Effects of non-steroidal anti-inflammatory drugs and other eicosanoid
pathway modifiers on antiviral and allergic responses. EAACI task force
on eicosanoids consensus report in times of COVID-19
Non-steroidal anti-inflammatory drugs (NSAIDs) and other eicosanoid
pathway modifiers are among the most ubiquitously used medications in
the general population. Their broad anti-inflammatory, antipyretic and
analgesic effects are applied against symptoms of respiratory
infections, including SARS-CoV-2, as well as in other acute and chronic
inflammatory diseases that often coexist with allergy and asthma.
However, the current pandemic of COVID-19 also revealed the gaps in our
understanding of their mechanism of action, selectivity and interactions
not only during viral infections and inflammation, but also in asthma
exacerbations, uncontrolled allergic inflammation, and
NSAIDs-exacerbated respiratory disease (NERD). In this context, the
consensus report summarises currently available knowledge, novel
discoveries and controversies regarding the use of NSAIDs in COVID-19,
and the role of NSAIDs in asthma and viral asthma exacerbations. We also
describe here novel mechanisms of action of leukotriene receptor
antagonists (LTRAs), outline how to predict responses to LTRA therapy
and discuss a potential role of LTRA therapy in COVID-19 treatment.
Moreover, we discuss interactions of novel T2 biologicals and other
eicosanoid pathway modifiers on the horizon, such as prostaglandin D2
antagonists and cannabinoids, with eicosanoid pathways, in context of
viral infections and exacerbations of asthma and allergic diseases.
Finally, we identify and summarise the major knowledge gaps and unmet
needs in current eicosanoid research.