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Use of biologicals in allergic and type-2 inflammatory diseases during the current COVID-19 pandemic: Position paper of Ärzteverband Deutscher Allergologen (AeDA)A, Deutsche Gesellschaft für Allergologie und Klinische Immunologie (DGAKI)B, Gesellschaft für Pädiatrische Allergologie und Umweltmedizin (GPA)C, Österreichische Gesellschaft für Allergologie und Immunologie (ÖGAI)D, Luxemburgische Gesellschaft für Allergologie und Immunologie (LGAI)E, Österreichische Gesellschaft für Pneumologie (ÖGP)F in co-operation with the German, Austrian, and Swiss ARIA groupsG, and the European Academy of Allergy and Clinical Immunology (EAACI)H.
Journal article

Use of biologicals in allergic and type-2 inflammatory diseases during the current COVID-19 pandemic: Position paper of Ärzteverband Deutscher Allergologen (AeDA)A, Deutsche Gesellschaft für Allergologie und Klinische Immunologie (DGAKI)B, Gesellschaft für Pädiatrische Allergologie und Umweltmedizin (GPA)C, Österreichische Gesellschaft für Allergologie und Immunologie (ÖGAI)D, Luxemburgische Gesellschaft für Allergologie und Immunologie (LGAI)E, Österreichische Gesellschaft für Pneumologie (ÖGP)F in co-operation with the German, Austrian, and Swiss ARIA groupsG, and the European Academy of Allergy and Clinical Immunology (EAACI)H.

  • Klimek L Ärzteverband Deutscher Allergologen (AeDA).
  • Pfaar O Deutsche Gesellschaft für Allergologie und Klinische Immunologie (DGAKI).
  • Worm M Deutsche Gesellschaft für Allergologie und Klinische Immunologie (DGAKI).
  • Eiwegger T European Academy of Allergy and Clinical Immunology (EAACI).
  • Hagemann J Ärzteverband Deutscher Allergologen (AeDA).
  • Ollert M Luxemburgische Gesellschaft für Allergologie und Immunologie (LGAI).
  • Untersmayr E European Academy of Allergy and Clinical Immunology (EAACI).
  • Hoffmann-Sommergruber K European Academy of Allergy and Clinical Immunology (EAACI).
  • Vultaggio A European Academy of Allergy and Clinical Immunology (EAACI).
  • Agache I European Academy of Allergy and Clinical Immunology (EAACI).
  • Bavbek S European Academy of Allergy and Clinical Immunology (EAACI).
  • Bossios A European Academy of Allergy and Clinical Immunology (EAACI).
  • Casper I Ärzteverband Deutscher Allergologen (AeDA).
  • Chan S European Academy of Allergy and Clinical Immunology (EAACI).
  • Chatzipetrou A European Academy of Allergy and Clinical Immunology (EAACI).
  • Vogelberg C Gesellschaft für Pädiatrische Allergologie und Umweltmedizin (GPA).
  • Firinu D European Academy of Allergy and Clinical Immunology (EAACI).
  • Kauppi P European Academy of Allergy and Clinical Immunology (EAACI).
  • Kolios A European Academy of Allergy and Clinical Immunology (EAACI).
  • Kothari A European Academy of Allergy and Clinical Immunology (EAACI).
  • Matucci A European Academy of Allergy and Clinical Immunology (EAACI).
  • Palomares O European Academy of Allergy and Clinical Immunology (EAACI).
  • Szépfalusi Z Österreichische Gesellschaft für Allergologie und Immunologie (ÖGAI).
  • Pohl W Österreichische Gesellschaft für Allergologie und Immunologie (ÖGAI).
  • Hötzenecker W Österreichische Gesellschaft für Allergologie und Immunologie (ÖGAI).
  • Rosenkranz AR Österreichische Gesellschaft für Allergologie und Immunologie (ÖGAI).
  • Bergmann KC Ärzteverband Deutscher Allergologen (AeDA).
  • Bieber T German, Austrian, and Swiss ARIA groups.
  • Buhl R Deutsche Gesellschaft für Allergologie und Klinische Immunologie (DGAKI).
  • Buters J German, Austrian, and Swiss ARIA groups.
  • Darsow U German, Austrian, and Swiss ARIA groups.
  • Keil T German, Austrian, and Swiss ARIA groups.
  • Kleine-Tebbe J Ärzteverband Deutscher Allergologen (AeDA).
  • Lau S Deutsche Gesellschaft für Allergologie und Klinische Immunologie (DGAKI).
  • Maurer M German, Austrian, and Swiss ARIA groups.
  • Merk H Ärzteverband Deutscher Allergologen (AeDA).
  • Mösges R Deutsche Gesellschaft für Allergologie und Klinische Immunologie (DGAKI).
  • Saloga J Deutsche Gesellschaft für Allergologie und Klinische Immunologie (DGAKI).
  • Staubach P Ärzteverband Deutscher Allergologen (AeDA).
  • Jappe U Ärzteverband Deutscher Allergologen (AeDA).
  • Rabe KF German, Austrian, and Swiss ARIA groups.
  • Rabe U Ärzteverband Deutscher Allergologen (AeDA).
  • Vogelmeier C German, Austrian, and Swiss ARIA groups.
  • Biedermann T Deutsche Gesellschaft für Allergologie und Klinische Immunologie (DGAKI).
  • Jung K Ärzteverband Deutscher Allergologen (AeDA).
  • Schlenter W Ärzteverband Deutscher Allergologen (AeDA).
  • Ring J Ärzteverband Deutscher Allergologen (AeDA).
  • Chaker A Ärzteverband Deutscher Allergologen (AeDA).
  • Wehrmann W Ärzteverband Deutscher Allergologen (AeDA).
  • Becker S Ärzteverband Deutscher Allergologen (AeDA).
  • Freudelsperger L Ärzteverband Deutscher Allergologen (AeDA).
  • Mülleneisen N Ärzteverband Deutscher Allergologen (AeDA).
  • Nemat K Ärzteverband Deutscher Allergologen (AeDA).
  • Czech W Ärzteverband Deutscher Allergologen (AeDA).
  • Wrede H Ärzteverband Deutscher Allergologen (AeDA).
  • Brehler R Ärzteverband Deutscher Allergologen (AeDA).
  • Fuchs T Ärzteverband Deutscher Allergologen (AeDA).
  • Tomazic PV European Academy of Allergy and Clinical Immunology (EAACI).
  • Aberer W Österreichische Gesellschaft für Allergologie und Immunologie (ÖGAI).
  • Fink-Wagner AH Österreichische Gesellschaft für Allergologie und Immunologie (ÖGAI).
  • Horak F Österreichische Gesellschaft für Allergologie und Immunologie (ÖGAI).
  • Wöhrl S Österreichische Gesellschaft für Allergologie und Immunologie (ÖGAI).
  • Niederberger-Leppin V German, Austrian, and Swiss ARIA groups.
  • Pali-Schöll I German, Austrian, and Swiss ARIA groups.
  • Pohl W German, Austrian, and Swiss ARIA groups.
  • Roller-Wirnsberger R German, Austrian, and Swiss ARIA groups.
  • Spranger O German, Austrian, and Swiss ARIA groups.
  • Valenta R German, Austrian, and Swiss ARIA groups.
  • Akdis M European Academy of Allergy and Clinical Immunology (EAACI).
  • Matricardi PM Ärzteverband Deutscher Allergologen (AeDA).
  • Spertini F Charité - Universitätsmedizin Berlin.
  • Khaltaev N Division of Allergy and Immunology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
  • Michel JP GARD Chairman, Genf, Switzerland.
  • Nicod L Department of Rehabilitation and Geriatrics, University of Geneva, Genf, Switzerland.
  • Schmid-Grendelmeier P Clinic Cecil of Hirslanden Group of Lausanne; Centre Hôpitalier Universitaire du canton de Vaud Lausanne, Switzerland.
  • Idzko M German, Austrian, and Swiss ARIA groups.
  • Hamelmann E Deutsche Gesellschaft für Allergologie und Klinische Immunologie (DGAKI).
  • Jakob T Kinderzentrum Bethel, Evangelisches Klinikum Bethel, Universitätsmedizin OWL der Universität Bielefeld.
  • Werfel T Deutsche Gesellschaft für Allergologie und Klinische Immunologie (DGAKI).
  • Wagenmann M Deutsche Gesellschaft für Allergologie und Klinische Immunologie (DGAKI).
  • Taube C Deutsche Gesellschaft für Allergologie und Klinische Immunologie (DGAKI).
  • Jensen-Jarolim E Österreichische Gesellschaft für Allergologie und Immunologie (ÖGAI).
  • Korn S Ärzteverband Deutscher Allergologen (AeDA).
  • Hentges F Luxemburgische Gesellschaft für Allergologie und Immunologie (LGAI).
  • Schwarze J European Academy of Allergy and Clinical Immunology (EAACI).
  • O Mahony L European Academy of Allergy and Clinical Immunology (EAACI).
  • Knol EF European Academy of Allergy and Clinical Immunology (EAACI).
  • Del Giacco S European Academy of Allergy and Clinical Immunology (EAACI).
  • Chivato Pérez T European Academy of Allergy and Clinical Immunology (EAACI).
  • Bousquet J German, Austrian, and Swiss ARIA groups.
  • Bedbrook A German, Austrian, and Swiss ARIA groups.
  • Zuberbier T German, Austrian, and Swiss ARIA groups.
  • Akdis C German, Austrian, and Swiss ARIA groups.
  • Jutel M European Academy of Allergy and Clinical Immunology (EAACI).
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  • 2020-09-11
Published in:
  • Allergologie select. - 2020
COVID-19
SARS-CoV-2
benralizumab
dupilumab
mepolizumab
omalizumab
reslizumab
telemedicine
English BACKGROUND
Since the beginning of the COVID-19 pandemic, the treatment of patients with allergic and atopy-associated diseases has faced major challenges. Recommendations for "social distancing" and the fear of patients becoming infected during a visit to a medical facility have led to a drastic decrease in personal doctor-patient contacts. This affects both acute care and treatment of the chronically ill. The immune response after SARS-CoV-2 infection is so far only insufficiently understood and could be altered in a favorable or unfavorable way by therapy with monoclonal antibodies. There is currently no evidence for an increased risk of a severe COVID-19 course in allergic patients. Many patients are under ongoing therapy with biologicals that inhibit type 2 immune responses via various mechanisms. There is uncertainty about possible immunological interactions and potential risks of these biologicals in the case of an infection with SARS-CoV-2.


MATERIALS AND METHODS
A selective literature search was carried out in PubMed, Livivo, and the internet to cover the past 10 years (May 2010 - April 2020). Additionally, the current German-language publications were analyzed. Based on these data, the present position paper provides recommendations for the biological treatment of patients with allergic and atopy-associated diseases during the COVID-19 pandemic.


RESULTS
In order to maintain in-office consultation services, a safe treatment environment must be created that is adapted to the pandemic situation. To date, there is a lack of reliable study data on the care for patients with complex respiratory, atopic, and allergic diseases in times of an imminent infection risk from SARS-CoV-2. Type-2-dominant immune reactions, as they are frequently seen in allergic patients, could influence various phases of COVID-19, e.g., by slowing down the immune reactions. Theoretically, this could have an unfavorable effect in the early phase of a SARS-Cov-2 infection, but also a positive effect during a cytokine storm in the later phase of severe courses. However, since there is currently no evidence for this, all data from patients treated with a biological directed against type 2 immune reactions who develop COVID-19 should be collected in registries, and their disease courses documented in order to be able to provide experience-based instructions in the future.


CONCLUSION
The use of biologicals for the treatment of bronchial asthma, atopic dermatitis, chronic rhinosinusitis with nasal polyps, and spontaneous urticaria should be continued as usual in patients without suspected infection or proven SARS-CoV-2 infection. If available, it is recommended to prefer a formulation for self-application and to offer telemedical monitoring. Treatment should aim at the best possible control of difficult-to-control allergic and atopic diseases using adequate rescue and add-on therapy and should avoid the need for systemic glucocorticosteroids. If SARS-CoV-2 infection is proven or reasonably suspected, the therapy should be determined by weighing the benefits and risks individually for the patient in question, and the patient should be involved in the decision-making. It should be kept in mind that the potential effects of biologicals on the immune response in COVID-19 are currently not known. Telemedical offers are particularly desirable for the acute consultation needs of suitable patients.
Language
  • English
Open access status
green
Identifiers
Persistent URL
https://sonar.ch/global/documents/230127
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