Treating COVID-19: Review of Drug Hypersensitivity Reactions

Dordal, M T; Regás, Valeria Herrera-Lasso; Martí-Garrido, Jaume; Cumplido, Dolores Rodríguez; Vazquez-Revuelta, P.; Bellfill, Ramón Lleonart

doi:10.18176/jiaci.0588

Cited by 7 publications

(4 citation statements)

References 99 publications

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“… 191 , 192 The diagnosis and management of DHRs induced by medications repurposed and off‐label for the treatment of COVID‐19 have been discussed in a few review papers. 191 , 192 , 193 …”

Section: Management Of Allergic Diseases During the Covid‐19 Pandemicmentioning

confidence: 99%

“…Switching from subcutaneous to sublingual immunotherapy may be considered for AIT during COVID‐19 190 . Skin manifestations of COVID‐19 may be similar to other viral infections and drug hypersensitivity reactions (DHRs) 191,192 . The diagnosis and management of DHRs induced by medications repurposed and off‐label for the treatment of COVID‐19 have been discussed in a few review papers 191–193 …”

Section: Management Of Allergic Diseases During the Covid‐19 Pandemicmentioning

confidence: 99%

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Recent developments in the immunopathology of COVID‐19

Zhang

Sun

Wang

et al. 2022

Allergy

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There has been an important change in the clinical characteristics and immune profile of Coronavirus disease 2019 patients during the pandemic thanks to the extensive vaccination programs. Here, we highlight recent studies on COVID-19, from the clinical and immunological characteristics to the protective and risk factors for severity and mortality of COVID-19. The efficacy of the COVID-19 vaccines and potential allergic reactions after administration are also discussed. The occurrence of new variants of concerns such as Omicron BA.2, BA.4, and BA.5 and the global administration of COVID-19 vaccines have changed the clinical scenario of COVID-19. Multisystem inflammatory syndrome in children (MIS-C) may cause severe and heterogeneous disease but with a lower mortality rate. Perturbations in immunity of T cells, B cells, and mast cells, as well as autoantibodies and metabolic reprogramming may contribute to the long-term symptoms of COVID-19. There is conflicting evidence about whether atopic diseases, such as allergic asthma and rhinitis, are associated with a lower susceptibility and better outcomes of COVID-19. At the beginning of pandemic, the European Academy of Allergy and Clinical Immunology (EAACI) developed guidelines that provided timely information for the management of allergic diseases and preventive measures to reduce transmission in the allergic clinics. The global distribution of COVID-19 vaccines and emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with reduced pathogenic potential dramatically decreased the morbidity, severity, and mortality of COVID-19. Nevertheless, breakthrough infection remains a challenge for disease control. Hypersensitivity reactions (HSR) to COVID-19 vaccines are low compared to other vaccines, and these were addressed in EAACI statements that provided indications for the management of allergic reactions, including anaphylaxis to COVID-19 vaccines. We have gained a depth knowledge and experience in the over 2 years since the start of the pandemic, and yet a full eradication of SARS-CoV-2 is not on the horizon. Novel strategies are warranted to prevent severe disease in high-risk groups, the development of MIS-C and long COVID-19.

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Section: Management Of Allergic Diseases During the Covid‐19 Pandemicmentioning

confidence: 99%

Section: Management Of Allergic Diseases During the Covid‐19 Pandemicmentioning

confidence: 99%

Recent developments in the immunopathology of COVID‐19

Zhang

Sun

Wang

et al. 2022

Allergy

View full text Add to dashboard Cite

show abstract

“…As most patients with severe COVID-19 in the ICU likely receive multiple medications known to be associated with interstitial nephritis, this finding may be somewhat surprising. Discussion of the risk of drug reactions in the literature has thus far focused on potential specific therapeutic agents for COVID-19 itself [17,18], although many other medications are used simultaneously given the severity of illness (Fig. 1).…”

Section: Discussionmentioning

confidence: 99%

“…Many patients, given the severity of illness, receive multiple medications including a variety of antibiotics, and increasingly potential therapies are being tested with encouraging results. Patients may therefore be expected to be at risk of drug-associated hypersensitivity [17,18]. Initially the use of corticosteroids was not routinely advocated, however recent data showed a reduction in 28-day mortality when used in severe COVID-19 [19].…”

Section: Introductionmentioning

confidence: 99%

Granulomatous interstitial nephritis in a patient with SARS-CoV-2 infection

et al. 2021

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Background Acute kidney injury (AKI) associated with severe coronavirus disease 19 (COVID-19) is common and is a significant predictor of morbidity and mortality, especially when dialysis is required. Case reports and autopsy series have revealed that most patients with COVID-19 – associated acute kidney injury have evidence of acute tubular injury and necrosis - not unexpected in critically ill patients. Others have been found to have collapsing glomerulopathy, thrombotic microangiopathy and diverse underlying kidney diseases. A primary kidney pathology related to COVID-19 has not yet emerged. Thus far direct infection of the kidney, or its impact on clinical disease remains controversial. The management of AKI is currently supportive. Case Presentation The patient presented here was positive for SARS-CoV-2, had severe acute respiratory distress syndrome and multi-organ failure. Within days of admission to the intensive care unit he developed oliguric acute kidney failure requiring dialysis. Acute kidney injury developed in the setting of hemodynamic instability, sepsis and a maculopapular rash. Over the ensuing days the patient also developed transfusion-requiring severe hemolysis which was Coombs negative. Schistocytes were present on the peripheral smear. Given the broad differential diagnoses for acute kidney injury, a kidney biopsy was performed and revealed granulomatous tubulo-interstitial nephritis with some acute tubular injury. Based on the biopsy findings, a decision was taken to adjust medications and initiate corticosteroids for presumed medication-induced interstitial nephritis, hemolysis and maculo-papular rash. The kidney function and hemolysis improved over the subsequent days and the patient was discharged to a rehabilitation facility, no-longer required dialysis. Conclusions Acute kidney injury in patients with severe COVID-19 may have multiple causes. We present the first case of granulomatous interstitial nephritis in a patient with COVID-19. Drug-reactions may be more frequent than currently recognized in COVID-19 and are potentially reversible. The kidney biopsy findings in this case led to a change in therapy, which was associated with subsequent patient improvement. Kidney biopsy may therefore have significant value in pulling together a clinical diagnosis, and may impact outcome if a treatable cause is identified.

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Management of Allergic Diseases During COVID-19 Outbreak

Izquierdo-Domínguez

Rojas-Lechuga

Alobid

2021

Curr Allergy Asthma Rep

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Purpose of Review The coronavirus disease 2019 (COVID-19) has challenged healthcare system capacities and safety for health care workers, reshaping doctor-patient interaction favoring e-Health or telemedicine. The pandemic situation may make difficult to prioritize patients with allergies diseases (AD), face-to-face evaluation, and moreover concern about the possible COVID-19 diagnosis, since COVID-19 shared many symptoms in common with AD. Being COVID-19 a novel disease, everyone is susceptible; there are some advances on vaccine and specific treatment. We evaluate existing literature on allergic diseases (AD): allergic rhinitis, asthma, food allergy, drug allergy, and skin allergy, and potential underlying mechanisms for any interrelationship between AD and COVID-19. Recent Findings There is inconclusive and controversial evidence of the association between AD and the risk of adverse clinical outcomes of COVID-19. AD patients should minimize hospital and face-to-face visits, and those who have used biologics and allergen immunotherapy should continue the treatment. It is essential to wear personal protective equipment for the protection of health care workers. Summary Social distancing, rational use of facemasks, eye protection, and hand disinfection for health care workers and patients deserve further attention and promotion. Teleconsultation during COVID-19 times for AD patients is very encouraging and telemedicine platform can provide a reliable service in patient care.

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Treating COVID-19: Review of Drug Hypersensitivity Reactions

Abstract: This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record.

Cited by 7 publications

References 99 publications

Recent developments in the immunopathology of COVID‐19

Recent developments in the immunopathology of COVID‐19

Granulomatous interstitial nephritis in a patient with SARS-CoV-2 infection

Management of Allergic Diseases During COVID-19 Outbreak

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