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 summarizes 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 summarize the major knowledge gaps and unmet needs in current eicosanoid research.

Allergy Unit Málaga Regional University Hospital IBIMA UMA Málaga Spain

Asthma UK Centre in Allergic Mechanisms of Asthma School of Immunology and Microbial Sciences King's College London London UK

Child Life and Health and Centre for Inflammation Research The University of Edinburgh Edinburgh UK

Christine Kühne Center for Allergy Research and Education Davos Switzerland

Department Microbiology Immunology and Transplantation Ku Leuven Catholic University of Leuven Belgium

Department of Biochemistry and Molecular Biology School of Chemistry Complutense University Madrid Spain

Department of Medicine Jagiellonian University Medical College Krakow Poland

Department of Otorhinolaryngology Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps Universität Marburg Marburg Germany

Department of Pharmaceutical Sciences Section of Pharmacology and Biosciences University of Milan Milano Italy

Department of Pulmonology and Phthisiology Department of Allergology and Clinical Immunology Department of Pediatrics Jessenius Faculty of Medicine in Martin Comenius University in Bratislava University Teaching Hospital in Martin Slovakia

Department of Respiratory Medicine 1st Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic

Department of Respiratory Medicine and Allergology Skane University Hospital Lund Sweden

Departments of Medicine and Microbiology APC Microbiome Ireland University College Cork Cork Ireland

Institute of Environmental Medicine and the Centre for Allergy Research Karolinska Institute and the Department of Respiratory Medicine Karolinska University Hospital Stockholm Sweden

Institute of Pathophysiology and Allergy Research Center for Pathophysiology Infectiology and Immunology Medical University of Vienna Vienna Austria

London North Genomic Laboratory Hub Great Ormond Street Hospital for Children NHS Foundation Trust London UK

Swiss Institute of Allergy and Asthma Research University of Zurich Davos Switzerland

VIB Center for Inflammation Research Ghent University Ghent Belgium

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