Allergic disorders and susceptibility to and severity of COVID-19: A nationwide cohort study

Abstract

Background: There is inconclusive and controversial evidence of the association between allergic diseases and the risk of adverse clinical outcomes of coronavirus disease 2019 (COVID-19). Objective: We sought to determine the association of allergic disorders with the likelihood of a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test result and with clinical outcomes of COVID-19 (admission to intensive care unit, administration of invasive ventilation, and death). Methods: A propensity-score-matched nationwide cohort study was performed in South Korea. Data obtained from the Health Insurance Review & Assessment Service of Korea from all adult patients (age, >20 years) who were tested for SARS-CoV-2 in South Korea between January 1, 2020, and May 15, 2020, were analyzed. The association of SARS-CoV-2 test positivity and allergic diseases in the entire cohort (n 5 219,959) and the difference in clinical outcomes of COVID-19 were evaluated in patients with allergic diseases and SARS-CoV-2 positivity (n 5 7,340). Results: In the entire cohort, patients who underwent SARS-CoV-2 testing were evaluated to ascertain whether asthma and allergic rhinitis were associated with an increased likelihood of SARS-CoV-2 test positivity. After propensity score matching, we found that asthma and allergic rhinitis were associated with worse clinical outcomes of COVID-19 in patients with SARS-CoV-2 test positivity. Patients with nonallergic asthma had a greater risk of SARS-CoV-2 test positivity and worse clinical outcomes of COVID-19 than patients with allergic asthma. Conclusions: In a Korean nationwide cohort, allergic rhinitis and asthma, especially nonallergic asthma, confers a greater risk of susceptibility to SARS-CoV-2 infection and severe clinical outcomes of COVID-19.

Allergic rhinitis

“…In addition, SARS-CoV-2 binds to angiotensin-converting enzyme 2 (ACE2), and expression of ACE2 is lower in patients with allergic diseases, suggesting that they may be less prone to SARS-CoV-2 infection 204,205 . The effect of AR on COVID-19 is still a matter of debate, and no firm conclusion can be drawn 206 . Smell dysfunction and anosmia are common COVID-19 symptoms 207 .…”

Zoonotic coronavirus epidemics

“…143,144 Similarly, rates of asthma, allergic rhinitis, and atopic dermatitis were all lower in patients with COVID-19 (9.9%, 57.4%, 1.9%) compared to the total tested population (14.9%, 63.1%, 3.9%) in a Korean nationwide cohort study. 145 When 37 major pediatric asthma and allergy centers estimated to treat 1,000 asthmatics in Europe and Turkey were surveyed between September 2019 and July 2020, none reported any symptomatic COVID-19 cases or positive SARS-CoV-2 tests among their patients. 146 Three studies suggest that perhaps asthma rates may be concentrated in pediatric patients with 145 Data regarding the effect of asthma on COVID-19 outcomes shown in Table 1 are mixed and conflicting.…”

“…145 When 37 major pediatric asthma and allergy centers estimated to treat 1,000 asthmatics in Europe and Turkey were surveyed between September 2019 and July 2020, none reported any symptomatic COVID-19 cases or positive SARS-CoV-2 tests among their patients. 146 Three studies suggest that perhaps asthma rates may be concentrated in pediatric patients with 145 Data regarding the effect of asthma on COVID-19 outcomes shown in Table 1 are mixed and conflicting. Severe asthma was associated with increased risk of COVID-19-related death in one study reviewing a health analytics platform with records of 40% of England's patients, 149 but asthma was not necessarily associated with increased mortality in other studies.…”

“…147,[150][151][152] Interestingly, in at least two studies where asthma was associated with worse clinical outcomes, non-allergic asthma accounted for the increased risk for worse outcomes (severe COVID-19, ICU admission, intubation, death). 145,153 J o u r n a l P r e -p r o o f…”

Proton pump inhibitors and the risk of severe COVID-19: a post-hoc analysis from the Korean nationwide cohort

“…Data were obtained from the Korean nationwide cohort study, which includes patients (≥18 years) who underwent SARS-CoV-2 testing between 1 January and 15 May 2020. [2][3][4] We performed propensity score matching between current PPI users (prehospitalisation PPI usage) and non-users among patients with laboratory-confirmed COVID-19 (n=4785), as previously described. 2 Posthospitalisation PPI usage was defined as in-hospital PPI use in general wards, not intensive care units.…”