Four years into the <scp>COVID</scp>‐19 pandemic: Timely published articles for patient care and <scp>EAACI</scp>'s leadership role

In December 2019, the first infections by a new virus strain from the coronavirus family, not previously identified in humans, were reported in Wuhan, China. The disease caused by the virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was later defined as coronavirus disease 2019 (COVID-19). On March 11, 2020, the World Health Organization officially declared COVID-19 a pandemic. Soon, it became clear that, unequivocally, the COVID-19 pandemic would become the gravest health and socioeconomic crisis of the 21st century. Numerous questions emerged warranting further knowledge of its immunopathological mechanisms and evidence-based medical advice. In a very short time, the European Academy of Allergy and Clinical Immunology (EAACI) responded to this challenge by compiling and reviewing the scientific and clinical evidence and deriving sound clinical recommendations. As an official journal of EAACI, Allergy became the hub of scientific discussion on SARS-CoV-2, reporting studies on the disease pathophysiology, immunology, and EAACI guidance and position papers on asthma and allergy patient care during the pandemic (Table 1).1 On February 19, 2020, the first COVID-19 series was published, in which the authors reported the clinical characteristics of 140 cases of human-to-human coronavirus transmission unrelated to the Huanan market.2 Even in this early study, fever (91.7%), cough (75.0%), fatigue (75.0%), gastrointestinal symptoms (39.6%), and dyspnoea (36.7%) were identified as the main symptoms in severe cases with hospitalization, which, along with lymphopenia and eosinopenia, were later confirmed in many publications worldwide. Radiological findings were reported, and high levels of D-dimer, C-reactive protein, and procalcitonin were associated with severe patients as biomarkers for prognosis and follow-up. High blood pressure and diabetes were reported as risk factors, but not allergic diseases, which was later confirmed as a correct perception. In June 2020, Du et al.3 published data from a pediatric population of 182 patients with COVID-19, all of whom had a mild clinical course. In these children, 43 allergic patients did not show a significant difference compared to non-allergic patients in terms of disease incidence, clinical features, laboratory findings, and immune response.3 Allergy was not determined as a risk factor for disease incidence, course, or severity. As early as the end of June 2020, EAACI presented the immunology of COVID-19 disease in detail in a comprehensive position paper by Sokolowska et al.4 In particular, eosinopenia in COVID-19 patients and the possible antiviral role of eosinophils were further discussed in several subsequent publications, including studies by Jesenak et al. and Xie et al.5, 6 published in Allergy. Another chapter was opened after vaccinations began in the United Kingdom (UK) on December 8, 2020, when the first person in the world outside clinical trials received her first dose of the Pfizer–BioNTech COVID-19 vaccine. Soon after the start of vaccination campaigns in the UK, Canada and the USA, the first cases of vaccination-induced anaphylaxis were reported.7 As early as December 2020, EAACI and ARIA issued a position paper on vaccination-related allergic reactions and provided important information on the recommended course of action.7 Subsequent publications identified possible mechanisms of these allergic reactions [6]. Vaccine development under virological, immunological, and regulatory aspects was also comprehensively discussed in cooperation with the Paul Ehrlich Institute (PEI) and the European Medicines Agency (EMA).8, 9 Interesting new aspects were taken up by Klimek et al.10 with new forms of scientific patient studies using telemedicine and the investigation of the important aspect of olfactory function in COVID-19 patients. The development of the risk assessment of COVID-19 in the international scientific literature can be illustrated very well using the example of therapy evaluations for asthma, CRS, and respiratory allergies.11-13 While Johnston et al. and Licari et al.11, 12 discussed an increased risk for asthmatics and the use of topical steroids at the beginning of the pandemic, EAACI and ARIA were convinced that neither the disease itself nor therapy with topical corticosteroids posed an increased risk.13, 14 Later, Carli et al.,15 and Avdeev et al.,16 among several others, even regarded asthma to be protective against the development of severe COVID-19 disease. Similar comprehensive evaluations of allergen immunotherapy and therapy with T2-directed biologics provided the necessary therapeutic certainty for the treating physicians.17-19 In June 2020, 150 frequently asked questions on COVID-19 and allergic diseases were answered by experts in the field in a compendium published by EAACI, and Allergy readers were able to send further questions in this “living” compendium to the authors electronically.20 In addition, Pfaar et al.21 provided important practical considerations on the organization of an allergy clinic during the pandemic, and gave recommendations on the management of childhood allergies and immunodeficiencies during the pandemic.22 Similar advice was provided for managing chronic rhinosinusitis patients by Klimek et al.,23 ocular allergies by Leonardi et al.,24 and drug hypersensitivity by Gelincik et al. and Barbaud et al.25, 26 EAACI and Allergy have been at the forefront of patient-oriented research and knowledge during the COVID-19 pandemic, with the main aim not only of understanding the underlying mechanisms of the infection and identifying risk factors but also of giving physicians precise information on diagnostic tools and treatment. The pandemic is still ongoing, and EAACI and Allergy will continue to provide important updates for this area (e.g., Long COVID) in a timely manner. None Dr. Klimek reports grants and/or personal fees from Allergopharma, MEDA/Mylan, HAL Allergie, ALK Abelló, LETI Pharma, Stallergenes, Quintiles, Sanofi, ASIT biotech, Lofarma, Allergy Therapeut., AstraZeneca, GSK, Inmunotek, Cassella med, outside the submitted work; and Membership: AeDA, DGHNO, Deutsche Akademie für Allergologie und Klinische Immunologie, HNO-BV, GPA, EAACI. Dr. Cooke reports to be a Member of the European Medicines Agency, Amsterdam, Netherlands. Dr. Jutel reports personal fees from ALK-Abello, Allergopharma, Stallergenes, Anergis, Allergy Therapeutics, Leti, HAL, during the conduct of the study; personal fees from GSK, Novartis, Teva, Takeda, Chiesi, outside the submitted work. Dr. Akdis reports grants from Allergopharma, Idorsia, Swiss National Science Foundation, Christine Kühne-Center for Allergy Research and Education, European Commission’s Horizon 2020 Framework Programme, Cure, Novartis Research Institutes, Basel, AstraZeneca, Switzerland, SciBase, Stockholm, advisory role for Sanofi/ Regeneron, GlaxoSmithKline, Novartis. Dr. Agache and Dr. O'Hehir have nothing to disclose. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

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