Intranasal steroids appear to have protective effect against loss of smell and/or taste during Covid-19 with no adverse impact on the course of the disease in patients with chronic rhinitis, according to a study published in the journal Allergy and Asthma Proceedings.^1,2

Seventy-one Covid-positive patients with chronic rhinosinusitis visiting allergy outpatient clinics in four tertiary centers in Istanbul were enrolled in this study to examine the effects of INCs on nasal symptoms in these patients. The 22-item Sino-Nasal Outcome Test (SNOT-22) and the total symptom score-6 (TSS-6) scale were used to evaluate the nasal symptoms. The Visual Analog Scale (VAS) was used to assess quality of life (QoL).

The study participants were segregated into two groups: 21 patients used only intranasal steroids when they developed Covid-19 (Group 1), while the remaining 50 patients did not (Group 2). Of these, 24 used at least one drug either antihistamines and/or leukotriene receptor antagonists (LTRA) (Group 2a) and 26 patients used neither oral nor intranasal drugs (Group 2b).

Forty-eight of the 71 patients (67.6%) had allergic rhinitis; 12 (25%) in Group 1, 17 (35.4%) in Group 2a and 19 (39.6%) in Group 2b. Analysis also revealed the five most common symptoms prior to Covid-19; majority of patients had runny nose and nasal blockage (80.3%) followed by nose blowing (74.6%), sneezing (73.2%), while half reported postnasal discharge (50.7%). During Covid, the most common symptoms were fatigue (50.7%), decreased sense of smell and/or taste (50.7%), cough (39.4%), nasal blockage (35.2%) and dizziness (29.6%).

A marked increase in the total SNOT-22 scores were noted in all the three groups during Covid in contrast to before acquiring the infection. Compared to pre-Covid, the chronic rhinitis-related symptoms showed a significant rise in Group 2a and 2b patients vs Group 1. All the three groups also reported an increase in impairment of quality-of-life during Covid-19 with comparable VAS scores during Covid when compared to before the Covid infection. The reduction in the sense of smell and/or taste, however, was quite less in Group 1 patients compared to patients in Group 2a and 2b; 9 patients in Group 1 (42.9%) and 36 in group 2 (72%). The TSS-6 scores in subjects with allergic rhinitis and other Covid-19 symptoms were comparable in all the three groups during the COVID-19 infection.

This study demonstrates that chronic rhinitis patients who develop Covid-19 can safely and effectively use intranasal steroids to prevent or reduce their odds of developing loss of smell and/or taste with no adverse effect on the outcomes or severity of Covid-19. Intranasal steroids also help to improve nasal symptoms by reducing the local inflammation. Clinicians may consider prescribing intranasal steroids for their patients with chronic rhinitis who also have Covid-19.

References

1. Tuzer C, et al. Clinical effects of intranasal corticosteroids on nasal symptoms in subjects with chronic rhinitis during COVID-19. Allergy Asthma Proc. 2022 Mar 1;43(2):106-115. doi: 10.2500/aap.2022.43.210116.
2. https://www.healio.com/news/allergy-asthma/20220510/intranasal-corticosteroids-mitigate-loss-of-smell-in-chronic-rhinosinusitis-with-covid19, Dated May 10, 2022. Accessed on Jan. 3, 2022.