COVID-19
Advances in clinical outcomes: What we have learned during the COVID-19 pandemic

https://doi.org/10.1016/j.jaci.2021.12.775Get rights and content

Our understanding of risk factors and interventions influencing outcomes from coronavirus disease 2019 (COVID-19) has continued to evolve, revealing advances emerging from hypotheses formed at the start of the pandemic. Epidemiologic studies have shown that asthma control, rather than a diagnosis of asthma, is a determinant of COVID-19 severity. Clinical outcomes in patients with primary immunodeficiencies, even in those with impaired cellular immunity, are variable. IL-6 has emerged as a reliable biomarker of COVID-19 severity, and large clinical trials have shown the potential for improving outcomes through inhibition of IL-6 signaling in some patients. Studies of genetic risk factors for severe COVID-19 have also revealed the importance of interferon homeostasis in the defense against severe acute respiratory syndrome coronavirus 2. Because COVID-19 vaccines constitute the primary tool for ending this pandemic, strategies have been developed to address potential allergic and immune-mediated reactions. Here, we discuss advances in our understanding of COVID-19 risk factors and outcomes within the context of allergic and immunologic mechanisms.

Key words

SARS-CoV-2
COVID-19
asthma
primary immunodeficiency
biologics

Abbreviations used

COVID-19
Coronavirus disease 2019
CVID
Common variable immunodeficiency
CXCL
CXC motif chemokine ligand
EUA
Emergency use authorization
HR
Hazard ratio
IFN
Interferon
JAK
Janus kinase
OR
Odds ratio
PEG
Polyethylene glycol
PID
Primary immunodeficiency
RCT
Randomized controlled trial
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
TLR
Toll-like receptor

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This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (grant no. R01DK130465 to J.C.) and the National Institute of Allergy and Infectious Diseases (grant no. R01AI139633-04S1 to J.C.; grant no. T32AI007512 to B.L. and A.A.N.).

Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest.

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