PMID- 32524611 OWN - NLM STAT- MEDLINE DCOM- 20210225 LR - 20220716 IS - 1398-9995 (Electronic) IS - 0105-4538 (Print) IS - 0105-4538 (Linking) VI - 76 IP - 2 DP - 2021 Feb TI - Clinical characteristics of 182 pediatric COVID-19 patients with different severities and allergic status. PG - 510-532 LID - 10.1111/all.14452 [doi] AB - BACKGROUND: The pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has made widespread impact recently. We aim to investigate the clinical characteristics of COVID-19 children with different severities and allergic status. METHODS: Data extracted from the electronic medical records, including demographics, clinical manifestations, comorbidities, laboratory and immunological results, and radiological images of 182 hospitalized COVID-19 children, were summarized and analyzed. RESULTS: The median age was 6 years, ranging from 3 days to 15 years, and there were more boys (male-female ratio about 2:1) within the studied 182 patients. Most of the children were infected by family members. Fever (43.4%) and dry cough (44.5%) were common symptoms, and gastrointestinal manifestations accounted for 11.0%, including diarrhea, abdominal discomfort, and vomiting. 71.4% had abnormal chest computed tomography (CT) scan images, and typical signs of pneumonia were ground-glass opacity and local patchy shadowing on admission. Laboratory results were mostly within normal ranges, and only a small ratio of lymphopenia (3.9%) and eosinopenia (29.5%) were observed. The majority (97.8%) of infected children were not severe, and 24 (13.2%) of them had asymptomatic infections. Compared to children without pneumonia (manifested as asymptomatic and acute upper respiratory infection), children with pneumonia were associated with higher percentages of the comorbidity history, symptoms of fever and cough, and increased levels of serum procalcitonin, alkaline phosphatase, and serum interleukins (IL)-2, IL-4, IL-6, IL-10, and TNF-alpha. There were no differences in treatments, duration of hospitalization, time from first positive to first negative nucleic acid testing, and outcomes between children with mild pneumonia and without pneumonia. All the hospitalized COVID-19 children had recovered except one death due to intussusception and sepsis. In 43 allergic children with COVID-19, allergic rhinitis (83.7%) was the major disease, followed by drug allergy, atopic dermatitis, food allergy, and asthma. Demographics and clinical features were not significantly different between allergic and nonallergic groups. Allergic patients showed less increase in acute phase reactants, procalcitonin, D-dimer, and aspartate aminotransferase levels compared with all patients. Immunological profiles including circulating T, B, and NK lymphocyte subsets, total immunoglobulin and complement levels, and serum cytokines did not show any difference in allergic and pneumonia groups. Neither eosinophil counts nor serum total immunoglobulin E (IgE) levels showed a significant correlation with other immunological measures, such as other immunoglobulins, complements, lymphocyte subset numbers, and serum cytokine levels. CONCLUSION: Pediatric COVID-19 patients tended to have a mild clinical course. Patients with pneumonia had higher proportion of fever and cough and increased inflammatory biomarkers than those without pneumonia. There was no difference between allergic and nonallergic COVID-19 children in disease incidence, clinical features, and laboratory and immunological findings. Allergy was not a risk factor for developing and severity of SARS-CoV-2 infection and hardly influenced the disease course of COVID-19 in children. CI - (c) 2020 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd. FAU - Du, Hui AU - Du H AD - Department of Respiratory Medicine, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. FAU - Dong, Xiang AU - Dong X AUID- ORCID: 0000-0002-5241-4307 AD - Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China. FAU - Zhang, Jin-Jin AU - Zhang JJ AUID- ORCID: 0000-0002-4414-866X AD - Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China. FAU - Cao, Yi-Yuan AU - Cao YY AD - Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China. FAU - Akdis, Mubeccel AU - Akdis M AUID- ORCID: 0000-0003-0554-9943 AD - Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland. FAU - Huang, Pei-Qi AU - Huang PQ AD - Department of Respiratory Medicine, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. FAU - Chen, Hong-Wei AU - Chen HW AD - Department of Respiratory Medicine, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. FAU - Li, Ying AU - Li Y AD - Department of Respiratory Medicine, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. FAU - Liu, Guang-Hui AU - Liu GH AD - Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China. FAU - Akdis, Cezmi A AU - Akdis CA AUID- ORCID: 0000-0001-8020-019X AD - Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland. FAU - Lu, Xiao-Xia AU - Lu XX AD - Department of Respiratory Medicine, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. FAU - Gao, Ya-Dong AU - Gao YD AUID- ORCID: 0000-0003-1251-7608 AD - Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China. LA - eng PT - Journal Article DEP - 20200903 PL - Denmark TA - Allergy JT - Allergy JID - 7804028 SB - IM MH - Adolescent MH - COVID-19/*complications/*immunology/*pathology MH - Child MH - Child, Preschool MH - Female MH - Humans MH - Hypersensitivity/*epidemiology MH - Incidence MH - Infant MH - Infant, Newborn MH - Male MH - Pneumonia, Viral/immunology/pathology MH - SARS-CoV-2 PMC - PMC7307120 OTO - NOTNLM OT - COVID-19 OT - SARS-CoV-2 OT - allergy OT - children OT - lymphocyte subsets OT - pneumonia COIS- Dr Akdis reports grants from Allergopharma, Idorsia, Swiss National Science Foundation, Christine Kuhne-Center for Allergy Research and Education, European Commission's Horizon 2020 Framework Programme, Cure, Novartis Research Institutes, Astra Zeneca, and Scibase, and for advisory role in Sanofi/Regeneron, outside the submitted work. Dr Cao, Dr Li, Dr Liu, Dr Chen, Dr Du, Dr Zhang, Prof. Akdis M, Dr Huang, Dr Dong, Dr Lu, and Dr Gao have nothing to disclose. EDAT- 2020/06/12 06:00 MHDA- 2021/02/26 06:00 PMCR- 2020/09/03 CRDT- 2020/06/12 06:00 PHST- 2020/05/11 00:00 [received] PHST- 2020/05/24 00:00 [revised] PHST- 2020/05/29 00:00 [accepted] PHST- 2020/06/12 06:00 [pubmed] PHST- 2021/02/26 06:00 [medline] PHST- 2020/06/12 06:00 [entrez] PHST- 2020/09/03 00:00 [pmc-release] AID - ALL14452 [pii] AID - 10.1111/all.14452 [doi] PST - ppublish SO - Allergy. 2021 Feb;76(2):510-532. doi: 10.1111/all.14452. Epub 2020 Sep 3.