key: cord-0873130-98s2l05p authors: Abdelmaksoud, Ayman; Goldust, Mohamad; Vestita, Michelangelo title: Omalizumab and COVID19 Treatment: Could It Help? date: 2020-06-08 journal: Dermatol Ther DOI: 10.1111/dth.13792 sha: 501302fd8809c6cfe23dfe0dcf914165ff6a2a86 doc_id: 873130 cord_uid: 98s2l05p nan The current threat of coronavirus disease 2019 (COVID19) pandemic may cause close to half a billion deaths, i.e. 6% of the global population -and potentially more. 2 The nasal epithelium is one of the first sites of infection with SARS-CoV-2. Angiotensin-converting enzyme 2 (ACE2) is a cellular receptor which has been proven to bind to SARS-CoV-2 spike protein and promote internalization of the virus into human cells, thus inhabitating and replicating in the nasal and pharyngeal mucosa. SARS-CoV-2, like other coronavirus species, is primarily attacked by immune cells, such as mast cells (MCs), that are located in the submucosa of the respiratory tract and in the nasal cavity and involved in prevention of microinvasion. Activation of MCs results in release inflammatory agents, such as histamine and protease, in addition to pro-inflammatory cytokines including IL-1, OMZ has showed reduction of local nasal mucosal inflammation and improving nasal respiration, in addition to improvement of sino-nasal function in patients with chronic rhinosinusitis, 4 a mechanism that could be essential for the initial combating of COVID-19. OMZ can be used in treatment of patients with different types of MCs disorders, even in low-dose 5 , mitigating viral-triggered release of the proinflammatory mediators and risk of subsequent serious complications in COVID19 patients. Researchers noted OMZ treatment in vivo restored IFN-α responses to both rhinovirus and influenza via OMZ-reduced expression of FcεRIα on the cell surface secondary to OMZ-reduction of free serum IgE levels, denoting an antiviral potential of OMZ. 6 Further, excessive synthesis of pro-inflammatory cytokines such as IL-6, IL-1β and tumor necrosis factor (TNF)-α is induced by activated neutrophils and alveolar macrophages, that attracts more neutrophils and results in further release of chemokines and cytokines. Pro-inflammatory mediators and upstream nuclear factorkappa β (NF-kβ) signaling pathways might have a key role in COVID19-related acute lung injury (ALI) pathogenesis. Interestingly, these cytokines are significantly elevated when lung tissue is exposed to SARS-CoV. 7 Infiltration of inflammatory cells into lung parenchyma is a crucial process in acute lung injury with subsequent This article is protected by copyright. All rights reserved. acute respiratory distress syndrome (ARDS). OMZ has not only anti-IgE effect, but also have inhibitory effects on inflammatory cells, such as neutrophil, and coagulation in patients with CSU. 8 In addition to clinical manifestations of COVID-19, such as fever, fatigue, myalgia, headache, diarrhea, dry cough, dyspnea that may lead to ARDS and death, it may manifest with cutaneous signs. Among the cuaneous manifestations of COVID-19 in hospitalized patients, urticaria has been reported, that may be widespread, according to reports from Wuhan, China, and Lombardy. 9,10 Infected COVID-19 patients have a hypercoagulable state to presented with vascular skin symptoms, such as acroischemia, and chilblain-like lesions. 11 OMZ may be tried for COVID-19 patients manifested with urticaria or vascular lesions. In an experimental study, Wang et On the basis of current evidence at this time, and according to the experts, the use of ACE inhibitor should be maintained for the control of blood pressure, and not to be discontinued. 13 In only one report, ACE-inhibitors have shown to sustain CSU exacerbations and to annul the therapeutic effect of OMZ in 2 patients who had been previously responding to the drug. 14 Whether that therapeutic resistance was a dosedependent or patient-specific, remains to be studied in accumulating similar cases. OMZ may be worth to try in treatment of COVID19 by international research groups. With possible home administration of OMZ, the patients would refrain from usual clinic visits, and keep on the recommended social distancing. 15 This article is protected by copyright. All rights reserved. Omalizumab for Treating Chronic Spontaneous Urticaria: An Expert Review on Efficacy and Safety.Expert Opin Biol Ther Mast cells contribute to coronavirusinduced inflammation: new anti-inflammatory strategy Double-Blind, Placebo-Controlled Trial of anti-IgE for Chronic Rhinosinusitis Idiopathic Mast Cell Activation Syndrome With Low-Dose Omalizumab Enhanced plasmacytoid dendritic cell antiviral responses after omalizumab Severe acute respiratory syndrome (SARS) coronavirus-induced lung epithelial cytokines exacerbate SARS pathogenesis by modulating intrinsic functions of monocyte-derived macrophages and dendritic cells The Effect of Omalizumab on Hematological and Inflammatory Parameters in Patients With Chronic Spontaneous Urticaria Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan 10: Recalcati S. Cutaneous manifestations in COVID-19: a first perspective A French Observational Study Preventative effect of OMZ-SPT on lipopolysaccharideinduced acute lung injury and inflammation via nuclear factor-kappa B signaling in mice ACE inhibitors may interfere with omalizumab in chronic spontaneous urticaria This article is protected by copyright. All rights reserved