Glenis K S, Peter W H, Claus B, et al.

World Allergy Organ J. 2020 May 16;100124. doi: 10.1016/j.waojou.2020.100124. Online ahead of print.

Acute COVID-19 infection and onset of seasonal allergic rhinitis share some features, which may be confusing, especially in those new to such symptoms. Cough and fever are the most prominent symptoms of COVID-19, while conjunctivitis and itching are allergic rhinitis symptoms. Sudden and complete anosmia may be an early sign of COVID-19 infection, differentiating it from allergic rhinitis. The EUFOREA expert teams makes an overview of recommendations for people with seasonal allergic rhinitis.

Given that 44 % of all COVID-19 transmission occurs from asymptomatic people, it is important to keep seasonal allergic rhinitis under the best possible control in order to diminish symptoms, such as sneezing, rhinorrhoea and coughing, which may be responsible for viral spread to others via aerosol formation in those who do not realise that they also have COVID-19.

They recommend that seasonal allergic rhinitis treatment to be started early and used regularly in the pollen season. Systemic corticosteroids should be avoided as they may suppress the immune system. There is no contraindication to the use of intranasal corticosteroids, as they do not reduce immunity and normalize the structure and function of the nasal mucosa. Asthma inhalers should be continued as before and taken regularly to maintain control in the pollen season. Inhaled corticosteroids and inhaled corticosteroids combinations with bronchodilators, long acting beta agonists protect against virally induced asthma exacerbations and may be beneficial in COVID-19. Also, treatment with biologicals for people with more severe asthma and severe chronic rhinosinusitis with nasal polyps should be continued to avoid aggravation of these diseases. Ongoing allergen-specific immunotherapy (AIT) should be continued, if feasible within the health care system, as long as no COVID-19 infection has been diagnosed. New AIT treatments are not advised, except for sublingual immunotherapy, which requires only one does under supervision.

In case of COVID-19 infection, oral corticosteroids may be needed in asthma patients for severe virus-evoked exacerbations. NSAIDs, which were suggested to be avoided for all possible patients, are vital in NSAID-sensitive asthma.

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