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      Considerations on Biologicals for Patients with allergic disease in times of the COVID‐19 pandemic: an EAACI Statement

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          Abstract

          The outbreak of the SARS‐CoV‐2‐induced Coronavirus Disease 2019 (COVID‐19) pandemic re‐shaped doctor‐patient interaction and challenged capacities of healthcare systems. It created many issues around the optimal and safest way to treat complex patients with severe allergic disease. A significant numberof the patients are on treatment with biologicals and clinicians face the challenge to provide optimal care during the pandemic. Uncertainty of the potential risks for these patients is related to the fact that the exact sequence of immunological events during SARS‐CoV‐2 is not known. Severe COVID‐19 patients may experience a “cytokine storm” and associated organ damage characterized by an exaggerated release of proinflammatory type 1 and type 3 cytokines. These inflammatory responses are potentially counteracted by anti‐inflammatory cytokines and type 2 responses. This expert based EAACI statement aims to provide guidance on the application of biologicals targeting type 2 inflammation in patients with allergic disease.

          Currently, there is very little evidence for an enhanced risk of patients with allergic diseases to develop severe COVID‐19 with studies focusing on severe allergic phenotypes lacking. At present, non‐infected patients on biologicals for the treatment of asthma, atopic dermatitis, chronic rhinosinusitis with nasal polyps or chronic spontaneous urticaria should continue their biologicals targeting type 2 inflammation via self‐application. In case of an active SARS‐CoV‐2 infection, biological treatment needs to be stopped until clinical recovery and SARS‐CoV‐2 negativity is established and treatment with biologicals should be re‐initiated. Maintenance of add‐on therapy and a constant assessment of disease control, apart from acute management is demanded.

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          Author and article information

          Contributors
          thomas.eiwegger@sickkids.ca
          Journal
          Allergy
          Allergy
          10.1111/(ISSN)1398-9995
          ALL
          Allergy
          John Wiley and Sons Inc. (Hoboken )
          0105-4538
          1398-9995
          05 June 2020
          : 10.1111/all.14407
          Affiliations
          [ 1 ] Immunoallergology Unit Careggi University Hospital Florence Italy
          [ 2 ] Transylvania University Brasov Romania
          [ 3 ] Swiss Institute of Allergy and Asthma Research (SIAF) University Zurich Davos Switzerland
          [ 4 ] Ankara University School of Medicine Department of Chest Disease Division of Immunology and Allergy Ankara Turkey
          [ 5 ] Department of Respiratory Medicine and Allergy Karolinska University Hospital Huddinge and Department of Medicine Huddinge, Karolinska Institutet Stockholm Sweden
          [ 6 ] Centre for Allergy Research Karolinska Institutet Stockholm Sweden
          [ 7 ] Universitätsmedizin Berlin Humboldt‐Universität zu Berlin, and Berlin Institute of Health Comprehensive Allergy Center Department of Dermatology and Allergy Charité Berlin Germany
          [ 8 ] MACVIA‐France, Montpellier, and CHU Monpellier Montpellier France
          [ 9 ] Department of Immunology University Hospital Zurich Zurich Switzerland
          [ 10 ] Faculty of Medicine University of Zurich Zurich Switzerland
          [ 11 ] Technical University of Munich TUM School of Medicine Klinikumrechts der Isar Department of Otolaryngology and Center for Allergy and Environment Munich Germany
          [ 12 ] Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London, United KingdomKing’s College LondonSchool of Life Course Sciences & School of Immunology & Microbial Sciences King’s Health Partners London United Kingdom
          [ 13 ] Allergy Unit 2 nd Department of Dermatology and Venereology National University of Athens Medical School University General Hospital ‘ATTIKON” Athens Greece
          [ 14 ] Department of Pediatric Allergy and Pneumology Medical University of Warsaw Warsaw Poland
          [ 15 ] Department of Medical Sciences and Public Health University of Cagliari Monserrato Italy
          [ 16 ] Department of Clinical Immunology Wroclaw Medical University ALL‐MED Medical Research Institute Wrocław Poland Wroclaw Poland
          [ 17 ] Department of Allergy Inflammation Center Helsinki University Hospital and Helsinki University Helsinki Finland
          [ 18 ] Centre for Rhinology and Allergy Wiesbaden Germany
          [ 19 ] Department of Medicine Beth Israel Deaconess Medical Center Harvard Medical School Boston Massachusetts USA
          [ 20 ] Translational Medicine Program Peter Gilgan Centre for Research and Learning Hospital for Sick Children Toronto Ontario Canada
          [ 21 ] Department of Immunology and Allergy Medical University of Lodz Lodz Poland
          [ 22 ] Department of Biochemistry and Molecular Biology Chemistry School Complutense University of Madrid Madrid Spain
          [ 23 ] Department of Otorhinolaryngology, Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
          [ 24 ] Department of Internal Diseases Allergology & Clinical Immunology Medical University of Silesia Katowice Poland
          [ 25 ] Institute of Pathophysiology and Allergy Research Center of Pathophysiology, Infectiology and Immunology Medical University of Vienna Vienna Austria
          [ 26 ] Division of Immunology and Allergy Food Allergy and Anaphylaxis Program The Hospital for Sick Children Departments of Paediatrics and Immunology University of Toronto Toronto ON Canada
          [ 27 ] Department of Immunology University of Toronto Toronto ON Canada
          Author notes
          [*] [* ] Corresponding Author

          Thomas Eiwegger, MD, Division of Immunology and Allergy, Food allergy and Anaphylaxis Program, Research Institute, The Department of Paediatrics, Hospital for Sick Children, 555 University Ave, Toronto, Canada

          E‐mail: thomas.eiwegger@ 123456sickkids.ca

          Author information
          https://orcid.org/0000-0001-7994-364X
          https://orcid.org/0000-0003-0554-9943
          https://orcid.org/0000-0002-0494-2690
          https://orcid.org/0000-0001-8279-5545
          https://orcid.org/0000-0002-5768-391X
          https://orcid.org/0000-0003-1980-161X
          https://orcid.org/0000-0003-4516-0369
          https://orcid.org/0000-0003-4374-9639
          https://orcid.org/0000-0002-3077-0271
          https://orcid.org/0000-0002-1963-499X
          https://orcid.org/0000-0002-2914-7829
          Article
          ALL14407
          10.1111/all.14407
          7300800
          32500526
          d13d7bc8-83ae-4dd0-8f92-3854073dd82a
          This article is protected by copyright. All rights reserved.

          This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

          History
          Page count
          Figures: 0, Tables: 0, Pages: 29, Words: 834
          Categories
          Eaaci Position Paper
          Eaaci Position Paper
          Custom metadata
          2.0
          accepted-manuscript
          Converter:WILEY_ML3GV2_TO_JATSPMC version:5.8.4 mode:remove_FC converted:18.06.2020

          Immunology
          Immunology

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