COVID-19

According to existing evidence, COVID-19 does not appear more severe in patients with chronic rhinosinusitis (CRS). CRS is often accompanied by lower airway symptoms – even if no asthma has been previously diagnosed. In general, be vigilant on COVID-19 symptoms (e.g. loss of smell, ‘’common’’ cold or flu-like symptoms, fever and lower airway symptoms: cough, shortness of breath). It is important to keep your CRS well-controlled and to follow the treatment advice of your physician.

Chronic use of tablets with corticosteroids should be avoided or used with caution in patients with chronic rhinosinusitis (CRS) during the pandemic and should only be reserved for patients with severe symptoms and in the absence of an alternative. Treatment decisions (corticosteroids, surgery or biologics) should be taken on an individual basis. In case of worsening of your CRS symptoms, contact your physician, as starting or stopping corticosteroids on yourself may induce general health risks as well as may affect your CRS control. It may also affect your susceptibility to SARS-CoV2 infection (the virus causing COVID-19).

Presently, there is no evidence that the use of a corticosteroid nasal spray leads to an increased risk of COVID-19 infection or trigger a more severe course of COVID-19. A considerable percentage of COVID-19 patients experience loss of smell as an early sign of the disease. There is no indication that intranasal corticosteroid treatment has a positive impact on the recovery. However, there is no evidence either suggesting that this treatment has a negative impact on the symptoms and/or the development of (more severe) COVID-19. Therefore, it is recommended to continue regular treatment with your corticosteroid nasal spray for chronic rhinosinusitis.

All patients who have tested positive for COVID-19 or show clinical signs or symptoms of COVID-19 infection, irrespective of the severity of the infection, should consult their physician to discuss continuation of their biologic therapy. Patients who have tested negative for COVID-19 or do not show clinical signs or symptoms of COVID-19 can continue the treatment, while being monitored (either face2face or remote) by their treating physician.

The loss of smell (anosmia) in chronic rhinosinusitis (CRS) (often in combination with nasal polyps) is caused by chronic inflammation of the nasal and sinus mucosa. In COVID-19, the exact mechanism of potential olfactory nerve damage in the nose is not fully clear. If your loss of smell is caused by COVID-19 infection, it may subside in a few weeks or months after recovery. If you experience a loss of smell during the COVID-19 pandemic, do not hesitate to contact your physician.

Until today the available evidence suggests that allergic rhinitis patients are not at higher risk for Sars-CoV-2 infection (the virus causing COVID-19). Moreover, if allergic rhinitis patients develop COVID-19, there is no evidence for a more severe disease course compared to non-allergic patients.

In case of new-onset (sudden) loss of smell, the probability of COVID-19 is high and we recommend you to contact your doctor who can advise you to get tested and/or self-quarantine. However, reduced sense of smell or loss-of-smell might also be a symptom of allergic rhinitis. In those cases there is often associated nasal obstruction/congestion and symptoms increase more over time.

Up until now, there is no scientific evidence that treatments for allergic rhinitis increase the risk of infection with Sars-CoV-2 (the virus causing COVID-19) or the severity of COVID-19. This means that allergen avoidance, nasal rinsing with salt water, nasal corticosteroids and anti-histamine treatment should be continued as prescribed, both in COVID-19 infected and non-infected patients.

Allergen-immunotherapy (AIT) or allergen vaccines (both injections and under the tongue) for the treatment of allergic rhinitis should be discontinued in COVID-19 diagnosed patients or suspected COVID-19 cases until complete clinical recovery (negative test result and/or adequate quarantine). Allergen-immunotherapy for allergic rhinitis should be continued in non-infected individuals and patients recovered from COVID-19.

For patients who are receiving immunotherapy via injections (SCIT) and therefore need repeated visits to a physician or hospital, it can be considered an option to permanently or temporarily switch from SCIT to SLIT (therapy via drops or tablets), when there is a suitable alternative available.

If your asthma is well-controlled, you are not at higher risk of severe infection with COVID-19 than the general population. In contrast, if your asthma is uncontrolled, it does become a risk factor of severe COVID-19. All efforts should be made to continue the use of your routine controller medication. Apart from this, as part of more general recommendations, it is important that you take into account the following other preventive measures: take care of your lifestyle including regular exercise in fresh air, healthy food and sufficient (healthy) sleep. Also, do not forget your annual flu vaccination.

Until today there is no evidence suggesting that patients who are taking inhaled corticosteroids are at higher risk of COVID-19 infection or of more severe infection than the general population. To ensure that your asthma is well-controlled and consequently, to prevent a higher risk of COVID19, doctors advise to continue using your routine controller medication, including inhaled corticosteroids during the pandemic. Should your asthma symptoms worsen, do not hesitate to contact your physician.

Until today there is no evidence suggesting that a short course of tablets with corticosteroids impacts the evolution of COVID-19. This means that an asthma exacerbation should be treated as usual with oral corticosteroids. In case of long-term oral corticosteroid usage in combination with high-dose inhaled corticosteroids, monitoring of asthma and/or changing your medications should be conducted in close communication with your (respiratory) physician to prevent asthma exacerbations. Your (respiratory) physician may also decide to add other medications to the corticosteroids (e.g. long-acting relievers or leukotriene receptor antagonists or other medications) in order to reduce the overall dose of the corticosteroids. It is not advised to reduce your corticosteroid-containing medications yourself: this may induce health complications and your asthma control to worsen.

Biologic treatment should be continued in patients who are not infected with COVID-19. It is advised to use self-administration devices at home, whenever this option is available to minimize face-to-face contact in the clinic. Patients who are infected with COVID-19 should, irrespective of the severity of their infection and symptoms, contact their (respiratory) physician on the continuation of their asthma medications including their biologics treatment.