DISCUSSION
Coronavirus disease 2019 (COVID-19), has become in a short period of
time, one of the worst infection diseases ever known around the world,
declaring a Public Health Emergency of International Concern. Spain has
been one of the most severely affected countries in Europe. Data dated
on the 12 of August 2020, declares 3.350.547 confirmed cases in all of
Europe, 329.784 of which correspond to Spain.
When studying severe pediatric asthma patients in treatment with MAB,
corresponding to our Medical Department, two important observations can
be drawn. Firstly, 2 patients had direct and continuous contact with the
virus, as several members of their family got infected, but although
both experienced mild symptoms that could be attributed to the disease,
neither of them had a positive serological test. This could be because,
they really did not get infected by COVID-19, or because they did not
acquire immunity to the virus. Secondly, in case they had suffered the
disease, although they did not acquire immunity, this study suggests
they would have shown mild symptoms. Reasoning for this include a series
of factors recently studied in the wake of COVID -19 pandemic.
Theoretically, asthmatic patients should have increased susceptibility
and severity for SARS-CoV-2 infection due to a deficient antiviral
immune response and the tendency for exacerbation caused by common
respiratory viruses. However, certain aspects of type 2 immune response,
might provide potential protective effects against COVID-19. Allergy
seems not to be a risk factor, nor influence the course and severity of
the disease. [2] Furthermore, conventional therapeutics used for
asthma control, including inhaled corticosteroids, [10] and anti-IgE
monoclonal antibody, seem to provide beneficial effects, reducing the
risk of COVID-19 infection. [3,11] Recent studies have shown that
blocking IgE could reduce susceptibility to respiratory virus infection.
Taken together, these observations suggest a potential effect of
omalizumab on antiviral responses.
Uncontrolled asthma may be included as a risk factor for severe
COVID-19. [4] A sufficient control of symptoms in children with
asthma is key in the current pandemic. [12] It is therefore
recommended that asthmatic patients continue with prescribed medications
during the pandemic [11] to optimize asthma controls.
The conclusions drawn from this study, underline that pediatric patients
with severe asthma, in treatment with MAB have a societal behavior
comparable to the general population, and their lifestyle before the
pandemic did not influence the probability of being affected by the
disease. Therefore, they do not have an increased susceptibility for
being infected by the virus, but in the case that they contracted the
disease, they would have shown very weak to no symptoms. The fact that
they may not acquire immunity to the disease, needs to be corroborated
with further investigation.
DATA SHARING: The data that support the findings of this study
are available from the corresponding author upon reasonable request.