ACE2 expression in allergic airway disease may decrease the risk and severity of COVID-19
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ACE2 expression in allergic airway disease may decrease the risk and severity of COVID‑19 Sunita Chhapola Shukla1 Received: 17 August 2020 / Accepted: 28 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The coronavirus disease (COVID-19) is caused by Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and presents with respiratory symptoms which can be life threatening in severe cases. At the start of the pandemic, allergy, asthma, and chronic obstructive pulmonary disease (COPD) were considered as risk factors for COVID-19 as they tend to exacerbate during respiratory viral infections. Recent literature has not shown that airway allergic diseases is a high-risk factor or that it increases the severity of COVID-19. This is due to a decrease in Angiotensin-converting enzyme 2 (ACE2) gene expression in the nose and bronchial cells of allergic airway diseases. Conventional asthma treatment includes inhaled corticosteroids (ICS), allergen immunotherapy (AIT), and biologics, and should be continued as they might reduce the risks of asthmatics for coronavirus infection by enhancing antiviral defence and alleviating inflammation. Keywords Allergic rhinitis · Asthma · SARS-CoV-2 · COVID-19 · Angiotensin-converting enzyme 2 (ACE2) · Transmembrane protease serine 2 (TMPRSS2) · Inhaled corticosteroids (ICS) · Allergen immunotherapy (AIT)
Introduction Coronavirus was discovered in 1930. They are enveloped single-stranded RNA virus with spikes on their surface, which looks like a crown and hence the name “Corona”. Human coronavirus producing severe symptoms are Severe acute respiratory syndrome coronavirus (SARS-CoV, 2003), Middle East respiratory syndrome coronavirus (MERS-CoV, 2012), and Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2, 2019). COronaVIrus Disease 2019 (COVID-19) outbreak was declared a pandemic on 11th March 2020 by World Health Organization. Since then, numerous medical literature is released worldwide to spread awareness about this new infection, its physiology, treatment guidelines, and prevention. COVID-19 presents with mild to severe respiratory symptoms and is associated with a cytokine storm. Old age and comorbidities such as cardiovascular diseases, hypertension, diabetes, obesity, and tobacco exposure are factors for increased morbidity and mortality [1]. Allergic
* Sunita Chhapola Shukla [email protected] 1
Mumbai Port Trust Hospital, Mumbai, India
airway diseases ie allergic rhinitis and allergic asthma is of concern in this pandemic since symptoms of upper respiratory tract viral infection, allergic rhinitis, influenza, etc. overlap during the early stages. Hence, allergists and otolaryngologists are responsible for timely diagnosis and treatment and thus alleviate the patient’s anxiety. Respiratory viruses can trigger and cause serious illness in individuals with chronic airway diseases and hence it was thought that individuals with allergies, asthma, and chronic lung diseases (COPD) are at high risk for
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