Severity of COVID-19 in hospitalized patients with and without atopic disease

Dylan T Timberlake; Deepika Narayanan; Princess U Ogbogu; Rekha Raveendran; Kyle Porter; Rebecca Scherzer; Benjamin Prince; Mitchell H Grayson

doi:10.1016/j.waojou.2021.100508

Severity of COVID-19 in hospitalized patients with and without atopic disease

World Allergy Organ J. 2021 Feb;14(2):100508. doi: 10.1016/j.waojou.2021.100508. Epub 2021 Jan 9.

Authors

Dylan T Timberlake^{1

2

3}, Deepika Narayanan⁴, Princess U Ogbogu^{2

3}, Rekha Raveendran^{2

3}, Kyle Porter⁵, Rebecca Scherzer^{1

3}, Benjamin Prince^{1

3}, Mitchell H Grayson^{1

6

3}

Affiliations

¹ Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.
² Division of Allergy and Immunology, Department of Otolaryngology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
³ The Ohio State University Wexner Medical Center/Nationwide Children's Hospital World Allergy Organization Center of Excellence, Columbus, Ohio, USA.
⁴ College of Medicine, The Ohio State University, Columbus, OH, USA.
⁵ Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA.
⁶ The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.

Abstract

Background: Data from the 2009 influenza pandemic suggested asthma might protect from severe disease in hospitalized patients. Asthma does not appear to increase risk for hospitalization or mortality with COVID-19.

Objective: This study was undertaken to see if atopy actually protected those hospitalized with COVID-19.

Methods: Retrospective chart review on all patients testing positive for SARS-CoV-2 over 2 months at a major adult and pediatric tertiary referral center hospital. Charts were evaluated for history of atopic disease, as were the need for ICU admission, requirement for supplemental oxygen and/or intubation, and in hospital mortality.

Results: No significant differences in outcomes for patients (n = 275) based on atopic disease were noted: ICU admission, 43% versus 44.7% (atopic versus no atopic disease, respectively; p = 0.84); supplemental oxygen use, 79.1% versus 73.6% (p = 0.36); intubation rate, 35.8% versus 36.5% (p = 0.92); and mortality rate, 13.4% versus 20.7% (p = 0.19). More patients with atopic disease had COPD listed as a diagnosis in their chart (38.8% versus 17.3%, p < 0.001). COPD was associated with an increased rate of ICU admission (aOR = 2.22 (1.15, 4.30) p = 0.02) and intubation (aOR = 2.05 (1.07, 3.92) p = 0.03). After adjusting for COPD, patients with atopic disease had a trend for reduced mortality (aOR 0.55 (0.23, 1.28), p = 0.16), but those with asthma did not (p > 0.2).

Conclusion: Severity of COVID-19 in hospitalized patients does not differ based on atopic status. However, adjusting for presence of COPD led to a suggestion of possible reduced severity in patients with atopy but not asthma.

Keywords: Asthma; Atopy; CDC, Centers for Disease Control and Prevention; COPD, Chronic Obstructive Pulmonary Disease; COVID-19; COVID-19, Coronavirus Disease 2019; CRP, C Reactive Peptide; Hospitalization; ICS, Inhaled corticosteroid; ICU, Intensive Care Unit; Il-6, Interleukin 6; LABA, Long acting beta agonist; NHANES, National Health and Nutrition Examination Survey; RAST, Radioallergosorbent test; RT-PCR, Real time polymerase chain reaction; SARS-CoV-2; SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2; Severity.

Grants and funding

UL1 TR002733/TR/NCATS NIH HHS/United States