Reply: COVID-19, A and Hypersensitivity Pneumonitis

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217 https://icjournal.org

Dear Editors:

I appreciate your interest in our study, and would like to share clinical experiences regarding the article titled “COVID-19: A Clinical Syndrome Manifesting as Hypersensitivity Pneumonitis,” in which the use of steroids was demonstrated to not be efficacious, albeit the underlying asthma [1]. COVID-19 can be defined as a hypersensitivity reaction by SARS-CoV-2 infection. Its exact pathophysiology may be unraveled in future through extensive scientific evidence. Its clinical manifestations are greatly diverse, and the immune system (including innate and adaptive immunity) seems to play a major role in clearing the virus. Many cells, such as monocytes, macrophages, eosinophils, neutrophils, and lymphocytes might contribute to the surge of cytokines that induce inflammation and cell death. Excessive inflammation can promote the extracellular spread of the virus and lead to lung destruction. We have suggested in our report that prednisolone (PD) could be important for treatment of this condition; based on the hypothesis that COVID-19 is a hypersensitivity pneumonitis (HP) [2].

Homeostasis of human cells is regulated by the secretion of the stress hormone

glucocorticoid, to varying degrees, under different external stimuli. PD has been the most effective and safer drug for HP for a long time. It can strongly suppress several cytokines, such as IL-1, IL-6, TNF-α, and type-2 biomarker [3, 4]. Further, the short course of PD does not lower the overall immunity, and hypersensitivity reactions are less common than methylprednisolone [5]. If oral PD is administered at an earlier stage of infection, fewer side effects will develop, since the inflammatory cascade might be overcome at a lower dose of PD.

REFERENCES

1. Joob B, Wiwanikit V. COVID-19, A and hypersensitivity pneumonitis. Infect Chemother. Infect Chemother 2020;52:216.

PUBMED | CROSSREF

2. Vasakova M, Morell F, Walsh S, Leslie K, Raghu G. Hypersensitivity pneumonitis: perspectives in diagnosis and management. Am J Respir Crit Care Med 2017;196:680-9.

3. Villar J, Confalonieri M, Pastores SM, Meduri GU. Rationale for prolonged corticosteroid treatment in the acute respiratory distress syndrome caused by coronavirus disease 2019. Crit Care Explor 2020;2:e0111.

PUBMED | CROSSREF Infect Chemother. 2020 Jun;52(2):217-218

https://doi.org/10.3947/ic.2020.52.2.217 pISSN 2093-2340·eISSN 2092-6448

Correspondence

Received: May 25, 2020 Corresponding Author:

Hyoung-Shik Shin, MD, PhD

Infectious Diseases Specialist, Korean Society of Zoonoses, 806, Seocho Town Trapalace, 23 Seocho-daero 74 gil, Seocho-gu, Seoul 06621, Korea.

Tel: +82-10-8651-7617

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://

creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ORCID iDs Hyoung-Shik Shin

https://orcid.org/0000-0001-6504-3413 Conflict of Interest

No conflicts of interest.

Hyoung-Shik Shin

Infectious Diseases Specialist, Korean Society of Zoonoses, Seoul, Korea

Reply: COVID-19, A and

Hypersensitivity Pneumonitis

► See the letter “COVID-19, A and Hypersensitivity Pneumonitis” in volume 52 on page 216.

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4. Busby J, Holweg CTJ, Chai A, Bradding P, Cai F, Chaudhuri R, Mansur AH, Lordan JL, Matthews JG, Menzies-Gow A, Niven R, Staton T, Heaney LG. Change in type-2 biomarkers and related cytokines with prednisolone in uncontrolled severe oral corticosteroid dependent asthmatics: an interventional open- label study. Thorax 2019;74:806-9.

5. Vatti RR, Ali F, Teuber S, Chang C, Gershwin ME. Hypersensitivity reactions to corticosteroids. Clin Rev Allergy Immunol 2014;47:26-37.

218 https://icjournal.org https://doi.org/10.3947/ic.2020.52.2.217