Suggestions for allergic illness care throughout the COVID-19 pandemic – Well being and Life-style

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Maria Patricia S. Abes, MD; Maria Remedios D. Ignacio MD; Nanneth T. Tiu, MD – A group of skilled Filipino allergists is joining forces as the H&L Allergy Team, whose aim is to provide advice, help readers understand how to deal with common allergic conditions, and find relief.

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Acute COVID-19 infection and seasonal allergic rhinitis (SAR) have some similarities, but also differences.

COVID-19 is common as a flu-like illness with fever and persistent cough as the main symptoms. Some patients may also have a runny nose, sore throat, nasal congestion, and pain or diarrhea. Some suffer from a sudden and complete loss of smell and taste. This clinical presentation could be confused with SAR, especially those new to such symptoms. Cough and fever are the most common symptoms of COVID-19, while conjunctivitis and itching suggest allergic rhinitis (AR) as a diagnosis.

It is very important to keep SAR and other allergic respiratory diseases under the best possible control to reduce symptoms such as sneezing, rhinorrhea, and coughing, which can be responsible for aerosolizing viruses to others if they are not aware of COVID- 19th

Similarities and differences between seasonal allergic rhinitis and COVID-19 symptoms (Scadding et al., World Allergy Organization Journal (2020) 13: 100124)

ALLERGIC RESPIRATORY DISEASE

SAR therapy is best started early and is used regularly during the respective pollen season. None of the recommended treatments for SAR are contraindicated, except for systemic corticosteroids. According to over 90% of experts, there is no contraindication to the use of intranasal corticosteroids (INS). INS do not decrease immunity; In fact, they normalize the structure and function of the nasal mucosa and do not affect mucociliary clearance. However, systemic corticosteroids should be avoided as they can suppress the human immune system.

Although viral infection is a major cause of asthma and allergic diseases, it is believed that asthma is not a predisposing condition to infection with Coronavirus Disease 2019 (COVID-19). However, patients with severe asthma / allergic diseases who require systemic corticosteroids or immunosuppressants may be at greater risk of a more severe clinical course of this infectious disease. Asthma inhalers should be continued as before and taken regularly. If necessary, increase the dose to maintain control during the pollen season. Inhaled corticosteroids (ICS) and ICS combinations with bronchodilators, long-acting beta agonists (LABAs), are known to protect against virally induced asthma exacerbations and may be beneficial in COVID-19.

Pediatric allergists should treat patients with asthma, AR, or other allergic conditions according to standard guidelines. During the current pandemic, asthmatic children should continue to receive preventive treatment to be under good control.

Patients with more severe asthma and severe chronic rhinosinusitis with nasal polyps who have used biologics (currently available to treat type 2 inflammation) should continue treatment while minimizing hospital and personal visits. It is important to wear protective equipment to protect both health workers and patients.

Ongoing allergen-specific immunotherapy (AIT) should be continued as long as no COVID-19 infection has been diagnosed. New AIT treatment with subcutaneous immunotherapy (SCIT) is not recommended because it requires repeated visits to a doctor or hospital. However, initiation of sublingual immunotherapy (SLIT), which only prescribes a starting dose under supervision, should be preferred or a switch from SCIT to SLIT should be considered if a suitable alternative to SCIT is available for the allergen in question.

ATOPIC DERMATITIS

To maintain optimal skin care regimen, moisturizers, topical immunosuppressants, and immunomodulatory therapies should not be postponed or stopped if a doctor’s judgment is necessary to prevent flare-ups.

CHRONIC URTICARIA (CU)

UC may require long-term maintenance therapy as symptoms can persist for years in many cases. In healthy subjects with no underlying medical conditions, UC symptoms are usually not life threatening, and visits to health care facilities may be delayed and postponed during this COVID-19 pandemic. Elderly patients with comorbidities such as high blood pressure, diabetes, cardiovascular disease, and chronic respiratory disease are prone to infection and are more cautious when visiting hospitals. However, going to health care facilities would be beneficial for patients whose quality of life deteriorates significantly without regular medication. If patients develop severe symptoms such as anaphylaxis, angioedema, bronchospasm, dizziness, and hypotension associated with urticaria, they should go to the emergency room to treat the symptoms. Patients must follow all infection control guidelines. Doctors should delay evaluating the causes of UC and postpone outpatient visits until the pandemic is over.

DRUG ALLERGY

Drug allergy should be treated immediately, especially if symptoms include generalized urticaria, angioedema, bronchospasm, and hypotension. If anaphylaxis is suspected, an adrenaline injection may be considered. Diagnostic procedures like drug challenge and drug skin tests need to be delayed until the pandemic is over. Drug desensitization is actively being considered in patients who require immediate administration of hypersensitivity drugs. Basically, desensitization must be carried out in the hospital according to the infection control procedure.

TAKE NEWS HOME

Early mild COVID-19 symptoms may be mistaken for AR or appear simultaneously.

Sudden and complete anosmia can be an early sign of COVID-19 infection and differentiate it from AR.

Proper treatment for AR and other allergic respiratory diseases is very important. Uncontrolled symptoms can increase the risk of the virus spreading in patients concomitantly infected with COVID-19.

Topical and inhaled corticosteroids can even be useful or preventive for COVID-19 infection.

Allergen immunotherapy (AIT) is not immunosuppressive and is not a risk factor for more severe COVID-19-induced disease.

It is still uncertain whether COVID-19 increases the risk of asthma or allergic diseases. Detailed monitoring and optimal treatment with AIT, ICS and biologics required

Continued in all patients with asthma and allergic diseases. This can be achieved in a safe state through optimal protective measures.

REFERENCES:

Management of Allergic Patients During the COVID-19 Pandemic in Asia

Allergy Asthma Immunol Res. 2020 Sep; 12 (5): 783- 791

Treating Allergic Respiratory Diseases in the COVID-19 Era: An EUFOREA Statement

Scadding et al. World Allergy Organization Journal (2020) 13: 100124

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