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What we know and still ignore on COVID-19 immune pathogenesis and a proposal based on the experience of allergic disorders.
Maggi, Enrico; Azzarone, Bruno Giuseppe; Canonica, Giorgio Walter; Moretta, Lorenzo.
  • Maggi E; Department of Immunology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
  • Azzarone BG; Department of Immunology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
  • Canonica GW; Asthma & Allergy Clinic, Humanitas University & Research Hospital, IRCCS, Milan, Italy.
  • Moretta L; Department of Immunology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Allergy ; 77(4): 1114-1128, 2022 04.
Article in English | MEDLINE | ID: covidwho-1440721
ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic started in March 2020 and caused over 5 million confirmed deaths worldwide as far August 2021. We have been recently overwhelmed by a wide literature on how the immune system recognizes severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and contributes to COVID-19 pathogenesis. Although originally considered a respiratory viral disease, COVID-19 is now recognized as a far more complex, multi-organ-, immuno-mediated-, and mostly heterogeneous disorder. Though efficient innate and adaptive immunity may control infection, when the patient fails to mount an adequate immune response at the start, or in advanced disease, a high innate-induced inflammation can lead to different clinical outcomes through heterogeneous compensatory mechanisms. The variability of viral load and persistence, the genetic alterations of virus-driven receptors/signaling pathways and the plasticity of innate and adaptive responses may all account for the extreme heterogeneity of pathogenesis and clinical patterns. As recently applied to some inflammatory disorders as asthma, rhinosinusitis with polyposis, and atopic dermatitis, herein we suggest defining different endo-types and the related phenotypes along COVID-19. Patients should be stratified for evolving symptoms and tightly monitored for surrogate biomarkers of innate and adaptive immunity. This would allow to preventively identify each endo-type (and its related phenotype) and to treat patients precisely with agents targeting pathogenic mechanisms.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Allergy Year: 2022 Document Type: Article Affiliation country: All.15112

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 Type of study: Prognostic study Topics: Long Covid Limits: Humans Language: English Journal: Allergy Year: 2022 Document Type: Article Affiliation country: All.15112