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Molecular mechanisms and epidemiology of COVID-19 from an allergist’s perspective - 05/08/20

Doi : 10.1016/j.jaci.2020.05.033 
Koa Hosoki, MD, PhD, Abhijit Chakraborty, PhD, Sanjiv Sur, MD
 Department of Medicine, Immunology Allergy and Rheumatology, Baylor College of Medicine, Houston, Tex 

Corresponding author: Sanjiv Sur, MD, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030.Baylor College of Medicine1 Baylor PlazaHoustonTX77030

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Abstract

The global pandemic caused by the newly described severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused worldwide suffering and death of unimaginable magnitude from coronavirus disease 2019 (COVID-19). The virus is transmitted through aerosol droplets, and causes severe acute respiratory syndrome. SARS-CoV-2 uses the receptor-binding domain of its spike protein S1 to attach to the host angiotensin-converting enzyme 2 receptor in lung and airway cells. Binding requires the help of another host protein, transmembrane protease serine S1 member 2. Several factors likely contribute to the efficient transmission of SARS-CoV-2. The receptor-binding domain of SARS-CoV-2 has a 10- to 20-fold higher receptor-binding capacity compared with previous pandemic coronaviruses. In addition, because asymptomatic persons infected with SARS-CoV-2 have high viral loads in their nasal secretions, they can silently and efficiently spread the disease. PCR-based tests have emerged as the criterion standard for the diagnosis of infection. Caution must be exercised in interpreting antibody-based tests because they have not yet been validated, and may give a false sense of security of being “immune” to SARS-CoV-2. We discuss how the development of some symptoms in allergic rhinitis can serve as clues for new-onset COVID-19. There are mixed reports that asthma is a risk factor for severe COVID-19, possibly due to differences in asthma endotypes. The rapid spread of COVID-19 has focused the efforts of scientists on repurposing existing Food and Drug Administration–approved drugs that inhibit viral entry, endocytosis, genome assembly, translation, and replication. Numerous clinical trials have been launched to identify effective treatments for COVID-19. Initial data from a placebo-controlled study suggest faster time to recovery in patients on remdesivir; it is now being evaluated in additional controlled studies. As discussed in this review, till effective vaccines and treatments emerge, it is important to understand the scientific rationale of pandemic-mitigation strategies such as wearing facemasks and social distancing, and implement them.

El texto completo de este artículo está disponible en PDF.

Key words : ACE2, asthma, allergic rhinitis, COVID-19, severe acute respiratory syndrome coronavirus 2, receptor-binding domain, TMPRSS2

Abbreviations used : ACE2, ARDS, CDC, CoV, COVID-19, FDA, IDO, JAK, MERS, MERS-CoV, MMWR, MX1, NIH, RBD, RSV, RV, SARS, SARS-CoV, SARS-CoV-2, S protein, TMPRSS2, WHO


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 This research was supported by the National Heart, Lung, and Blood Institute (grant nos. 5R01HL145477-02 and 3R01HL145477-01S1) and the Department of Defense (grant no. PR171425 W81XWH-18-1-0743).
 Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest.


© 2020  American Academy of Allergy, Asthma & Immunology. Publicado por Elsevier Masson SAS. Todos los derechos reservados.
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Vol 146 - N° 2

P. 285-299 - août 2020 Regresar al número
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