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.