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Cough Update:Allergic Rhinitis in COVID-19 patients: list of recommendations

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eMediNexus    12 May 2021

The use of systemic corticosteroids in COVID‐19 infection is debatable. Not much Clinical evidence is in support of corticosteroid treatment for SARS‐CoV‐2 pneumonia.Current WHO guidelines indicate that corticosteroids should not be used for SARS‐CoV‐2 ‐induced lung injury or shock, except in the setting of a clinical trial.

Interestingly, a team of physicians from the Chinese Thoracic Society have developed an expert consensus statement on restricted use of corticosteroids in SARS‐CoV‐2 pneumonia in low doses for a short duration.

The Global Initiative for Asthma (GINA) has recently stated the following-

“Some sources have suggested that “corticosteroids” should be avoided during the 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.”

A Delphi process was initiated by Anna Bedbrook initiated a Delphi process by sending the 3 questions proposed by the Dutch ENT Society to the entire ARIA database (including 509 members, from 84 countries). Based on their answers, the following recommendation was framed10-

  • With the current knowledge, in patients with COVID‐19 infection, intranasal corticosteroids (including spray) can be continued in allergic rhinitis at the recommended dose.
  • Stopping local intranasal corticosteroids is not advised. Suppression of the immune system has not been proven and more sneezing after stopping means more spreading of the Coronavirus.
  • These recommendations are conditional since there is a paucity of data and they should be revised regularly with new knowledge.

Thus they recommend continuing using intranasal corticosteroids (including spray) for allergic rhinitis at the recommended dose, in patients with COVID19 infection.

Source:Intranasal corticosteroids in allergic rhinitis in COVID‐19 infected patients: An ARIA‐EAACI statement, European Journal of Allergy and Clinical Immunology,2020;75(10):2440-2444.  https://doi.org/10.1111/all.14302

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