- Published
- 31 March 2020
- Journal article
Intranasal corticosteroids in allergic rhinitis in COVID-19 infected patients: An ARIA-EAACI statement
- Authors
-
- Source
- Allergy
Full text
Abstract
A novel strain of human coronaviruses, named by the International Committee on Taxonomy of Viruses (ICTV) as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has emerged and caused an infectious disease. This disease has recently been referred to by the World Health Organisation (WHO) as the “coronavirus disease 2019” (COVID-19). Since the first report of this disease in December 2019 in Wuhan, China, COVID-19 has aggressively spread across the globe. WHO declared it a pandemic on March 11.
COVID-19 presents with many different clinical manifestations, ranging from asymptomatic cases to mild and severe disease, with or without pneumonia. Patients with common allergic conditions do not develop additional distinct symptoms and do not seem to be at an increased risk of severe disease. Allergic children show a mild course, like other children. COVID-19 cases with pre-existing COPD, or complicated by secondary bacterial pneumonia, are more severe, and this may be due to a complex immune pathogenesis.
Whether systemic corticosteroids have a deleterious effect on COVID-19 infection is still a matter of discussion. Clinical evidence does not support corticosteroid treatment for SARS-CoV-2 pneumonia. Moreover, corticosteroid therapy in patients with MERS (Middle East respiratory syndrome) was not associated with a difference in mortality after adjustment for time-varying confounders but was associated with delayed MERS coronavirus RNA clearance. In accordance with current WHO guidance, it has been proposed that corticosteroids should not be used for SARS-CoV-2 -induced lung injury or shock, except in the setting of a clinical trial. However, a team of front-line physicians from China had a different perspective. Given the inconclusive evidence and urgent clinical demand, physicians from the Chinese Thoracic Society have developed an expert consensus statement on the use of corticosteroids in SARS-CoV-2 pneumonia that may allow the restricted use of low doses of corticosteroids for a short duration.
Concerning inhaled corticosteroids in asthma, the Global Initiative for Asthma (GINA) recently stated the following (https://ginasthma.org/recommendations-for-inhaled-asthma-controller-medications/): “Some sources have suggested that “corticosteroids” should be avoided during the for SARS-CoV-2 epidemic. This advice is about the use of oral corticosteroids unless there is a clear indication for their use. However, patients with asthma should not stop their prescribed inhaled corticosteroid controller medication (or prescribed oral corticosteroids). Stopping inhaled corticosteroids often leads to potentially dangerous worsening of asthma, and avoiding oral corticosteroids during severe asthma attacks may have serious consequences. Long-term oral corticosteroids may sometimes be required to treat severe asthma, and it may be dangerous to stop them suddenly. Always discuss with your doctor or nurse before stopping any asthma medication. Keep taking your inhaled asthma controller medication, and if your asthma gets worse, follow the instructions on your asthma action plan for how to change your asthma medications and when to seek medical help.”
Some scientific societies have made recommendations for anosmia and have proposed the use of intranasal corticosteroids. However, the French Agency (Direction Générale de la Santé) has contraindicated their use in anosmia and ageusia without nasal obstruction. They have extended the contraindication to saline washing since this could promote viral dissemination.
ARIA and EAACI followed the example of the Dutch ENT Society and sent a questionnaire to all ARIA members regarding the recommendations for allergic rhinitis and anosmia. ARIA and EAACI are proposing a joint statement following the results of the questionnaire.
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Cite as
Bousquet, J., Akdis, C., Bachert, C., Klimek, L., Ansotegui, I., Bedbrook, A., Bosnic-Anticevich, S., Canonica, G., Chivato, T., Cruz, A., Czarlewski, W., Del Giacco, S., Du, H., Fonseca, J., Gao, Y., Haahtela, T., Hoffmann‐Sommergruber, K., Ivancevich, J., Khaltaev, N., Knol, E., Kuna, P., Larenas-Linnemann, D., Mullol, J., Naclerio, R., Ohta, K., Okamoto, Y., O'Mahony, L., Onorato, G., Papadopoulos, N., Pfaar, O., Samolinski, B., Schwarze, J., Toppila-Salmi, S., Ventura, M., Valiulis, A., Yorgancioglu, A., Zuberbier, T. & Pawankar, R. 2020, 'Intranasal corticosteroids in allergic rhinitis in COVID-19 infected patients: An ARIA-EAACI statement', Allergy, 75(10), pp. 2440-2444. https://doi.org/10.1111/all.14302