Management of patients with chronic rhinosinusitis during the COVID‐19 pandemic—An EAACI position paper

Abstract

Background Chronic rhinosinusitis is regarded as a chronic airway disease. According to WHO recommendations, it may be a risk factor for COVID‐19 patients. In most CRSwNP cases, the inflammatory changes affecting the nasal and paranasal mucous membranes are type‐2 (T2) inflammation endotypes. Methods The current knowledge on COVID‐19 and on treatment options for CRS was analyzed by a literature search in Medline, Pubmed, international guidelines, the Cochrane Library and the Internet. Results Based on international literature, on current recommendations by WHO and other international organizations as well as on previous experience, a panel of experts from EAACI and ARIA provided recommendations for the treatment of CRS during the COVID‐19 pandemic. Conclusion Intranasal corticosteroids remain the standard treatment for CRS in patients with SARS‐CoV‐2 infection. Surgical treatments should be reduced to a minimum and surgery preserved for patients with local complications and for those with no other treatment options. Systemic corticosteroids should be avoided. Treatment with biologics can be continued with careful monitoring in noninfected patients and should be temporarily interrupted during the course of the COVID‐19 infection.

Asthma and COVID-19 - A systematic review

“…Another aspect that could explain our results is that asthma treatment with inhaled corticosteroids allied to improved therapeutic and prophylactic adhesion has increased over the years, resulting in the reduction of respiratory distress episodes and allergy associated immunological imbalance (20)(21)(22)(23). Moreover, allergy and asthma international associations were e cient to rapidly produce and release COVID-19 guidelines that provided advice for health professionals involved in the care of asthma patients, as well as for reaching the general public (24)(25)(26)(27). These actions could have bene cially impacted on the control of asthma and also in uenced patients to follow social isolation procedures; thus, mitigating the risk of contracting COVID-19.…”

COVID‐19 pandemic: Practical considerations on the organization of an allergy clinic—An EAACI/ARIA Position Paper

“…Chronic rhinosinusitis (CRS) affects approximately 12% of the general population worldwide and is regarded as a chronic airway disease that, according to WHO recommendations, may be a risk factor for COVID‐19 patients 6,11 . The inflammatory changes affecting the nasal and paranasal mucous membranes in CRS with nasal polyps (CRSwNP) are, in most cases, of the type 2 (T2) inflammation endotype.…”

“…Recently, a number of reports have been indicating that a sudden and severe (anosmia) isolated onset of loss of smell (ISOA) and/or loss of taste may also be present in COVID‐19 patients who are otherwise asymptomatic. This is considered a marker symptom in screening for SARS‐CoV‐2 infection, 62,110,111 but may also interfere with loss of smell in CRS 11 . CRS is treated with intranasal corticosteroids (INCS), systemic corticosteroids or specific T2 endotype–driven anti‐inflammatory therapies according to the severity of disease 112 .…”

“…CRS is treated with intranasal corticosteroids (INCS), systemic corticosteroids or specific T2 endotype–driven anti‐inflammatory therapies according to the severity of disease 112 . INCS remain the standard treatment for CRS in the COVID‐19 pandemic and also for patients with SARS‐CoV‐2 infection 11 . Surgical treatments should be reduced to a minimum, and surgery preserved only for patients with local complications and those for whom no other treatment options exist.…”

“…However, until now, there is no clear advice on how to manage allergic patients with co‐morbid COVID‐19 or non‐SARS‐CoV‐2–infected allergic patients during the ongoing pandemic 6 . The European Academy of Allergy and Clinical Immunology (EAACI), in alliance with the global initiative “Allergic Rhinitis and Its Impact on Asthma” (ARIA), has published several recommendations and assessments in the field of allergic diseases such as allergic rhinoconjunctivitis (ARC), allergic asthma and others 7 regarding pharmacotherapy, allergen immunotherapy (AIT), biological treatment and others 5,8‐18 …”