of severe obesity.

Conclusions No differences regarding the SARS-CoV-2 infection have been found between the two treatments groups. Furthermore, any poor outcome has been observed, confirming the safety of biological therapies. The limited number of patients enrolled and the lack of a control group did not establish a significant risk for infections for these patients.

References

Castagnoli R, Votto M, Licari A, et al. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review. JAMA Pediatr. 2020;174(9):882-9.

Manti S, Licari A, Montagna L, et al. SARS-CoV-2 infection in pediatric population. Acta Biomed. 2020;91(11-S):e2020003.

Novelli V, Cutti S, Muzzi A, et al. Timely adaptation of a Pediatric Unit to COVID-19 emergency in Northern Italy: the experience of Fondazione IRCCS Policlinico San Matteo in Pavia. Acta Biomed. 2020;91(11-S):e2020004.

Votto M, De Filippo M; Pediatric Residents of the University of Pavia, Italy. How pediatric resident's life has changed during the COVID-19 pandemic. Ital J Pediatr. 2020 Oct;46(1):156.

Licari A, Votto M, Brambilla I, et al. Allergy and asthma in children and adolescents during the COVID outbreak: What we know and how we could prevent allergy and asthma flares. Allergy. 2020;75(9):2402-5.

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):487-9.

Smith SJ, Busby J, Heaney LG, et al. The impact of the first COVID-19 surgeon severe asthma patients in the UK. Which is worse: the virus or the lockdown? ERJ Open Res. 2021;7(1):00768-2020.

Matucci A, Caminati M, Vivarelli E, et al. COVID-19 in severe asthmatic patients during ongoing treatment with biologicals targeting type 2 inflammation: Results from a multicenter Italian survey. Allergy. 2021;76(3):871-4.

Licari A, Castagnoli R, Votto M, et al. Biologic Use in Allergic and Asthmatic Children and Adolescents During the COVID-19 Pandemic. Pediatr Allergy Immunol Pulmonol. 2020; 33(3):155–8.

Licari A, Manti S, Castagnoli R, et al. Targeted Therapy for Severe Asthma in Children and Adolescents: Current and Future Perspectives. Paediatr Drugs. 2019;21(4):215-37.

Antonicelli L, Tontini C, Manzotti G, et al. Severe asthma in adults does not significantly affect the outcome of COVID-19 disease: Results from the Italian Severe Asthma Registry. Allergy. 2021;76(3):902-5.

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.

Haroun-Díaz E, Vázquez de la Torre M, Ruano FJ, et al. Severe asthma during the COVID-19 pandemic: Clinical observations. J Allergy Clin Immunol Pract. 2020;8(8):2787-9.

De Filippo M, Votto M, Brambilla I, et al. Allergy and COVID-19. Acta Biomed. 2021;92(S7):e2021522.

Esquivel A, Busse WW, Calatroni A, et al. Effects of Omalizumab on Rhinovirus Infections, Illnesses, and Exacerbations of Asthma. Am J Respir Crit Care Med. 2017;196(8):985-92.

Huang YC, Weng CM, Lee MJ, et al. Endotypes of severe allergic asthma patients who clinically benefit from anti-IgE therapy. Clin Exp Allergy. 2019;49(1):44-53.

Lindsley AW, Schwartz JT, Rothenberg ME. Eosinophil responses during COVID-19 infections and coronavirus vaccination. J Allergy Clin Immunol. 2020;146(1):1-7.

Cardinale F, Ciprandi G, Barberi S, et al. Consensus statement of the Italian society of pediatric allergy and immunology for the pragmatic management of children and adolescents with allergic or immunological diseases during the COVID-19 pandemic. Ital J Pediatr. 2020;46(1):84.

Cianferoni A, Votto M. COVID-19 and allergy: How to take care of allergic patients during a pandemic? Pediatr Allergy Immunol. 2020;31 Suppl 26(Suppl 26):96-101.

Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention 2021. Available at: www.ginasthma.org.

Bousquet J, Jutel M, Akdis CA, et al. ARIA-EAACI statement on asthma and COVID-19 (June 2, 2020). Allergy. 2021;76(3):689-97.

Roberts G,Vazquez-Ortiz M, Knibb R, et al. EAACI Guidelines on the effective transition of adolescents and young adults with allergy and asthma. Allergy 2020;75:2734-52.

Li X, Xu S, Yu M, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol 2020;146:110–8.

Skevaki C, Karsonova A, Karaulov A, Xie M, Renz H. Asthma-associated risk for COVID-19 development. J Allergy Clin Immunol 2020;146:1295-1301.

Izquierdo JL, Almonacid C, González Y, et al. The impact of COVID-19 on patients with asthma. Eur Respir J 2021;57:2003142.

De Filippo M, Votto M, Licari A, et al. Novel therapeutic approaches targeting endotypes of severe airway disease. Expert Rev Respir Med 2021:1-14.

Williamson EJ, Walker AJ, Bhaskaran K, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature 2020;584:430-6.

Eggert LE, He Z, Collins W, et al. Asthma phenotypes, associated comorbidities, and long-term symptoms in COVID-19. Allergy. 2022;77(1):173-185.

Tosca MA, Licari A, Marseglia GL, et al. COVID-19 in Italian children and adolescents: the role of allergy and asthma. Allergy Asthma Proc. 2021;42:101-2

Boechat JL, Wandalsen GF, Kuschnir FC, et al. COVID-19 and pediatric asthma: clinical and management challenges. Int J Environ Res Public Health 2021;18:1093.

Moeller A, Thanikkel L, Duijts L, et al. COVID-19 in children with underlying chronic respiratory diseases: survey results from 174 centres. ERJ Open Res 2020;6:00409-2020.

Downloads

Published

06-06-2022

How to Cite

1.
Safety of biological therapy in children and adolescents with severe asthma during the COVID-19 pandemic: a case series. . Acta Biomed [Internet]. 2022 Jun. 6 [cited 2024 Mar. 29];93(S3):e2022053. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/13073