Altered COVID-19 Immunity in Children With Asthma by Atopic Status

Antiviral immunity is often diminished in atopic asthma. This study sought to determine if coronavirus disease 2019 (COVID-19) immunity is similarly compromised.This cohort study included 53 children recruited from the Allergen Reduction and Child Health Study, which is a 12-month randomized control trial based in New Orleans, LA. Age ranged from 5 to 17 with a median of 10, and the majority of participants were from historically underrepresented racial and ethnic groups and with household incomes less than $25, 000 per year. This study took place from April 2021 to March 2022 during the Delta and Omicron waves.Historical information on asthma control, previous COVID-19 infection and vaccination status, and demographics were collected by participant report. Laboratory data collected included COVID-19 nucleoprotein-specific IgG and plasma viral RNA; total serum IgE and specific IgE to mold, dust, cockroach, cat, and dog; and immune cell effector function using COVID-19 protein stimulation. Lung function data were collected via spirometry.The final analysis included a stratification of 15 infected and vaccinated, 27 infected and not vaccinated, 7 indeterminate (detectable viral RNA but without detectable COVID-19 antibodies), and 4 negative participants (no detectable viral markers). Researchers found a significant negative correlation between atopic status and COVID-19 immunity. Specifically, dust mite IgE was negatively correlated with COVID-19 specific antibodies (IgG) and T-cell measures (NME-specific IL-2, MIP-1a cytokine). Researchers also found a significant negative correlation between cockroach stimulated T cell mediators and COVID-19 specific antibodies and COVID-19 stimulated T cell mediators, independent of cockroach serum IgE levels. This indicates impaired humoral response in these participants distinct from the atopic association identified. These effects were more prominent in participants with more severe asthma.Atopic asthma is associated with impaired COVID-19 immunity by several mechanisms.This was the first study in children to identify and investigate if COVID-19 immunity is compromised in atopic asthma, which has been observed in other viral illnesses. Clinically, this is important as it helps stratify patients in practice with atopic asthma with previous COVID-19 infection and/or vaccination as compared with patients without atopic asthma, in regard to risk and severity of repeat infection. Of note, this study included an urban population and majority historically underrepresented race and ethnic groups, which lends particular validity in these populations with more significant asthma morbidity and mortality.