World Allergy Organization Journal (May 2023)

Aeroallergen immunotherapy associated with reduced risk of severe COVID-19 in 1095 allergic patients

  • Désirée Larenas-Linnemann, MD,
  • Blanca María Morfin-Maciel, MD,
  • Martín Bedolla-Barajas, MD, MSc,
  • Ana López-Bago, MD,
  • Elsy Maureen Navarrete Rodríguez, MD, MSc,
  • María Dolores Mogica-Martínez, MD,
  • José E. Gereda, MD,
  • Mauricio Sarrazola Sanjuan, MD, MSc,
  • Rosa Yazmín Cano Pedroza, MD,
  • María Cecilia Cavallo, MD,
  • Sergio de Jesús Romero Tapia, MD,
  • Roberto A. Jossen, MD,
  • José Miguel Fuentes Pérez, MD,
  • Blanca E. Del Rio Navarro, MD,
  • Erendira Rodríguez Zagal, MD,
  • Pedro A. Piraino Sosa, MD,
  • Yunuen Rocío Huerta Villalobos, MD,
  • Pierre Chavez-Vereau, MD,
  • Daniel Alberto García Imperial, MD,
  • Margarita Olivares Gómez, MD,
  • Francisco Valle Rodríguez, MD,
  • Carlos Omar Zuñiga Reyes, MD,
  • Mónica Rodríguez-González, MD,
  • Claudia Ivonne Gallego Corella, MD,
  • Juan Carlos Ivancevich, MD,
  • María de la Luz Hortencia García Cruz, MD,
  • María Susana Repka-Ramirez, MD,
  • Mauricio Ernesto Flores Morales, MD,
  • Juan Carlos Fernández De Córdova Aguirre, MD, MSc,
  • Jorge A. Luna-Pech, MD, PhD,
  • Daniela Rivero Yeverino, MD,
  • Edgar Martínez Guzmán, MD,
  • Cinthia Elizabeth Pérez Ortiz, MD,
  • Leonor Villa Médica, MD

Journal volume & issue
Vol. 16, no. 5
p. 100779

Abstract

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Introduction: Allergen immunotherapy (AIT) brings along changes in the immune system, restoring dendritic cell function, reducing T2 inflammation and augmenting the regulatory cell activation. Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, interferes with the immune system causing immune suppression during the first phase and over-activation in more advanced disease. We decided to explore the interaction of both in a real-world observational trial. Methods: We registered COVID-19 outcomes in patients with allergic disorders in Latin America, treated with and without AIT. The registry was conducted during the first 1.3 years of the pandemic, with most of the data collected before COVID-19 vaccination was concluded in most countries. Data collection was anonymous via a web-based instrument. Ten countries participated. Results: 630/1095 (57.6%) of the included patients received AIT. Compared to patients without AIT, those treated with AIT had a reduced risk ratio (RR) for COVID-19 lower respiratory symptoms (RR 0.78, 95% CI: 0.6703–0.9024; p = 0.001662) and need for oxygen therapy (RR 0.65, 95% CI: 0.4217–0.9992; p = 0.048). In adherent patients on maintenance sublingual immunotherapy/subcutaneous immunotherapy (SLIT/SCIT) the RR reduction was larger [RR = 0.6136 (95% CI 0.4623–0.8143; p < 0.001) and RR: 0.3495 (95% CI 0.1822–0.6701; p < 0.005), respectively]. SLIT was slightly more effective (NS). We excluded age, comorbidities, level of health care attendance, and type of allergic disorder as confounders, although asthma was related to a higher frequency of severe disease. When analyzing patients with allergic asthma (n = 503) the RR reduction favoring AIT was more pronounced with 30% for lower respiratory symptoms or worse (RR 0.6914, 95% CI 0.5264 to 0.9081, p = 0.0087) and 51% for need of oxygen therapy or worse (RR 0.4868, 95% CI 0.2829–0.8376, p = 0.0082). Among severe allergic patients treated with biologics (n = 24) only 2/24 needed oxygen therapy. There were no critical cases among them. Conclusion: In our registry AIT was associated with reduced COVID-19 severity.

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