A new form of irritant rhinitis to filtering facepiece particle (FFP) masks (FFP2/N95/KN95 respirators) during COVID-19 pandemic

Abstract

Filtering facepiece particle (FFP) masks are important items of personal protective equipment in fighting COVID-19 pandemic. They shall protect the wearer of the mask from particles, droplets, and aerosols, but they also can prevent the spread of aerosol-transmitted viruses if the wearer becomes infected. Most often, FFP respirators consist of multiple layers of non-woven fabric made from polypropylene. Worldwide, FFP respirators are subject to various regulatory standards that specify physical properties and performance characteristics. During the SARS-CoV-2 pandemic, health authorities have temporarily repealed standards for respirators. We report on 46 patients that presented with rhinitis-like symptoms strongly associated to the use of FFP masks. Some of them were obliged to use FFP masks in their work environment. Nasal endoscopy showed edemata of the nasal mucosa that significantly decreased after a period of non-use of FFP masks. Subjectively reported symptom levels decreased after cessation of FFP use for 3 or more days. The presence of polypropylene fibres isolated from nasal rinsing solution was significantly associated with the use of FFP masks in our patients. Material safety and performance deregulation of FFP masks can pose a health risk. Thus, especially health care professionals and other individuals with occupational need for FFP masks should be aware of possible hazards that come with COVID-19 pandemic protection measures.

Is a Mask That Covers the Mouth and Nose Free from Undesirable Side Effects in Everyday Use and Free of Potential Hazards?

“…They found statistically significant evidence of mask-induced rhinitis and itching and swelling of the mucous membranes as well as increased sneezing ( p < 0.01). Endoscopically, it showed an increased secretion and evidence of inhaled mask polypropylene fibers as the trigger of mucosal irritation [ 96 ].…”

“…In the case of medical masks, disposable polymers such as polypropylene, polyurethane, polyacrylonitrile, polystyrene, polycarbonate, polyethylene and polyester should be mentioned [ 140 ]. ENT physicians have already been able to detect such particles in the nasal mucosa of mask wearers with mucosal reactions in the sense of a foreign body reaction with rhinitis [ 96 ]. In the case of community masks, other substances from the textile industry are likely to be added to those mentioned above.…”

Filtering efficiency measurement of respirators by laser-based particle counting method

“…The Chinese version is the KN95 (having 95% filtering efficiency), according to the GB2626-20 06 standard. Although the standards slightly differ in the determination methods of the filtering efficiency, the FFP2, N95, and KN95 respirators can suppose to be equivalent [ 13 ],. Generally, respirators are built up from two outer textile layers, which do not have any filtering role, and 1-2 inner filter layers, which can block liquid and solid particles as well (valid for EU tested respirators) [ 14 ],.…”

The effect of N95 and surgical masks on mucociliary clearance function and sinonasal complaints

“…Furthermore, changes in the temperature, humidity, and pH of the inhaled air affect the cilia functions in the upper respiratory tract. Klimek et al described a new form of irritant rhinitis due to the use of N95 mask [ 26 ]. It is suggested that the irritation here may be due to polypropylene fibers seen in the nasal passage due to the use of N95 mask.…”