Désirée E Larenas-Linnemann1, José A Ortega-Martell2, María V Blandón-Vijil3, Noel Rodríguez-Pérez4, Jorge A Luna-Pech5, Alan Estrada-Cardona6, Alfredo Arias-Cruz7, Blanca E Del Rio-Navarro8, Elsy M Navarrete Rodríguez8, Cesar F Pozo-Beltrán9, Ernesto Onuma Takane1, María I Rojo-Gutiérrez10, Francisco J Espinosa-Rosales11, Eric A Martínez-Infante12. 1. From the Médica Sur, Clinical foundation and hospital, Mexico City, Mexico. 2. Centro Universitario de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Mexico. 3. Private practice, Hospital Médica Sur, Mexico City, Mexico. 4. Universidad Autónoma de Tamaulipas, Matamoros, Mexico. 5. Departamento de Disciplinas Filosóficas Metodoloógicas e Instrumentales, Universidad de Guadalajara, Jalisco, Mexico. 6. Grupo COSTAMED, Playa del Carmen, Mexico. 7. Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Mexico. 8. Servicio de Alegia e Inmunología Clínica, Hospital Infantil de Mexico Federico Gómez, Mexico City, Mexico. 9. Subdirección de Enseñanza e Investigación, Hospital General de Especialidades Juan María Salvatierra, Baja California Sur, Mexico. 10. División de Medicina, Hospital Juárez de Mexico, Ciudad de Mexico, Mexico. 11. Centro de Inmunologia, Alergia y Pediatria, Hospital Angeles Lomas, Estado de Mexico, Mexico; and. 12. Hospital General de Zona N. 1, Instituto Mexicano del Seguro Social, Oaxaca, Mexico.
Abstract
Background: Both, allergen immunotherapy (AIT) and SARS-COV-2 infection cause a set of immunologic changes that respectively vary during the course of the treatment or the disease. Objective: To review immune changes brought along by each of these entities and how they might interrelate. Methods: We start presenting a brief review of the structure of the new coronavirus and how it alters the functioning of the human immune system. Subsequently, we describe the immune changes induced by AIT and how these changes could be favorable or unfavorable in the allergic patient infected with SARS-CoV-2 at a particular point of time during the evolving infection. Results: We describe how a healthy immune response against SARS-CoV-2 develops, versus an immune response that is initially suppressed by the virus, but ultimately overactivated, leading to an excessive production of cytokines (cytokine-storm-like). These changes are then linked to the clinical manifestations and outcomes of the patient. Reviewing the immune changes secondary to AIT, it becomes clear how AIT is capable of restoring a healthy innate immunity. Investigators have previously shown that the frequency of respiratory infections is reduced in allergic patients treated with AIT. On the other hand it also increases immunoregulation. Conclusion: As there are many variables involved, it is hard to predict how AIT could influence the allergic patient's reaction to a SARS-CoV-2 infection. In any case, AIT is likely to be beneficial for the patient with allergic rhinitis and/or allergic asthma in the context of the SARS-CoV-2 pandemic as controlling allergic diseases leads to a reduced need for contact with healthcare professionals. The authors remind the reader that everything in this article is still theoretical, since at the moment, there are no published clinical trials on the outcome of COVID-19 in allergic patients under AIT.
Background: Both, allergen immunotherapy (AIT) and SARS-COV-2 infection cause a set of immunologic changes that respectively vary during the course of the treatment or the disease. Objective: To review immune changes brought along by each of these entities and how they might interrelate. Methods: We start presenting a brief review of the structure of the new coronavirus and how it alters the functioning of the human immune system. Subsequently, we describe the immune changes induced by AIT and how these changes could be favorable or unfavorable in the allergicpatientinfected with SARS-CoV-2 at a particular point of time during the evolving infection. Results: We describe how a healthy immune response against SARS-CoV-2 develops, versus an immune response that is initially suppressed by the virus, but ultimately overactivated, leading to an excessive production of cytokines (cytokine-storm-like). These changes are then linked to the clinical manifestations and outcomes of the patient. Reviewing the immune changes secondary to AIT, it becomes clear how AIT is capable of restoring a healthy innate immunity. Investigators have previously shown that the frequency of respiratory infections is reduced in allergicpatients treated with AIT. On the other hand it also increases immunoregulation. Conclusion: As there are many variables involved, it is hard to predict how AIT could influence the allergicpatient's reaction to a SARS-CoV-2 infection. In any case, AIT is likely to be beneficial for the patient with allergic rhinitis and/or allergic asthma in the context of the SARS-CoV-2 pandemic as controlling allergic diseases leads to a reduced need for contact with healthcare professionals. The authors remind the reader that everything in this article is still theoretical, since at the moment, there are no published clinical trials on the outcome of COVID-19 in allergicpatients under AIT.