Covid-19, severe asthma and omalizumab therapy: a case-based inquiry into associations, management, and the possibility of a better outcome

Abstract

Recent developments in research have put forward claims on the protective effect of allergic diseases especially allergic airway inflammation including allergic asthma—against the COVID-19 pandemic. This was first suggested by the underrepresentation of asthma patients in some cohorts and was later investigated by angiotensin-converting enzyme II (ACEII) receptor expression studies. Controversial data on this matter persists and continue to be a challenge for clinicians when it comes to managing allergic diseases during the pandemic. We present in this study a thorough review of related findings so far and our own experience with 2 severe asthma patients who presented with atypical symptoms. Interestingly, both patients were administered anti-IgE therapy prior to the initial positive polymerase chain reaction (PCR) results for COVID-19 and showed no symptoms of severe respiratory disease during the infection unlike what we know from other viral respiratory illnesses. Stemming from that, we wanted to combine the perspectives of allergists and infectious disease specialists to address certain concerns in the management of allergic diseases, such as biologicals, in the light of current guidelines. We have also pointed out certain gaps in clinical and molecular level research, such as the lack of phenotypical subgroup analysis among ill asthma patients and the lack of data concerning the molecular effects of biologicals on viral infection.