ABSTRACT
BACKGROUND: Data from the 2009 influenza pandemic suggested asthma might protect from severe disease in hospitalized patients. Asthma does not appear to increase risk for hospitalization or mortality with COVID-19. OBJECTIVE: This study was undertaken to see if atopy actually protected those hospitalized with COVID-19. METHODS: Retrospective chart review on all patients testing positive for SARS-CoV-2 over 2 months at a major adult and pediatric tertiary referral center hospital. Charts were evaluated for history of atopic disease, as were the need for ICU admission, requirement for supplemental oxygen and/or intubation, and in hospital mortality. RESULTS: No significant differences in outcomes for patients (n = 275) based on atopic disease were noted: ICU admission, 43% versus 44.7% (atopic versus no atopic disease, respectively; p = 0.84); supplemental oxygen use, 79.1% versus 73.6% (p = 0.36); intubation rate, 35.8% versus 36.5% (p = 0.92); and mortality rate, 13.4% versus 20.7% (p = 0.19). More patients with atopic disease had COPD listed as a diagnosis in their chart (38.8% versus 17.3%, p < 0.001). COPD was associated with an increased rate of ICU admission (aOR = 2.22 (1.15, 4.30) p = 0.02) and intubation (aOR = 2.05 (1.07, 3.92) p = 0.03). After adjusting for COPD, patients with atopic disease had a trend for reduced mortality (aOR 0.55 (0.23, 1.28), p = 0.16), but those with asthma did not (p > 0.2). CONCLUSION: Severity of COVID-19 in hospitalized patients does not differ based on atopic status. However, adjusting for presence of COPD led to a suggestion of possible reduced severity in patients with atopy but not asthma.
ABSTRACT
Eczema is a chronic, relapsing, and remitting disease that can affect patients from infancy through adulthood. Severity of eczema ranges from mild to severe and can be plagued with recurrent flares. These flares can be difficult to treat and may require use of different strategies to address the issue. In this article, the author addresses different therapeutic options that can be used in those patients with difficult-to-treat eczema.
Subject(s)
Eczema/diagnosis , Eczema/etiology , Eczema/therapy , Animals , Combined Modality Therapy , Diagnostic Tests, Routine , Disease Management , Eczema/prevention & control , Humans , Outcome Assessment, Health Care , Symptom AssessmentSubject(s)
Anaphylaxis/chemically induced , Gelatin Sponge, Absorbable/adverse effects , Spinal Fusion , Adrenergic Agonists/administration & dosage , Anaphylaxis/diagnosis , Anaphylaxis/drug therapy , Anaphylaxis/immunology , Child , Epinephrine/administration & dosage , Female , Humans , Treatment OutcomeSubject(s)
Allergens/immunology , Eosinophilic Esophagitis/diagnosis , Food/adverse effects , Hypersensitivity, Immediate/diagnosis , Adult , Endoscopy, Gastrointestinal , Eosinophilic Esophagitis/immunology , Female , Humans , Hypersensitivity, Immediate/immunology , Immunoglobulin E/blood , Immunoglobulin E/immunology , Male , Odds Ratio , Skin TestsABSTRACT
The treatment options for patients with sarcoidosis are presently limited, and it is unclear which treatments are most effective for any given patient. We have identified a sarcoidosis phenotype characterized by CD4(+) lymphopenia and resistance to conventional immunosuppressants, such as corticosteroids and methotrexate. Based on recent reports linking tumor necrosis factor (TNF)-alpha to regulatory T-cell (Treg) dysfunction, we hypothesized that sarcoidosis-associated CD4(+) lymphopenia would resolve with anti-TNFalpha treatment. Five consecutive patients with CD4(+) lymphopenia were treated with a chimeric anti-TNFalpha antibody (infliximab). Clinical disease manifestations and peripheral blood T-cell subsets were assessed before and after infliximab treatment. All patients experienced significant increases in absolute peripheral blood lymphocyte and CD4(+) T-cell counts and demonstrated improvement in clinical disease manifestations in response to infliximab. No change in the distribution of T-cell subsets was noted. The presence of CD4(+) lymphopenia identifies a distinct sarcoidosis phenotype that is particularly responsive to anti-TNFalpha therapy.
