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Early evidence during the coronavirus disease 2019 (COVID-19) pandemic indicated high levels of interleukin (IL)-6 in patients with severe COVID-19. This led to the off-label use of tocilizumab (TCZ) during the first wave of the pandemic. While the monoclonal antibody blocks IL-6 pathway, its effect on other inflammatory cytokines remains poorly described. To better understand the effect of TCZ on the biological inflammatory profile, we monitored a large panel of inflammatory cytokines in critically ill COVID-19 patients receiving off-label TCZ. Twenty-three patients with polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were included in the study, among which 15 patients received TCZ and 8 patients did not. Serum samples were collected for 8 days, before and following TCZ administration or hospital admission for the control group. Serum profile of 12 cytokines (IL-1

Introduction Dans le nord de l’Europe, l’allergie alimentaire aux PR-10 est generalement secondaire a une sensibilisation a Bet v1. Du fait de leurs proprietes physico-chimiques (sensibilite a la chaleur et a la digestion), les symptomes allergiques qu’elles induisent se limitent le plus souvent a un syndrome oral allergique (SOA) et aux aliments crus. Le cas que nous decrivons nuance ces donnees. Observation Une femme de 29 ans consulte suite a la survenue de 3 episodes anaphylactiques : –œdeme des paupieres et difficultes respiratoires apres melange de fruits secs (arachides, amandes et cajou) ayant conduit la patiente aux urgences ou elle a recu de l’adrenaline. – œdeme du visage, prurit palmoplantaire, urticaire traitee par adrenaline apres ingestion d’une corne de gazelle (pâte d’amande). – œdeme du visage, prurit palmoplantaire, urticaire, difficultes respiratoires importantes et rhino conjonctivite apres consommation d’un abricot au petit dejeuner. Il n’y avait pas de cofacteur sauf un contexte de stress important. La patiente n’a pas de rhinite saisonniere mais note un SOA leger avec la cerise et le raisin. Sur le plan respiratoire, elle presente un asthme non controle. Les tests cutanes sont positifs pour l’amande fraiche (5 mm) et grillee salee (3 mm), l’abricot cru (6 mm) et cuit (6 mm), la noisette fraiche (6 mm) et grillee (6 mm). Les autres trophallergenes usuels sont negatifs ainsi que les pneumallergenes. Les IgE specifiques sont positives pour : Noisette 1,53 kU/L, Cerise 0,36 kU/L et Cor a1 3,87 kU/L. Le Bet v1 est Diagnostic Anaphylaxie alimentaire a la noisette, l’amande et l’abricot par sensibilisation probable a leur PR10, sans reaction croisee avec celle du bouleau. Implication probable d’epitopes conformationnels thermoresistants ou presents sur la structure lineaire. Toutefois, le role d’un autre allergene non identifie ne peut etre exclu.

Early evidence during the COVID-19 pandemic indicated high levels of IL-6 in patients with severe COVID-19. This led to the off-label use of tocilizumab (TCZ) during the first wave of the pandemic.We aimed to monitor IL-6 and several inflammatory cytokines in critically ill COVID-19 patients receiving off-label TCZ. Fifteen critically ill SARS-CoV-2 PCR confirmed cases were enrolled and serum samples were collected during 8 days, before and following administration of a single dose of TCZ. In parallel, a control group consisting of 8 non-treated COVID-19 patients not receiving TCZ was established. Serum profile of 12 cytokines (IL-1β, -2, -4, -6, -8, -10, -12, -13, -17, -18, TNF-α and INF-γ) and of IL-6R were assessed in these two groups. Although the increased IL-6 concentrations after TCZ infusion were expected, we observed an unexpected increase in IL-1β, -2, -4, -10, -12p70, -18 and IL-6R levels in the treated patients with maximal values reached 2 to 4 days after TCZ. In contrast, no change in cytokine levels was observed in the control group. There was no significant difference in cytokine levels between survivors (TCZ/S) or non-survivors (TCZ/D). This observation suggests that some inflammatory pathways escape IL-6R blockade leading to an increase in several pro-inflammatory cytokines. Our findings could highlight an anti-inflammatory role of IL-6 and may explain why TCZ has failed to improve survival in critically ill COVID-19 patients when given alone.

Introduction Coronavirus disease 2019 (COVID-19) appeared in China in December 2019 and has spread around the world. High Interleukin-6 (IL-6) levels in COVID-19 patients suggest that a cytokine storm may play a major role in the pathophysiology and are considered as a relevant parameter in predicting most severe course of disease. The aim of this study was to assess repeated IL-6 levels in critically ill COVID-19 patients admitted to our Intensive Care Unit (ICU) and to evaluate their relationship with patient’s severity and outcome. Methods We conducted a retrospective study on patients admitted to the ICU with a diagnosis of COVID-19 between March 10 (i.e. the date of the first admitted patients) and April 30, 2020. Demographic, clinical and laboratory data were collected at admission. On the day of IL-6 blood concentration measurement, we also collected results of D-Dimers, C-Reactive Protein, white blood cells and lymphocytes count, lactate dehydrogenase (LDH) and ferritin as well as microbiological samples, whenever present. Results Of a total of 65 patients with COVID-19 admitted to our ICU we included 41 patients with repeated measure of IL-6. There was a significant difference in IL-6 levels between survivors and non-survivors over time (p = 0.001); moreover, non survivors had a significantly higher IL-6 maximal value when compared to survivors (720 [349–2116] vs. 336 [195–646] pg/mL, p = 0.01). The IL-6 maximal value had a significant predictive value of ICU mortality (AUROC 0.73 [95% CI 0.57–0.89]; p = 0.01). Conclusions Repeated measurements of IL-6 can help clinicians in identifying critically ill COVID-19 patients with the highest risk of poor prognosis., info:eu-repo/semantics/published