key: cord-1028725-v1cetiyp
authors: Özdemir, Öner; Pop, Serdar; Mesut Nezir Engin, Muhammet
title: COVID-19 in an Allergic Bronchopulmonary Aspergillosis Patient: A Case Report
date: 2021-07-01
journal: Turk Arch Pediatr
DOI: 10.5152/turkarchpediatr.2021.21073
sha: e7a35f9defb6c2e5a601dedc91ceb1e401bea448
doc_id: 1028725
cord_uid: v1cetiyp

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There are two points to be addressed in our patient. First, according to our literature review, there has not been any report describing the effect and course of SARS-CoV-2 infection in an ABPA patient. There has been a case report of uncommon presentation of ABPA development (without SARS-CoV-2 infection) in a previously healthy male during mandatory lockdown (isolation) in Italy, who decided to live in the basement of his house due to the COVID-19 pandemic. 4 Second, the effect of omalizumab therapy on COVD-19 disease in an ABPA patient. Although it is not probable to make big implications concerning omalizumab use in ABPA from a distinct case, the experience with omalizumab from other chronic lung diseases such as asthma is better to be discussed. Severe asthma patients utilizing biologic therapy such as omalizumab shown by Eger et al. 5 to be related with a more severe progress of COVID-19 compared to the general population. This was thought to be a result of co-morbidities, the severity of asthmatic respiratory tract inflammation, the utilization of biologics, or a combination of these. However, there was not any reported experience of SARS-CoV-2 infection and omalizumab use in ABPA, such as in our patient, in the literature.

In contrast to Eger et al.'s report, Omalizumab treatment has been speculated to protect from severe forms of COVID-19 by means of enhancing anti-viral immunity. The use of omalizumab in vivo reinstated interferon-alpha (IFN-α) signaling in plasmacytoid dendritic cells to such respiratory viruses via omalizumab-downregulated FcεRIα expression on the cell surface. 6-8 Moreover, omalizumab was also shown to have inhibitory effects on inflammatory cells, such as neutrophils, in chronic urticaria. 9 There are also literature data stating that omalizumab lessens inflammation by hindering proinflammatory cytokines and affects mast cells, hampering the discharge of inflammatory agents, for example, proteases. 10 In Preventative Omalizumab or Step-up Therapy for Severe Fall Exacerbations (PROSE) study, omalizumab therapy was able to decline rhinovirus infection duration, viral clearance, and illness frequency. 2, 6, 7 Since the reasons mentioned above, our patient may have mild signs and symptoms of COVID-19 disease and overcome it without any complications. Also, World Allergy Organization (WAO), multinational Allergic Rhinitis and its Impact on Asthma (ARIA) groups, and the European Academy of Allergy and Clinical Immunology (EAACI) recommend continuing as usual in patients without suspected infection or proven SARS-CoV-2 infection by weighing the benefits and risks individually. 11, 12 We did not hesitate to continue omalizumab therapy, in our patient, because he did not have a severe and/or complicated SARS-CoV-2 infection and recovered rapidly.

In conclusion, this patient showed us that ABPA patients experiencing SARS-CoV-2 infection could probably overcome COVID-19 disease without any significant consequences. However, the course and prognosis of COVID-19 in ABPA patients, especially using omalizumab, is not yet satisfactorily known. 

Coronavirus disease 2019 (COVID-19): diagnosis and management

COVID-19 and asthma: reflection during the pandemic

An asthmatic child with allergic bronchopulmonary aspergillosis (ABPA)

Uncommon presentation of allergic bronchopulmonary aspergillosis during the COVID-19 lockdown: a case report

Poor outcome of SARS-CoV-2 infection in patients with severe asthma on biologic therapy

Enhanced plasmacytoid dendritic cell antiviral responses after omalizumab

Effects of omalizumab on rhinovirus infections, illnesses, and exacerbations of asthma

COVID-19 in a patient with severe asthma treated with omalizumab

The effect of omalizumab on hematological and inflammatory parameters in patients with chronic spontaneous urticaria

Omalizumab and COVID-19 treatment: could it help?

No significant change before (a) and after (b) the COVID-19 treatment in thorax CT. COVID-19 in ABPA

COVID-19, asthma, and biological therapies: what we need to know

Österreichische Gesellschaft für Allergologie und Immunologie (ÖGAI), Luxemburgische Gesellschaft für Allergologie und Immunologie (LGAI), Österreichische Gesellschaft für Pneumologie (ÖGP) in co-operation with the German, Austrian, and Swiss ARIA groups, and the European Academy of

The authors have no conflicts of interest to declare.

The authors declared that this study has received no financial support.