Association of Virus-Induced Wheezing With COVID-19

Background: Viral respiratory tract infections are the most common triggers of wheezing illnesses in children. Though rare, COVID-19 infection in children may trigger a viral-induced wheeze that requires distinguishing from other viral and asthma triggers. Objectives: The current study aimed to assess the role of COVID-19 in causation of viral induced wheeze in pediatrics age group in our locality. Methods: The study included 30 pediatrics cases = 2 months attending the Emergency Room and Department of Pediatrics, Faculty of Medicine, Zagazig University Hospital. According to the inclusion criteria for the study, patients were aged from 2 - 144 months with mean age (21.1±35.3 month). They were 13 females (43.3%) and 17 males (56.7%). Twelve patients had positive family history of asthma (40.0%). The standard technique for confirming COVID-19 is the real-time polymerase chain reaction (RT-PCR). Results: 30 children hospitalized with wheezing, 24 patients (80%) presented with difficult breathing, 18 patients (60%) were feverish, and 17 patients (56.7%) had cough. Running nose was noted in 9 patients (30%), grunting was observed in only one patient (3.3%). The mean O2 saturation of all patients was 91.8±2.6 and ranged from (92-95%). GIT manifestation was reported in 13.3%. The two confirmed cases has positive PCR test for Covid-19, a 7 year old male and a 5 year old female. Positive family history of COVID-19 was reported in both cases, neither of them has blood eosinophilia, they were on regular controller medication. Patients presented with wheeze, cough, difficult breathing, with no grunting or GIT manifestation. They were treated for 2 to 3 days by O2, inhaled B agonists plus short course of systemic steroids. Conclusion: Covid-19 is uncommon cause of viral induced wheeze among our patients. Only two cases of covid-19 related asthma exacerbation were reported in our study. [ FROM AUTHOR] Copyright of Zagazig University Medical Journal is the property of Association of Arab Universities and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

TSANZSRS 2023 Australia and New Zealand Society of Respiratory Science and The Thoracic Society of Australia and New Zealand (ANZSRS/TSANZ) Annual Scientific Meeting for Leaders in Lung Health and Respiratory Science

The proceedings contain 360 papers. The topics discussed include: comparison of three methods assessing spirometry bronchodilator responsiveness in children;the quality of spirometry testing: a systematic review;airflow severity in asthma minimally affects within-session oscillometry variability;corrected normative multiple breath washout data in pre-school aged children;prevalence and predictors of tidal expiratory-flow-limitation in healthy adolescents/young adults;impact of change of significant bronchodilator response definition;volume-dependence of reactance as a measure of ventilation inhomogeneity;mechanisms of impaired gas exchange following hospitalization for severe COVID-19;increased shunt and dead space in recovered COVID-19 pneumonitis patients;airway hyperresponsiveness detection in atopic asthma using exhaled nitric oxide;increased conductive ventilation heterogeneity following exposure to coal-mine fire smoke;accuracy of transcutaneous carbon dioxide monitoring during sleep studies;and effect of hematopoietic stem cell transplant on small airways function.

Aeroallergen immunotherapy associated with reduced risk of severe COVID-19 in 1095 allergic patients.

Introduction: Allergen immunotherapy (AIT) brings along changes in the immune system, restoring dendritic cell function, reducing T2 inflammation and augmenting the regulatory cell activation. Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, interferes with the immune system causing immune suppression during the first phase and over-activation in more advanced disease. We decided to explore the interaction of both in a real-world observational trial. Methods: We registered COVID-19 outcomes in patients with allergic disorders in Latin America, treated with and without AIT. The registry was conducted during the first 1.3 years of the pandemic, with most of the data collected before COVID-19 vaccination was concluded in most countries. Data collection was anonymous via a web-based instrument. Ten countries participated. Results: 630/1095 (57.6%) of the included patients received AIT. Compared to patients without AIT, those treated with AIT had a reduced risk ratio (RR) for COVID-19 lower respiratory symptoms (RR 0.78, 95% CI: 0.6703-0.9024; p = 0.001662) and need for oxygen therapy (RR 0.65, 95% CI: 0.4217-0.9992; p = 0.048). In adherent patients on maintenance sublingual immunotherapy/subcutaneous immunotherapy (SLIT/SCIT) the RR reduction was larger [RR = 0.6136 (95% CI 0.4623-0.8143; p < 0.001) and RR: 0.3495 (95% CI 0.1822-0.6701; p < 0.005), respectively]. SLIT was slightly more effective (NS). We excluded age, comorbidities, level of health care attendance, and type of allergic disorder as confounders, although asthma was related to a higher frequency of severe disease. When analyzing patients with allergic asthma (n = 503) the RR reduction favoring AIT was more pronounced with 30% for lower respiratory symptoms or worse (RR 0.6914, 95% CI 0.5264 to 0.9081, p = 0.0087) and 51% for need of oxygen therapy or worse (RR 0.4868, 95% CI 0.2829-0.8376, p = 0.0082). Among severe allergic patients treated with biologics (n = 24) only 2/24 needed oxygen therapy. There were no critical cases among them. Conclusion: In our registry AIT was associated with reduced COVID-19 severity.

Effects of allergen extract exchange in children and adolescents receiving house dust mite allergen immunotherapy during the Covid-19 pandemic: Real-life data

Background: In our country, allergen extracts (AEs) for house-dust mite (HDM) allergen immunotherapy (AIT), were provided by two companies which are Novohelisen Depot and Alutard SQ. During the Covid-19 pandemics, Novohelisen DepotHDM allergens could not be imported due to the unforeseen reasons. In order to ensure the continuity of AIT, consent obtained patients were treated with the AE of the other company. In this study, it was aimed to determine the frequencies of local and systemic side effects (SEs), clinical response, and the effect of AE change on these parameters during the Covid-19 pandemics. Method(s): 59 patients aged >= 5 years, followed up with the diagnosis of allergic rhinoconjunctivitis (ARC) and/or allergic asthma, and clinically related HDM allergy were included in the study. Demographic data of the patients and SEs during the treatment were recorded from the onset of subcutaneous AIT (SCIT) until September 2021. A transition protocol was created in order to maintain maximum effectiveness and minimize potential SEs of AIT after AE switching. After thetransition protocol, the frequency of SEs, and symptoms and medication scores were recorded during each AIT visit. Result(s): Of 59 patients, 38 (64.4%) were male, 27 (45.7%) had ARC and 32 (54.2%) had both allergic asthma and ARC. Age at the onset of AIT was 12 (6-17) years, and duration of the treatment was 30 (8-48) months. In this study 29 patients received Alutard-SQ (group 1) and 30 patients, Novohelisen-Depot (group 2). 19 patients in group 2 switched to AE of Alutard SQ. During the treatment period, 1209 Novohelisen Depot and 1504 Alutard SQ injections were administered and a total of 140 (5.2%) local reactions (LRs), 50 (1.8%) large local reactions (LLRs), and 7 (0.25%) systemic reactions (SRs) were observed. In group 2, 61 (8.3%) LRs and 1 (0.13%) SR were observed before switching, 5 (1.4%) LRs and neither LLR nor SR were observed after switching. Adherence to SCIT has been increased from 49.1% to 79.6% and the decrease in symptom and medication scores in the pre-transition period continued after switching. Conclusion(s): During the Covid-19 pandemics, HDM AEs transition protocol was safe in terms of local and systemic side effects, and AIT was effective.

COVID-19 severity in allergic patients with or without allergen immunotherapy

Background: SARS-CoV- 2 impacts on the immune response in a variable way. In pilot study we showed last year that in allergic patients allergen immunotherapy (AIT) seemed to reduce COVID-19 severity. Here we present final results. Method(s): in cooperation with allergists, dermatologists and ENTs we conducted a Latin-American registry of patients with allergic disorders, including urticaria, who got COVID-19. Apart from demographic data, COVID-19 severity, allergic diseases, comorbidities and compliance with underlying allergy/asthma treatment we collected data on AIT. Result(s): Of the 1095 registered patients, 54% female, 89.4% were confirmed and 10.6% highly suspected COVID-19 cases. IgE-mediated allergy was confirmed (81%) or clinically suspected (16%);while 3.2% had only urticaria. 630/1095 (57.5%) received AIT;in both groups (yes or no AIT) median age was 30-39y. For COVID-19 severity, see table. Compared to allergic patients without AIT, receiving AIT reduced the Risk Ratio (RR) for severe disease with lower respiratory symptoms or worse (COVID-4- 7) to 0.78 (.95 CI 0.6703-0.9024), p = 0.0017) and for critical COVID-19 in need of oxygen therapy or worse to 0.65 (.95 CI 0.42-0.9992, p = 0.048). There was only one fatality in the no-AIT group. There was no difference between groups in co-morbidities, public or private practice or allergic disease;AIT patients tended to be younger. Conclusion(s): These data seem to favor the outcome of COVID in allergic patients receiving AIT, but more in-depth analysis is needed.

Respiratory symptomatology of Covid-19 in healthcare workers

Introduction: Health personnel are particularly exposed to the risk of contamination by SARS-CoV2. Various symptoms, particularly respiratory, have been described in this population. Objective(s): Determine the socio-professional, clinical and paraclinical characteristics of healthcare workers with Covid-19. Method(s): Descriptive cross-sectional study with health staff at Rabta hospital, suffering from Covid-19. The information was collected using a questionnaire administered by the doctor during the return to work consultation. Result(s): Our population included 418 health workers and was predominantly female (75.4%) with an average age of 41.5 +/- 10.5 years. They belonged to medical services in 40.1% of cases and held the position of nurse in 33.7% of cases. Contamination was intra-hospital in 45.7% of cases. A history of allergic asthma was noted in 7.4% of health workers. Respiratory symptoms were present in 63.9% of cases, mainly consisting of cough (45.9%) and dyspnea (28.9%). It was a moderate form in 24.2% of cases. A chest computed tomography was performed in 10.3% of cases, objectifying interstitial lung disease in 49% of cases. Hospitalization was necessary for 5.7% of staff with an average duration of 7.9 days. It was significantly related to the presence of respiratory signs (p<=10-3). On returning to work, 14.6% of affected personnel reported the persistence of exertional dyspnea. Conclusion(s): The respiratory signs of Covid-19, dominated by cough and dyspnea, were widely represented in our population and statistically associated with the need for hospitalization.

Better COVID-19 outcomes in children with good asthma control

Background: The role of pediatric asthma in susceptibility to COVID-19 is poorly defined. The aim of our study was to assess possible risk factors for severe COVID-19 in children with asthma. Method(s): In our observational study, we systematically assessed the occurrence of COVID-19 in children with asthma <18 years in a six-month period prior to their regular outpatient visit in our asthma clinic from December 1, 2020 to March 31, 2021, by using a predefined questionnaire. We compared characteristics of patients presenting with signs of SARS-CoV-2 upper (URTI) or lower respiratory tract infection (LRTI), focusing on factors that could be associated with severity of COVID-19, such as asthma phenotype, treatment with inhaled corticosteroids (ICS), asthma severity and the degree of asthma control assessed by the Asthma Control Test at the outpatient visit. Result(s): Out of 210 screened patients, 27% (57/210) reported exposure to COVID-19. Forty-two children were symptomatic after the exposure. In the symptomatic group, 64% (27/42) reported symptoms of URTI and 36% (15/42) of LRTI. We observed poorer asthma control in patients with LRTI compared to URTI (80% vs 7%, p <0.001). Moreover, patients with LRTI were older (14.6+/-3.2 years vs 12.0+/-4.1 years, p=.042), more frequently girls (60% vs 26%, p=.029), with a non-allergic asthma phenotype (43% vs 13%, p=.020). Regular ICS use and asthma severity were not associated with COVID-19 presentation in these children. However, patients on regular ICS had better asthma control (p=.026). Conclusion(s): The results of our study suggest that good asthma control, treatment adherence optimization and allergic asthma phenotype enable better COVID-19 outcomes in children with asthma.

Tixagevimab/ Cilgavimab Outcomes Among Patients with Immunodeficiency

Rationale: The FDA granted an emergency use authorization for tixagevimab/ cilgavimab in December 2021 for COVID-19 pre-exposure prophylaxis for individuals that are moderate to severely immunocompromised and has since recommended repeat dosing every 6 months. Given its novelty and resultant hesitation for use among some physicians and patients, our study aimed to observe safety and efficacy of tixagevimab/ cilgavimab, including against one of the newest variants, Omicron BA.5, among our patient population with immunodeficiencies 6 months post-administration via a telephone survey. We hypothesized that adverse outcomes would be minimal and COVID-19 incidence and severity would lessen following tixagevimab/cilgavimab administration. Methods: The Atrium Health Wake Forest Baptist Allergy, Asthma, and Immunology department recruited 15 patients with immunodeficiencies receiving immunoglobulin replacement and tixagevimab/ cilgavimab in March 2022 for a prospective cohort study. A telephone survey was conducted 6 months later regarding tixagevimab/ cilgavimab adverse effects and incidence/severity of COVID infection before and after administration. Results: Two patients experienced minor adverse effects (fatigue, bruising) following tixagevimab/ cilgavimab administration. No severe reactions were reported. Two patients required hospitalization for severe COVID-19 infection prior to tixagevimab/cilgavimab administration, whereas 0 patients required hospitalization for COVID-19 in the 6 months following administration. Four of 5 patients that had COVID-19 following administration had not yet received the bivalent Omicron booster vaccine and 2 had received no COVID-19 vaccines. Conclusions: Tixagevimab/ cilgavimab is associated with minor adverse effects and reduction of COVID-19 severity, albeit perhaps not associated with diminished incidence of newest COVID-19 strains, in a prospective, population-based cohort.

Particle Pollution, increase in Allergy and Asthma cases and application of Nanotechnology

Rationale: The aerosolized solid, liquid, mix-phased particles are the Particulate Matter or PM having serious health impacts. In the recent years with the unprecedented situation of COVID-19 pandemic, it became a necessity that the scientific world comes forward with an objective of developing more equipment for air purification with novel technology to combat airborne pathogen, aeroallergen and viruses. We have applied AFLPCO Nanotechnology to build equipment and mask. Methods: We built a fiberglass chamber to evaluate the capacity of the AFL-Mask to prevent entry of particulate matters and pathogens. To evaluate the air in the chamber, we used a LightHouse Handheld Particle Counter to sample airborne particles. We have recorded the particle concentrations at time-intervals to determine the percentage of particles entering the other chamber with the mask placed in the junction dividing the chamber. Results: This mask involves a 4-stage filtration system designed to combat all forms of airborne pathogens including bacteria, viruses, mold spores and harmful VOCs. We found that the AFL-Mask was efficient in preventing any particulate matter including PM2.5, PM10, bacterial and fungal spores and VOCs. Conclusions: The AFL-Mask and AFLPCO air purifiers built for long-term use to improve the inhaled air quality. The ergonomic design with padded lining and straps and improved filtration technology made the AFL-Mask a superior mask that provides a continuous airflow to prevent suffocation, troubled breathing and fluctuating blood pressure, especially pertaining to patients with cardiovascular or pulmonary issues. AFLPCO airpurifers were efficient in improving IAQ.

What do patients with asthma want to know? Google Trends insights into U.S. general population interest between 2004 and 2022 can help structure patient education initiatives

Rationale: The aim of this study is to use the research tool Google Trends to analyze U.S. general population interest in asthma. Methods: The research tool Google Trends (trends.google.com) was used to access data sets for the searched term "asthma” between 2004 and 2022 (English language, U.S. location). Data were normalized and adjusted to make comparisons between search terms substantiated. Each data point was divided by the total searches of the geography and time range it represented. Results: Searches for asthma detected have remained stable in terms of volume between 2004 and 2022 apart from a spike during February-May 2020 which corresponded with one of the peaks of the COVID pandemic. Top 5 states for asthma searches in 2022 were Kentucky, Tennessee, Connecticut, Mississippi, Maryland. The list of the top states is dynamic and has changed since 2004.Top search terms in the U.S. in 2022 were: allergy, allergy asthma, asthma and allergy, asthma symptoms, asthma attack. Searches for allergy have consistently been present in the top 5 terms when patients searched for asthma during the last 18 years, between 2004 and 2022. Conclusions: Asthma-related Google searches reveal topics of high interest that could supplement the understanding about general population interest. Searches for allergy have consistently been present in the top 5 terms when patients searched for asthma during the last 18 years, emphasizing the role of allergists/immunologists in asthma care. Knowledge of variability in search patterns and specific topics could help allergy organizations and practicing allergists focus their educational programs towards patients' interests.

Examination of Homologies between COVID-19 Vaccines and Common Allergens: The Potential for T Cell-mediated Responses for Allergic Rhinitis and Asthma

As the SARS-CoV-2 virus shares relatively large protein sequences homologous to grass pollens, dust mites, and molds, our objective was to assess the potential overlap between the COVID-19 mRNA vaccines from Pfizer-BioNtech and Moderna and known allergens. We found 7 common allergens with potential for cross-reactivity with the Pfizer vaccine and 19 with the Moderna vaccine, including common grasses, molds, and dust mites. T-cell mediated antigen cross-reactivity between viruses and allergens is a relatively new area of study in clinical immunology;a discipline that may be particularly useful regarding the SARS-CoV-2 virus and the allergic response in humans. These results suggest that vaccination with the Pfizer-BioNtech and Moderna COVID-19 vaccines may contribute to T-cell cross-reactivity with allergens that impact allergic asthma and allergic rhinitis. Further research should assess the clinical implications of COVID-19 vaccination on the severity and symptomatology of the allergic disease, in addition to natural viral infection. Copyright © 2022 Lippincott Williams and Wilkins. All rights reserved.

Citrus junos Tanaka Peel Extract Ameliorates HDM-Induced Lung Inflammation and Immune Responses In Vivo.

In the wake of the COVID-19 pandemic, lung disorders have become a major health concern for humans. Allergic asthma is the most prevalent form of asthma, and its treatments target the inflammation process. Despite significant developments in the diagnosis and management of allergic asthma, side effects are a major concern. Additionally, its extreme heterogeneity impedes the efficacy of the majority of treatments. Thus, newer, safer therapeutic substances, such as natural products, are desired. Citrus junos Tanaka has traditionally been utilized as an anti-inflammatory, sedative, antipyretic, and antitoxic substance. In this study, the protective effects of Citrus junos Tanaka peel extract (B215) against lung inflammation were examined, and efforts were made to understand the underlying protective mechanism using an HDM-induced lung inflammation murine model. The administration of B215 reduced immune cell infiltration in the lungs, plasma IgE levels, airway resistance, mucus hypersecretions, and cytokine production. These favorable effects alleviated HDM-induced lung inflammation by modulating the NF-κB signaling pathway. Hence, B215 might be a promising functional food to treat lung inflammation without adverse effects.

Patients with allergic asthma have lower risk of severe COVID-19 outcomes than patients with nonallergic asthma.

BACKGROUND: Although asthma does not appear to be a risk factor for severe coronavirus disease 2019 (COVID-19), outcomes could vary for patients with different asthma subtypes. The objective of this analysis was to compare COVID-19 outcomes in real-world cohorts in the United States among patients with asthma, with or without evidence of allergy. METHODS: In a retrospective analysis of the COVID-19 Optum electronic health record dataset (February 20, 2020-January 28, 2021), patients diagnosed with COVID-19 with a history of moderate-to-severe asthma were divided into 2 cohorts: those with evidence of allergic asthma and those without (nonallergic asthma). After 1:1 propensity score matching, in which covariates were balanced and potential bias was removed, COVID-19 outcomes were compared between cohorts. RESULTS: From a COVID-19 population of 591,198 patients, 1595 patients with allergic asthma and 8204 patients with nonallergic asthma were identified. After propensity score matching (n = 1578 per cohort), risk of death from any cause after COVID-19 diagnosis was significantly lower for patients with allergic vs nonallergic asthma (hazard ratio, 0.48; 95% CI 0.28-0.83; P = 0.0087), and a smaller proportion of patients with allergic vs nonallergic asthma was hospitalized within - 7 to + 30 days of COVID-19 diagnosis (13.8% [n = 217] vs 18.3% [n = 289]; P = 0.0005). Among hospitalized patients, there were no significant differences between patients with allergic or nonallergic asthma in need for intensive care unit admission, respiratory support, or COVID-19 treatment. CONCLUSIONS: Asthma subtype may influence outcomes after COVID-19; patients with allergic asthma are at lower risk for hospitalization/death than those with nonallergic asthma.

Clinical evaluation of surgical face mask efficacy in reducing asthma and rhinitis symptoms in birch-allergic subjects in ALYATEC environmental exposure chamber

Aim of the study: Currently, there is no clinical evidence that face masks are efficient in birch pollen-induced asthma. As the use of face masks has become widespread worldwide to limit the spread of SARS-CoV-2, it was chosen to demonstrate the clinical efficacy of medical masks in patients allergic to birch in the same way that clinical trial with drugs. Patients and Methods: 24 birch-related asthmatic patients, were exposed to 60 ng/m3 of airborne Bet v 1 in ALYATEC environmental exposure chamber. All patients had positive skin prick tests and specific IgE to birch at screening visit. Patients with asthma response during 1-hour baseline exposure were randomized into 2 groups: with and without a KOLMI surgical face mask (OP-Air), for a 6-hour exposure to birch allergen. Result(s): The median time to obtain an early asthma response in the group without mask was 37 minutes, and 67 min in the group with mask (P = 0.219). At 1 hour-exposure, patients with masks still present in the environmental exposure chamber was twice as much as the group without masks. Conclusion(s): This pilot study showed a tendency of face masks to increase the time to develop allergic symptoms. Copyright © 2022

Évaluation clinique de l’efficacité d’un masque chirurgical dans la réduction des symptômes d’asthme et de rhinite, chez des sujets allergiques au pollen de bouleau dans la chambre d’exposition environnementale ALYATEC

Résumé But de l’étude À ce jour, aucune étude clinique n’a mis en évidence l’efficacité des masques médicaux dans l’asthme induit par le pollen de bouleau. Suite à la généralisation de l’utilisation des masques dans le monde afin de limiter la propagation du SARS-CoV-2, il a été choisi de démontrer l’efficacité des masques chirurgicaux chez des patients allergiques au pollen de bouleau, en suivant les mêmes principes que les études cliniques avec médicaments. Patients et méthodes 24 patients asthmatiques au pollen de bouleau ont été exposés à 60ng/m3 de Bet v 1 dans la chambre d’exposition environnementale ALYATEC. Tous les patients avaient des tests cutanés et des taux d’IgE spécifiques au pollen de bouleau positifs lors de la visite de sélection. Les patients présentant une réponse asthmatique pendant l’exposition baseline de 1h ont été randomisés en 2 groupes : avec et sans masque chirurgical KOLMI® (OP-Air), pour une exposition de 6h aux allergènes de pollen de bouleau. Résultats Le temps médian d’apparition d’une réponse bronchique immédiate dans le groupe sans masque était de 37minutes, et de 67min dans le groupe avec masque (p=0,219). À 1h d’exposition, le nombre de patients dans le groupe avec masque encore présents dans la chambre d’exposition environnementale était deux fois plus important que dans le groupe sans masque. Conclusion Cette étude pilote a montré une tendance des masques à retarder le temps d’apparition des symptômes allergiques. Aim of the study Currently, there is no clinical evidence that face masks are efficient in birch pollen-induced asthma. As the use of face masks has become widespread worldwide to limit the spread of SARS-CoV-2, it was chosen to demonstrate the clinical efficacy of medical masks in patients allergic to birch in the same way that clinical trial with drugs. Patients and methods 24 birch-related asthmatic patients, were exposed to 60ng/m3 of airborne Bet v 1 in ALYATEC environmental exposure chamber. All patients had positive skin prick tests and specific IgE to birch at screening visit. Patients with asthma response during 1-hour baseline exposure were randomized into 2 groups: with and without a KOLMI® surgical face mask (OP-Air), for a 6-hour exposure to birch allergen. Results The median time to obtain an early asthma response in the group without mask was 37minutes, and 67min in the group with mask (P=0.219). At 1 hour-exposure, patients with masks still present in the environmental exposure chamber was twice as much as the group without masks. Conclusion This pilot study showed a tendency of face masks to increase the time to develop allergic symptoms.

Bioinformatics and systems-biology analysis to determine the effects of Coronavirus disease 2019 on patients with allergic asthma.

Background: The coronavirus disease (COVID-19) pandemic has posed a significant challenge for global health systems. Increasing evidence shows that asthma phenotypes and comorbidities are major risk factors for COVID-19 symptom severity. However, the molecular mechanisms underlying the association between COVID-19 and asthma are poorly understood. Therefore, we conducted bioinformatics and systems biology analysis to identify common pathways and molecular biomarkers in patients with COVID-19 and asthma, as well as potential molecular mechanisms and candidate drugs for treating patients with both COVID-19 and asthma. Methods: Two sets of differentially expressed genes (DEGs) from the GSE171110 and GSE143192 datasets were intersected to identify common hub genes, shared pathways, and candidate drugs. In addition, murine models were utilized to explore the expression levels and associations of the hub genes in asthma and lung inflammation/injury. Results: We discovered 157 common DEGs between the asthma and COVID-19 datasets. A protein-protein-interaction network was built using various combinatorial statistical approaches and bioinformatics tools, which revealed several hub genes and critical modules. Six of the hub genes were markedly elevated in murine asthmatic lungs and were positively associated with IL-5, IL-13 and MUC5AC, which are the key mediators of allergic asthma. Gene Ontology and pathway analysis revealed common associations between asthma and COVID-19 progression. Finally, we identified transcription factor-gene interactions, DEG-microRNA coregulatory networks, and potential drug and chemical-compound interactions using the hub genes. Conclusion: We identified the top 15 hub genes that can be used as novel biomarkers of COVID-19 and asthma and discovered several promising candidate drugs that might be helpful for treating patients with COVID-19 and asthma.

ATYPICAL VARIANT OF GRANULOMATOSIS WITH POLYANGIITIS WITH EOSINOPHILIA

SESSION TITLE: Critical Systemic Disease Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Granulomatosis with polyangiitis (GPA) is a necrotizing granulomatous vasculitis affecting small-to-medium sized blood vessels. GPA is highly associated with antineutrophil cytoplasmic antibodies (ANCAs) and often triggered by environmental factors such as medications and infectious agents. Tracheobronchial stenosis and diffuse alveolar hemorrhage are serious complications of GPA. CASE PRESENTATION: A 35-year-old Caucasian male with a history of chronic sinusitis requiring balloon sinuplasty and recent tympanostomy had presented multiple times to the emergency room due to dyspnea and cough with pinkish sputum production. This was associated with sore throat and fever, which were attributed to his COVID-19 infection and treated with supportive care. Due to persistent drainage through his tympanostomy he was prescribed levofloxacin by his ENT specialist. After the second dose of levofloxacin, he developed Raynaud's phenomenon, diffuse purpuric lesions and swelling over his lower extremity, eyelids, and elbows. Four days later he developed worsening hemoptysis and dyspnea for which he was admitted for further evaluation. Laboratory findings were remarkable for peripheral eosinophilia, elevated ESR 19mm/hr, CRP 9.2mg/dl, c-ANCA 1:320 titer, positive proteinase-3 antibodies and normal p-ANCA titers. Urinalysis with microscopic hematuria. Chest CT scan showed ground glass opacity, consolidative infiltrate with subpleural sparing and minimal left bronchial stenosis. Bronchoscopy suggestive of diffuse alveolar hemorrhage. Limited lung biopsy showed ulcer and granulation tissue with abundant eosinophils, but no granulomatous inflammation noted. Pulse dose steroids and Rituximab were initiated, and rapid clinical improvement was noted. Patient was discharged on prednisone taper and Pneumocystis jiroveci prophylaxis. DISCUSSION: We believe that GPA may have been triggered by recent COVID-19 infection and levofloxacin use. Mild peripheral blood and tissue eosinophilia (<12%) has been described in GPA, however it is a rare finding. GPA and eosinophilic granulomatosis with polyangiitis (EGPA) are both ANCA vasculitis that involve lungs and kidneys. GPA presents with sinusitis, alveolar hemorrhage and high titers of PR-3 antibodies. EGPA presents with a history of atopic, asthma and high titers of myeloperoxidase-ANCA along with abundant peripheral eosinophils. Our patient best fits the diagnostic criteria for GPA with eosinophilia variant rather than EGPA. Our patient had no history of asthma or atopic disease and p-ANCA was normal, which also points away from EGPA. CONCLUSIONS: Clinicians should recognize the differential diagnosis for eosinophils in ANCA vasculitis. Early diagnosis of ANCA vasculitis and initiation of appropriate treatment is important to decrease morbidity and mortality. Reference #1: Potter MB, Fincher RK, Finger DR. Eosinophilia in Wegener's Granulomatosis. Chest 116: 1480-1483, 1999 Reference #2: Krupsky, Meir et al. Wegener's Granulomatosis With Peripheral Eosinophilia. CHEST, Volume 104, Issue 4, 1290 - 1292 Reference #3: Kitching AR, Anders HJ, et al. ANCA-associated vasculitis. Nat Rev Dis Primers. 2020 Aug 27;6(1):71. doi: 10.1038/s41572-020-0204-y. PMID: 32855422. DISCLOSURES: No relevant relationships by Afoma King No relevant relationships by Joshuam Ruiz Vega No relevant relationships by Krishna Shah no disclosure on file for Milos Tucakovic;

NOT THE VACCINE, BUT ANAPHYLAXIS TO THE COVID-19 VIRUS ITSELF

SESSION TITLE: Poster Cases in Asthma and Allergy SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Anaphylaxis is an acute, potentially life-threatening, systemic allergic reaction that presents as a multitude of manifestations after exposure to an allergen. It is rare to have an anaphylactic reaction to the SARS-Cov-2 vaccine, however, we present a patient who had a prolonged anaphylactic reaction to the SARS-CoV-2 virus itself. CASE PRESENTATION: A 23-year-old female with past medical history of chronic idiopathic urticaria and dermatographism presented with fatigue, rash, rhinitis, and lip swelling in the setting of being COVID-19 positive. She had received two doses of the Pfizer-BioNTech COVID-19 vaccine nine months prior without any adverse affects. During the SARS-CoV-2 Omicron variant surge, the patient was exposed to a family member who had contracted COVID-19 infection. Two days prior to presentation, she started having a diffuse rash throughout her body. In the Emergency Department, she was given IM epinephrine x2, IV Solu-Medrol and IV Benadryl with temporary improvement in her symptoms. She developed hypotension that required initiation of a continuous epinephrine infusion and was admitted to the Medical Intensive Care Unit. Each time the epinephrine was held, generalized urticaria recurred and she would become hypotensive with her systolic blood pressure decreasing below 80 mmHg. The urticaria completely resolved and her blood pressure improved when the epinephrine infusion was restarted. The patient was treated with remdesivir, Solu-Medrol, loratadine, and famotidine. She was able to be weaned off the epinephrine infusion over the course of four days. Immunological workup was unremarkable apart from elevation of IL-10 on her cytokine panel. DISCUSSION: The symptoms and syndromes associated with COVID-19 infection remain diverse and while urticaria has been a documented manifestation of the virus, it is uncommon (1). There is a single case report of an anaphylactic reaction in response to COVID-19 (2). Given our patient's symptoms were temporally related to the COVID-19 infection, we believe the SARS-COV-2 virus was the trigger. She did not have any other exposure during this time. This case is unique in that the virus not only triggered the urticaria, but that her symptoms persisted for four days. After receiving antiviral therapy plus steroids and antihistamines, her symptoms finally resolved. The SARS-COV-2 virus itself is primarily attacked by immune cells, including mast cells, which release an array of proinflammatory cytokines (3). We postulate that in our patient, her history of chronic urticaria predisposed her to an exaggerated inflammatory response. CONCLUSIONS: SARS-CoV-2 has clinically presented itself in a multitude of ways across many disciplines. In a patient with a history of urticaria, prolonged anaphylactic symptoms can be triggered by the virus itself. Reference #1: Adeliño R., Andrés-Cordón J.F., De la Cruz Martínez C.A. Acute urticaria with angioedema in the setting of coronavirus disease 2019. J Allergy Clin Immunol Pract. 2020;8(7):2386–2387. Reference #2: Alvarez-Perea A, Baeza ML. Anaphylactic shock following the diagnosis of coronavirus disease 2019. Ann Allergy Asthma Immunol. 2020;125(4):477-478. Reference #3: Kritas SK, Ronconi G, Caraffa A, Gallenga CE, Ross R, Conti P. Mast cells contribute to coronavirus-induced inflammation: new anti-inflammatory strategy. J Biol Regul Homeost Agents. 2020 January-February,;34(1):9-14. 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