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Impact of allergic rhinitis and asthma on COVID-19

Published: October 30, 2021

The emergence of COVID-19 has had a huge impact on population health globally. Allergic rhinitis (AR) and asthma are common and underappreciated respiratory diseases and often simultaneously occur as united airway disease. Whether AR and asthma act as independent risk factors for the infection, hospitalization and mortality of COVID-19 remains controversial.  

Ren et al ’s study published on The Journal of Allergy and Clinical Immunology: In Practice aimed to explore the role of AR and/or asthma in the risk of infection, severity and mortality of COVID-19, and to evaluate whether long-term medications for AR and/or asthma would affect the clinical manifestations and outcomes of COVID-19. Demographic and clinical data of 70,557 adult participants who completed SARS-Cov-2 testing between March 16 and December 31, 2020 in the UK Biobank were analyzed. The rates of COVID-19 infection, hospitalization and mortality in relation to preexisting AR and/or asthma were assessed based on adjusted generalized linear models. The fully adjusted model included gender, age, Townsend deprivation index, education, current employment status, BMI, ethnic background, smoking and drinking status, and comorbidities. The model was analyzed concurrently for AR group, asthma group, AR and asthma group, respectively, and the reference was the healthy control group for all relevant analyses. The impact of long-term AR and/or asthma medications on the risk of COVID-19 hospitalization and mortality were further analyzed. Medication analyses were conducted for participants who had either AR or asthma, and participants who had AR or asthma but never used those medicines served as the controls in corresponding analyses. In order to conduct a more in-depth analysis for asthma, asthma participants were further divided into allergic asthma and non-allergic asthma groups, and the fully adjusted model was applied for the sub-analysis. In another sub-analysis, the authors explored the differences in the outcomes of COVID-19 between asthma patients with or without COPD versus participants without asthma or COPD (reference group).

AR patients of all ages had lower positive rates of SARS-Cov-2 tests (RR:0.75, 95% CI: 0.69-0.81, p<0.001), with lower susceptibility in males (RR: 0.74, 95%CI: 0.65-0.85, p<0.001) than females (RR: 0.8, 95% CI: 0.72-0.9, p<0.001). However, similar effects of asthma against COVID-19 hospitalization were only observed in participants aged <65 (RR:0.93, 95% CI: 0.86-1, p=0.044) but not older patients. In contrast, asthma patients who tested positively had higher risk of hospitalization (RR:1.42, 95% CI: 1.32-1.54, p<0.001). Neither AR nor asthma had impact on COVID-19 mortality. None of conventional medications for AR or asthma, e.g., antihistamines, corticosteroids or β2 adrenoceptor agonists showed an association with COVID-19 infection or severity. No significant difference between allergic and non-allergic asthma was observed in the results. Asthma patients without COPD had a slightly protective effect against COVID-19 infection, but such patients had an increased hospitalization risk of COVID-19.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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