What the physicians should know about mast cells, dendritic cells, urticaria and omalizumab during COVID-19 or asymptomatic infections due to SARS-CoVi2?

https://onlinelibrary.wiley.com/doi/abs/10.1111/dth.14068

Dermatologic Therapy, First published: 25 July 2020. https://doi.org/10.1111/dth.14068

Paulo Ricardo Criado MD, PhD, Carla Pagliari BSc, PhD, Roberta Fachini Jardim Criado MD, PhD, Gabriela Franco Marques MD, PhD, Walter Belda Junior MD, PhD

ABSTRACT

COVID‐19 pandemic presents several dermatological manifestations described in the present indexed literature, with around 700 cases reported until May 2020, some described as urticaria or urticarial rashes. Urticaria is constituted by evanescent erythematous‐edematous lesions (wheals and flare), which does not persist in the same site for more than 24‐48 hours and appears in other topographic localization, resolving without residual hyper pigmentation. During the SARS‐CoV‐2 infection, some cytokines are synthesized, including Interferon type I, TNF‐α, and chemokines which may induce mast cells and basophils degranulation by mechanisms similar to the autoinflammatory monogenic or polygenic diseases. In this article we discuss the spectrum of the urticaria and urticarial‐like lesions in the COVID‐19’s era, besides other aspects related to innate and adaptative immune response to viral infections, interactions between dermal dendritic cells and mast cells, degranulation of mast cells by different stimuli. Plasmacytoid dendritic cells share in allergic patients expression of the high affinity IgE receptors on cell membranes and demonstrated a low pattern of type I interferon secretion in viral infections. We discuss the previous descriptions of the effects of omalizumab, a monoclonal antibody directed to IgE and high affinity IgE receptors, to improve the interferon responses and enhance their antiviral effects.

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