Prevalence and Severity of COVID-19 among Pediatric Patients with Atopy: A Cross-sectional Study in Kerman, Southeast Iran
-
Fakhry Shafiee
,
Afshin Sarafinejad
,
Nasrin Bazargan Harandi
,
Ali Hossininasab
,
Sareh Saadat Ebrahimi
Abstract
The tragic COVID-19 pandemic affected many children worldwide. Among the factors that may influence the course of viral infections including COVID-19, it is still uncertain whether atopy has a protective or predisposing role. The study aims to address the knowledge gap by investigating the prevalence and severity of COVID-19 among atopic children in Kerman, in 2022.
A descriptive-analytical cross-sectional study on children with a history of atopy was performed in Kerman Medical University. Demographic information, type of atopy (including allergic rhinitis, Hyper-Reactive Airway Disease (HRAD) or asthma, eczema, urticaria, anaphylaxis, and food allergy), history of COVID-19 infection, and disease severity were recorded.
A total of 1007 children and adolescents, (boys: 56.4%, girls: 43.6%, age:5.61±2.64 years) were included in the study. History of COVID-19 infection was positive in 53.5%, with 75.9% of the cases exhibiting mild disease severity. The frequency of atopies was HRAD or asthma (67.2%), allergic rhinitis (42.6%), and food allergy (27.4%). The frequency of COVID-19 cases was significantly higher among patients with HRAD or asthma, whereas it was significantly lower among those with food allergies, anaphylaxis, and eczema. Among atopic individuals, COVID-19 severity was significantly lower in those with allergic rhinitis, while the opposite trend was observed among food-allergic individuals.
This study sheds light on the relationship between atopy and COVID-19 among pediatric patients. It seems specific types of atopies may influence the risk and severity of COVID-19 infection differently. A better understanding of these associations can inform clinical management and preventive measures for vulnerable pediatric populations.
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3. World Health O. WHO Coronavirus (COVID-19) Dashboard. 2023.
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6. Liu Y, Yang Y, Zhang C, Huang F, Wang F, Yuan J, et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci. 2020;63(3):364-74.
7. Li G, Fan Y, Lai Y, Han T, Li Z, Zhou P, et al. Coronavirus infections and immune responses. J Med Virol. 2020;92(4):424-32.
8. Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. lancet. 2020;395(10229):1033-4.
9. Liu M, Wang T, Zhou Y, Zhao Y, Zhang Y, Li J. Potential role of ACE2 in coronavirus disease 2019 (COVID-19) prevention and management. J Transl Int Med. 2020;8(1):9.
10. Wynn TA. Type 2 cytokines: mechanisms and therapeutic strategies. Nat Rev Immunol. 2015;15(5):271-82.
11. Zhang J-j, Dong X, Liu G-h, Gao Y-d. Risk and protective factors for COVID-19 morbidity, severity, and mortality. Clin Rev Allergy Immunol. 2023;64(1):90-107.
12. Rod JE, Oviedo-Trespalacios O, Cortes-Ramirez J. A brief-review of the risk factors for covid-19 severity. Revista de saude publica. 2020;54.
13. Caramelo F, Ferreira N, Oliveiros B. Estimation of risk factors for COVID-19 mortality-preliminary results. MedRxiv. 2020:2002-20.
14. Akinbami LJ, Simon AE, Schoendorf KC. Trends in allergy prevalence among children aged 0–17 years by asthma status, United States, 2001–2013. J Asthma. 2016;53(4):356-62.
15. Goronfolah L. Aeroallergens, atopy and allergic rhinitis in the Middle East. Eur Ann Allergy Clin Immunol. 2016;48(1):5-21.
16. Karimi M, Mirzaeei M, Akhondi R. Food Consumption and Prevalence of Asthma & Allergies Symptoms in Children. SSU_Journals. 2011;19(1):35-44.
17. Hassanzadeh J, Mohammadbeigi A, Mousavizadeh A, Akbari M. Asthma prevalence in Iranian guidance school children, a descriptive meta-analysis. J Res Med Sci. 2012;17(3):293.
18. Mohammadzadeh I, Ghafari J, Barari SKR, Tamadoni A, Esmaeili DMR, Alizadeh NR. The prevalence of asthma, allergic rhinitis and eczema in north of Iran: The international study of asthma and allergies in childhood (ISAAC). 2008.
19. Papadopoulos NG, Christodoulou I, Rohde G, Agache I, Almqvist C, Bruno A, et al. Viruses and bacteria in acute asthma exacerbations–A GA2LEN‐DARE* systematic review. Allergy. 2011;66(4):458-68.
20. Wollenberg A, Wetzel S, Burgdorf WHC, Haas J. Viral infections in atopic dermatitis: pathogenic aspects and clinical management. J Allergy Clin Immunol. 2003;112(4):667-74.
21. Kusel MMH, de Klerk NH, Kebadze T, Vohma V, Holt PG, Johnston SL, et al. Early-life respiratory viral infections, atopic sensitization, and risk of subsequent development of persistent asthma. J Allergy Clin Immunol. 2007;119(5):1105-10.
22. Leung JM, Niikura M, Yang CWT, Sin DD. Covid-19 and COPD. Eur Respir J.2020;56(2).
23. Kloepfer KM, Olenec JP, Lee WM, Liu G, Vrtis RF, Roberg KA, et al. Increased H1N1 infection rate in children with asthma. Am J Respir Crit Care Med. 2012;185(12):1275-9.
24. Santillan Salas CF, Mehra S, Pardo Crespo MR, Juhn YJ. Asthma and severity of 2009 novel H1N1 influenza: a population-based case–control study. J Asthma. 2013;50(10):1069-76.
25. Carli G, Cecchi L, Stebbing J, Parronchi P, Farsi A. Is asthma protective against COVID‐19? Allergy. 2021;76(3):866.
26. Mendes NF, Jara CP, Mansour E, Araújo EP, Velloso LA. Asthma and COVID-19: a systematic review. Allergy Asthma Clin Immunol. 2021;17(1):1-12.
27. Dong X, Cao Yy, Lu Xx, Zhang Jj, Du H, Yan Yq, et al. Eleven faces of coronavirus disease 2019. Allergy. 2020;75(7):1699-709.
28. Keswani A, Dhana K, Rosenthal JA, Moore D, Mahdavinia M. Atopy is predictive of a decreased need for hospitalization for coronavirus disease 2019. Ann Allergy Asthma Immunol. 2020;125(4):479.
29. Du H, Dong X, Zhang Jj, Cao Yy, Akdis M, Huang Pq, et al. Clinical characteristics of 182 pediatric COVID‐19 patients with different severities and allergic status. Allergy. 2021;76(2):510-32.
30. Scala E, Abeni D, Tedeschi A, Manzotti G, Yang B, Borrelli P, et al. Atopic status protects from severe complications of COVID-19. Allergy. 2021;76(3):899-902.
31. Jackson DJ, Busse WW, Bacharier LB, Kattan M, O’Connor GT, Wood RA, et al. Association of respiratory allergy, asthma, and expression of the SARS-CoV-2 receptor ACE2. J Allergy Clin Immunol. 2020;146(1):203-6.
32. Kimura H, Francisco D, Conway M, Martinez FD, Vercelli D, Polverino F, et al. Type 2 inflammation modulates ACE2 and TMPRSS2 in airway epithelial cells. J Allergy Clin Immunol. 2020;146(1):80-8.e8.
33. Liuzzo Scorpo M, Ferrante G, La Grutta S. An overview of asthma and COVID-19: protective factors against SARS-COV-2 in pediatric patients. Front Pediatrics. 2021;9:661206.
34. McKenna JJ, Bramley AM, Skarbinski J, Fry AM, Finelli L, Jain S, et al. Asthma in patients hospitalized with pandemic influenza A (H1N1) pdm09 virus infection–United States, 2009. BMC Infect Dis. 2013;13:1-8.
35. Obuchi M, Adachi Y, Takizawa T, Sata T. Influenza A (H1N1) pdm09 virus and asthma. Front Microbiol. 2013;4:307.
36. Nguyen-Van-Tam JS, Openshaw PJM, Hashim A, Gadd EM, Lim WS, Semple MG, et al. Risk factors for hospitalisation and poor outcome with pandemic A/H1N1 influenza: United Kingdom first wave (May–September 2009). Thorax. 2010;65(7):645-51.
37. Adir Y, Saliba W, Beurnier A, Humbert M. Asthma and COVID-19: an update. Eur Respir Rev. 2021;30(162).
38. Choi YJ, Park J-Y, Lee HS, Suh J, Song JY, Byun MK, et al. Effect of asthma and asthma medication on the prognosis of patients with COVID-19. Eur Respir J. 2021;57(3).
39. El-Sayed ZA, El-Owaidy RH, Harb WN, Shousha GA. COVID-19 in a group of children with asthma: presentation, severity, and outcome. Am J Clin Exp Immunol. 2022;11(6):92-102.
40. Schroeder JC, Sharron MP, Wai K, Pillai DK, Rastogi D. Asthma as a comorbidity in COVID‐19 pediatric ICU admissions in a large metropolitan children's hospital. Pediatr Pulmonol. 2023;58(1):206-12.
41. Robbins E, Daoud S, Demissie S, James P. The impact of asthma on COVID-19 disease severity in children and adolescents. J Asthma. 2022:1-7.
42. Peters MC, Sajuthi S, Deford P, Christenson S, Rios CL, Montgomery MT, et al. COVID-19–related genes in sputum cells in asthma. Relationship to demographic features and corticosteroids. Am J Respir Crit Care Med. 2020;202(1):83-90.
43. Vezir E, Hizal M, Yayla BC, Aykac K, Yilmaz A, Kaya G, et al., editors. Does aeroallergen sensitivity and allergic rhinitis in children cause milder COVID-19 infection? Allergy and asthma proceedings; 2021 20212021.
44. Chhiba KD, Patel GB, Vu THT, Chen MM, Guo A, Kudlaty E, et al. Prevalence and characterization of asthma in hospitalized and nonhospitalized patients with COVID-19. J Allergy Clin Immunol. 2020;146(2):307-14.
45. Beken B, Ozturk GK, Aygun FD, Aydogmus C, Akar HH. Asthma and allergic diseases are not risk factors for hospitalization in children with coronavirus disease 2019. Ann Allergy Asthma Immunol. 2021;126(5):569-75.
46. Scala E, Abeni D, Tedeschi A, Manzotti G, Yang B, Borrelli P, et al. Atopic status protects from severe complications of COVID‐19. Allergy. 2021;76(3):899.
47. D’Auria E, Anania C, Cuomo B, Decimo F, Indirli GC, Mastrorilli V, et al. COVID-19 and food allergy in children. Acta Biomed. 2020;91(2):204.
48. Protudjer JLP, Golding M, Salisbury MR, Abrams EM, Roos LE. High anxiety and health-related quality of life in families with children with food allergy during coronavirus disease 2019. Ann Allergy Asthma Immunol.2021;126(1):83-8.
2. Guan W-j, Ni Z-y, Hu Y, Liang W-h, Ou C-q, He J-x, et al. Clinical characteristics of coronavirus disease 2019 in China. New Eng J Med. 2020;382(18):1708-20.
3. World Health O. WHO Coronavirus (COVID-19) Dashboard. 2023.
4. World Health O. WHO Coronavirus (COVID-19) Dashboard, Islamic Republic of Iran. 2023.
5. Yin Y, Wunderink RG. MERS, SARS and other coronaviruses as causes of pneumonia. Respirology. 2018;23(2):130-7.
6. Liu Y, Yang Y, Zhang C, Huang F, Wang F, Yuan J, et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci. 2020;63(3):364-74.
7. Li G, Fan Y, Lai Y, Han T, Li Z, Zhou P, et al. Coronavirus infections and immune responses. J Med Virol. 2020;92(4):424-32.
8. Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. lancet. 2020;395(10229):1033-4.
9. Liu M, Wang T, Zhou Y, Zhao Y, Zhang Y, Li J. Potential role of ACE2 in coronavirus disease 2019 (COVID-19) prevention and management. J Transl Int Med. 2020;8(1):9.
10. Wynn TA. Type 2 cytokines: mechanisms and therapeutic strategies. Nat Rev Immunol. 2015;15(5):271-82.
11. Zhang J-j, Dong X, Liu G-h, Gao Y-d. Risk and protective factors for COVID-19 morbidity, severity, and mortality. Clin Rev Allergy Immunol. 2023;64(1):90-107.
12. Rod JE, Oviedo-Trespalacios O, Cortes-Ramirez J. A brief-review of the risk factors for covid-19 severity. Revista de saude publica. 2020;54.
13. Caramelo F, Ferreira N, Oliveiros B. Estimation of risk factors for COVID-19 mortality-preliminary results. MedRxiv. 2020:2002-20.
14. Akinbami LJ, Simon AE, Schoendorf KC. Trends in allergy prevalence among children aged 0–17 years by asthma status, United States, 2001–2013. J Asthma. 2016;53(4):356-62.
15. Goronfolah L. Aeroallergens, atopy and allergic rhinitis in the Middle East. Eur Ann Allergy Clin Immunol. 2016;48(1):5-21.
16. Karimi M, Mirzaeei M, Akhondi R. Food Consumption and Prevalence of Asthma & Allergies Symptoms in Children. SSU_Journals. 2011;19(1):35-44.
17. Hassanzadeh J, Mohammadbeigi A, Mousavizadeh A, Akbari M. Asthma prevalence in Iranian guidance school children, a descriptive meta-analysis. J Res Med Sci. 2012;17(3):293.
18. Mohammadzadeh I, Ghafari J, Barari SKR, Tamadoni A, Esmaeili DMR, Alizadeh NR. The prevalence of asthma, allergic rhinitis and eczema in north of Iran: The international study of asthma and allergies in childhood (ISAAC). 2008.
19. Papadopoulos NG, Christodoulou I, Rohde G, Agache I, Almqvist C, Bruno A, et al. Viruses and bacteria in acute asthma exacerbations–A GA2LEN‐DARE* systematic review. Allergy. 2011;66(4):458-68.
20. Wollenberg A, Wetzel S, Burgdorf WHC, Haas J. Viral infections in atopic dermatitis: pathogenic aspects and clinical management. J Allergy Clin Immunol. 2003;112(4):667-74.
21. Kusel MMH, de Klerk NH, Kebadze T, Vohma V, Holt PG, Johnston SL, et al. Early-life respiratory viral infections, atopic sensitization, and risk of subsequent development of persistent asthma. J Allergy Clin Immunol. 2007;119(5):1105-10.
22. Leung JM, Niikura M, Yang CWT, Sin DD. Covid-19 and COPD. Eur Respir J.2020;56(2).
23. Kloepfer KM, Olenec JP, Lee WM, Liu G, Vrtis RF, Roberg KA, et al. Increased H1N1 infection rate in children with asthma. Am J Respir Crit Care Med. 2012;185(12):1275-9.
24. Santillan Salas CF, Mehra S, Pardo Crespo MR, Juhn YJ. Asthma and severity of 2009 novel H1N1 influenza: a population-based case–control study. J Asthma. 2013;50(10):1069-76.
25. Carli G, Cecchi L, Stebbing J, Parronchi P, Farsi A. Is asthma protective against COVID‐19? Allergy. 2021;76(3):866.
26. Mendes NF, Jara CP, Mansour E, Araújo EP, Velloso LA. Asthma and COVID-19: a systematic review. Allergy Asthma Clin Immunol. 2021;17(1):1-12.
27. Dong X, Cao Yy, Lu Xx, Zhang Jj, Du H, Yan Yq, et al. Eleven faces of coronavirus disease 2019. Allergy. 2020;75(7):1699-709.
28. Keswani A, Dhana K, Rosenthal JA, Moore D, Mahdavinia M. Atopy is predictive of a decreased need for hospitalization for coronavirus disease 2019. Ann Allergy Asthma Immunol. 2020;125(4):479.
29. Du H, Dong X, Zhang Jj, Cao Yy, Akdis M, Huang Pq, et al. Clinical characteristics of 182 pediatric COVID‐19 patients with different severities and allergic status. Allergy. 2021;76(2):510-32.
30. Scala E, Abeni D, Tedeschi A, Manzotti G, Yang B, Borrelli P, et al. Atopic status protects from severe complications of COVID-19. Allergy. 2021;76(3):899-902.
31. Jackson DJ, Busse WW, Bacharier LB, Kattan M, O’Connor GT, Wood RA, et al. Association of respiratory allergy, asthma, and expression of the SARS-CoV-2 receptor ACE2. J Allergy Clin Immunol. 2020;146(1):203-6.
32. Kimura H, Francisco D, Conway M, Martinez FD, Vercelli D, Polverino F, et al. Type 2 inflammation modulates ACE2 and TMPRSS2 in airway epithelial cells. J Allergy Clin Immunol. 2020;146(1):80-8.e8.
33. Liuzzo Scorpo M, Ferrante G, La Grutta S. An overview of asthma and COVID-19: protective factors against SARS-COV-2 in pediatric patients. Front Pediatrics. 2021;9:661206.
34. McKenna JJ, Bramley AM, Skarbinski J, Fry AM, Finelli L, Jain S, et al. Asthma in patients hospitalized with pandemic influenza A (H1N1) pdm09 virus infection–United States, 2009. BMC Infect Dis. 2013;13:1-8.
35. Obuchi M, Adachi Y, Takizawa T, Sata T. Influenza A (H1N1) pdm09 virus and asthma. Front Microbiol. 2013;4:307.
36. Nguyen-Van-Tam JS, Openshaw PJM, Hashim A, Gadd EM, Lim WS, Semple MG, et al. Risk factors for hospitalisation and poor outcome with pandemic A/H1N1 influenza: United Kingdom first wave (May–September 2009). Thorax. 2010;65(7):645-51.
37. Adir Y, Saliba W, Beurnier A, Humbert M. Asthma and COVID-19: an update. Eur Respir Rev. 2021;30(162).
38. Choi YJ, Park J-Y, Lee HS, Suh J, Song JY, Byun MK, et al. Effect of asthma and asthma medication on the prognosis of patients with COVID-19. Eur Respir J. 2021;57(3).
39. El-Sayed ZA, El-Owaidy RH, Harb WN, Shousha GA. COVID-19 in a group of children with asthma: presentation, severity, and outcome. Am J Clin Exp Immunol. 2022;11(6):92-102.
40. Schroeder JC, Sharron MP, Wai K, Pillai DK, Rastogi D. Asthma as a comorbidity in COVID‐19 pediatric ICU admissions in a large metropolitan children's hospital. Pediatr Pulmonol. 2023;58(1):206-12.
41. Robbins E, Daoud S, Demissie S, James P. The impact of asthma on COVID-19 disease severity in children and adolescents. J Asthma. 2022:1-7.
42. Peters MC, Sajuthi S, Deford P, Christenson S, Rios CL, Montgomery MT, et al. COVID-19–related genes in sputum cells in asthma. Relationship to demographic features and corticosteroids. Am J Respir Crit Care Med. 2020;202(1):83-90.
43. Vezir E, Hizal M, Yayla BC, Aykac K, Yilmaz A, Kaya G, et al., editors. Does aeroallergen sensitivity and allergic rhinitis in children cause milder COVID-19 infection? Allergy and asthma proceedings; 2021 20212021.
44. Chhiba KD, Patel GB, Vu THT, Chen MM, Guo A, Kudlaty E, et al. Prevalence and characterization of asthma in hospitalized and nonhospitalized patients with COVID-19. J Allergy Clin Immunol. 2020;146(2):307-14.
45. Beken B, Ozturk GK, Aygun FD, Aydogmus C, Akar HH. Asthma and allergic diseases are not risk factors for hospitalization in children with coronavirus disease 2019. Ann Allergy Asthma Immunol. 2021;126(5):569-75.
46. Scala E, Abeni D, Tedeschi A, Manzotti G, Yang B, Borrelli P, et al. Atopic status protects from severe complications of COVID‐19. Allergy. 2021;76(3):899.
47. D’Auria E, Anania C, Cuomo B, Decimo F, Indirli GC, Mastrorilli V, et al. COVID-19 and food allergy in children. Acta Biomed. 2020;91(2):204.
48. Protudjer JLP, Golding M, Salisbury MR, Abrams EM, Roos LE. High anxiety and health-related quality of life in families with children with food allergy during coronavirus disease 2019. Ann Allergy Asthma Immunol.2021;126(1):83-8.
| Files | ||
| Issue | Vol 23 No 2 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijaai.v23i2.15317 | |
| Keywords | ||
| Allergy and immunology Clinical decision making COVID-19 | ||
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How to Cite
1.
Shafiee F, Sarafinejad A, Bazargan Harandi N, Hossininasab A, Ebrahimi SS. Prevalence and Severity of COVID-19 among Pediatric Patients with Atopy: A Cross-sectional Study in Kerman, Southeast Iran. Iran J Allergy Asthma Immunol. 2024;23(2):127-138.
