key: cord-0987466-jutdl9qu
authors: Mahdavinia, Mahboobeh; Codispoti, Christopher
title: Reply to Does asthma affect outcomes of patients with COVID-19 infections?
date: 2020-09-28
journal: J Allergy Clin Immunol Pract
DOI: 10.1016/j.jaip.2020.09.020
sha: e2c68c0bc37ab37902b0b74ee012d026a8655ca3
doc_id: 987466
cord_uid: jutdl9qu

nan

To the Editor: 23

We would like to thank Klemci et al (1) for highlighting our paper published in the August issue of 24

Journal of Allergy and Clinical Immunology-In practice.

(2) The impact of COVID-19 on asthma patients 25 and their COVID-19 outcome has been a matter of several investigations in the past months. As authors 26 mentioned, asthma is a heterogenic disease with several endotypes, which may respond to infectious 27 processes differently. Our results are in agreement with other papers that were published in the 28 following month showing that asthma does not decrease or increase hospitalization rate and length for 29 Additional studies showed that atopy might play an important role in the response to 30 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Our follow up large two-center study 31 has also shown that atopy is a potential protective factor and a positive prognostic factor for decreased 32 severity of COVID-19. (4) Furthermore, we have found that, among different endotypes of asthma, only 33 non-allergic asthma was associated with prolonged need for intubation(4), which agrees with a recent 34 comprehensive large study.(5) This study showed that non-allergic asthma was associated with a higher 35 risk of severe . This is also consistent with translational studies. While gene expressions of 36 two key mediators for SARS-CoV-2 infection, angiotensin-converting enzyme 2 (ACE2) and 37 transmembrane protease serine 2 (TMPRSS2), have been shown to be different in allergic individuals, 38 potentially protecting them from severe illness, in a large study in which all asthma patients were 39 combined together, the expression of both genes was similar between patients with asthma and healthy 40 subjects. (6) This indicates that asthma in general is not a risk factor for more or less severe COVID-19 41 illness. However, as a chronic lung disease prone to viral-induced exacerbation, this might place those 42 with severe COVID-19 at risk for a longer duration of pulmonary inflammation.(2, 5) Furthermore, an 43 allergic background and differential expression of ACE2 and TMPRSS2 may dampen the strong 44 inflammatory response to SARS-CoV-2 in patients with allergic asthma patients, leading to the lack of 45 increased severity reported in patients with non-allergic asthma. (2, 4, 5) 46

Another important factor that needs to be considered and further investigated is the impact of racial differences on COVID-19 outcome in asthma patients. The studies that did not find any difference in 48 terms of COVID-19 severity or intubation time in asthma patients were done in predominantly non-49

African American (AA) populations, such as from China, or study populations with only 21-26% AAs. (3) 50

In our series from the city of Chicago, 59% of COVID-19 patients with asthma were AA. (2) Interestingly 51 1. 3 higher expression of ACE2 and TMPRSS2. (6) Consistent with that study, our as yet unpublished follow 53 up study has shown that AA with asthma and COVID-19 infection had a significantly higher rate of 54 asthma exacerbation and longer duration of asthma symptoms after COVID-19 compared to their white 55 counterparts. Specifically, 68% of AA vs. 35% of whites (p=0.032) report symptoms suggestive of asthma 56 exacerbation after COVID, and mean ± SD duration of asthma exacerbation symptoms were 3.6±2.1 57 weeks vs. 1.5±1.3 weeks in AA and whites respectively; p=0.045). We have also demonstrated that, 58 while asthma is not a risk factor for COVID-19 hospitalization in any age group, AA children are at a 59 significantly higher risk for COVID-19 adverse outcomes. (7) 

Arife Zeybek Does asthma affect severe lung damage The journal of allergy and 78 clinical immunology In practice

Asthma prolongs 80 intubation in COVID-19. The journal of allergy and clinical immunology In practice

Prevalence and characterization 82 of asthma in hospitalized and nonhospitalized patients with COVID-19. The Journal of allergy and clinical 83 immunology

Atopy is predictive of a decreased 85 need for hospitalization for COVID-19

Association of asthma and its 88 genetic predisposition with the risk of severe COVID-19. The Journal of allergy and clinical immunology

Relationship to Demographic Features and Corticosteroids. American 92 journal of respiratory and critical care medicine

African American children are at higher risk of COVID-19 94 infection. Pediatric allergy and immunology : official publication of the European Society of Pediatric 95 Allergy and Immunology

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