Background: It remains unclear if asthma is a risk factor associated with worse outcomes among patients with coronavirus disease 2019 (COVID-19). Methods: We performed a comprehensive database search for studies published from January 1, 2019, to October 2, 2020. We included studies that evaluated outcomes among patients with COVID-19 and underlying asthma. Outcomes of interest included the need for hospitalization, length of hospitalization, intensive care unit (ICU) admission, and death. The meta-analysis was conducted by using random-effects methodology. Results: A total of 389 studies were identified through data base searches. After abstract and full-text screening, 16 observational studies with 92,275 patients were included in the analysis. Of the 16 studies, 15 were retrospective and 1 was a prospective cohort study. The average age was 39.6 years, with 48% female patients. Six of the studies included pediatric patients, and one of these studies only evaluated pediatric patients. One study only evaluated pregnant patients. Among patients with COVID-19, the presence of asthma was not associated with any significant increase in risk of hospitalization (odds ratio [OR] 1.46 [95% confidence interval {CI}, 0.29-7.28]), length of hospitalization (1.59 days [‐0.55 to 3.74]), ICU admission (OR 1.65 [95% CI, 0.56-4.17]), or death (OR 0.73 [95% CI, 0.38-1.40]). The overall risk of bias of the included studies was high. Conclusion: Among the patients with COVID-19, asthma did not seem to significantly increase the risk of hospitalization, length of hospitalization, ICU admission, or death.

Febrile neutropenia leads to over 100,000 hospitalizations in the US each year and can cause sepsis, septic shock, and death. Although first-line treatment for neutropenic fever is an anti-Pseudomonal betalactam, >10%of patients report a beta-lactam allergy. Since 90% of patients with a documented beta-lactam allergy do not have true allergy, we assessed the association of documented beta-lactam allergy to first-line febrile neutropenia antibiotic treatment. METHODS: In this national cross-sectional study of hospitalized patients, we determined the relation of documented beta-lactam allergy (i.e. a penicillin and/or cephalosporin allergy in the electronic medical record) to first-line febrile neutropenia treatment (i.e., cefepime, anti-Pseudomonal carbapenem, or piperacillin-tazobactam), using Generalized Estimating Equations models with logit link adjusted for age, sex, race, intensive care unit location, and resistant organism colonization/infection. RESULTS: Of 290 inpatients with febrile neutropenia receiving antibiotics at 64 US hospitals, 55 (19%) patients had a documented beta-lactam allergy. Patients with a documented beta-lactam allergy less frequently received first-line treatment (36% vs 63%), with less frequent cefepime (36% vs 63%) and piperacillin-tazobactam (9% vs 15%) but more frequent meropenem (35% vs 11%). In the fully adjusted model, patients with a documented beta-lactam allergy had reduced use of first-line febrile neutropenia treatment (adjusted Odds Ratio [aOR] 0.36, 95%CI [0.20, 0.64]). CONCLUSIONS: In this national sample of patients with febrile neutropenia, a documented beta-lactam allergy was associated with a significant, 64%, decreased use of first-line antibiotic treatment. Improved systems for optimizing first-line beta-lactam use in patients with febrile neutropenia are needed to improve care in this high-risk patient population.

Prof.RATIONALE: Vancomycin is recognized to be associated with ''allergy labels'' (VAL) in the electronic health record; however, clinical distribution and knowledge of host predisposition across distinct clinical phenotypes are lacking. METHODS: BioVu, a DNA Biobank paired with a deidentified EHR was used to review VAL. We included subjects with multiethnicity genotyping array (MegaEx) typing with HLA ABC DR DQ DP imputed by SNP2HLA. We interrogated specific VAL phenotypes for HLA associations, concurrent allergy labels, and outcomes compared with age, sex, race and disease matched vancomycin tolerant controls (conditional logistical analyses, R version 4.0.3) Bonferroni controlled for multiple comparisons. Where VAL phenotype sample size >100 , we performed MegaEx genome wide association studies (GWAS). RESULTS: 1020/3076236 (0.33%) BioVu MegaEx VAL patients were identified (non-IgE mediated reactions (Redman) type reactions (42%), nephrotoxicity (6.2%) cytopenias, and potential hypersensitivity reactions (15.7%). Those with Redman-type reactions were younger 40 IQR [23, 61] vs. 55 IQR [40, 67], p<0.0005. HLA-A*32:01, previously associated with vancomycin DRESS, was equally represented across the entire VAL group (67/1017 (6.59%) and BioVu MegaEx population 5634/94179 (5.98%)), but was less common in VAL nephrotoxicity group (1/42 (2.38%), driven by higher prevalence of African Americans in vancomycin-piperacillin tazobactam nephrotoxicity group (4/77 (5.2%) vs. 12/587 (2.0%) European-Americans, p50.08.). Cluster and network analyses from HLA and MegaEx data identified significant phenotype-genotype relationships. CONCLUSIONS: VAL are complex and heterogeneous clinical phenotypes that can be defined by epidemiological and genetic differences. Non-IgE mediated reactions, the most common, remain a permanent part of the EHR despite their modifiability.

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Live vaccines are contraindicated in patients with severe cellular immunodeficiencies while guidelines regarding the administration of live vaccines in patients with more mild disease are ill-defined. We sought to decipher different parameters used by practicing immunologists for the administration of live vaccines in cellular immunodeficiency patients. A 27-question survey assessing clinical and laboratory threshold parameters used in the administration of live vaccines to immunodeficient patients was distributed to practicing clinicians specializing in immune deficiencies. There were 83 survey respondents, 65% identified as female, and 71% were based in the United States. Allergy / Immunology and Immunodeficiency were the most common identified specialties, accounting for 84% of respondents. Most clinicians did administer live vaccines to patients with humoral (54/67; 80.6%), cellular (41/67; 61.2%), and combined diseases (37/67; 55.2%) . Most clinicians who reported giving live vaccines to patients with immune deficiencies considered a threshold CD4 count of ≥ 400 cells/mm3 (MMR 48/60 [80%], Varicella 42/53 [79%], Rotavirus 40/45 [88.89%]), a CD8 count of ≥ 250 cells/mm3 (MMR 30/39 [76.92%], Varicella 29/37 [78.34%], Rotavirus 27/34 [79.41%]), and normal mitogen function (MMR 44/53 [83.02%], Varicella 40/48 [83.33%], Rotavirus 37/40 [92.5%]). Using these survey results, we propose a treatment threshold of using CD4 count of ≥ 400 cells/mm3, a CD8 count of ≥ 250 cells/mm3, and normal lymphocyte proliferative responses to mitogen. Future studies are needed to determine clinical efficacy and safety using these thresholds.