WEBINAR REPORT
Covid-19 in rhinology and allergy Prof Joaquim Mullol, director of the Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic Barcelona, recently shared his extensive knowledge at a webinar held by Medical Chronicle and sponsored by iNova Pharmaceuticals. The following article is based on his presentation titled: Covid-19 in Rhinology and Allergy – impact on smell and type 2 inflammation.
T
HE LOSS OF smell and taste is common (60%-70% of cases) in SARS-CoV-2-infected patients. One in five patients with Covid-19, loss of smell and taste can present as sudden, severe, and isolated from other nasal or systemic symptoms. Loss of smell is more frequently diagnosed (70%-80%) when measured with smell tests than using questionnaires (45%-50%). For a proper and safe diagnosis, the use of individualised olfactory and gustatory tests or a visual analogue scale (VAS, 0-10cm horizontal line), in person or by telemedicine, is recommended in patients with Covid-19. A potential protective effect of developing Covid-19 is currently being hypothesised in patients with respiratory type 2 inflammation (allergic rhinitis, asthma, chronic rhinosinusitis with nasal polyps), potentially due to eosinophil tissue infiltration. During the outbreak of Covid-19, while awaiting immunisation by vaccination of the general population, the best treatment is prevention of infection: Frequent hand washing, use of facial masks, social distancing, and home isolation when required. In patients with sudden, severe and isolated loss of smell or taste, immediate home isolation is recommended when waiting for a SARS-CoV-2 diagnostic test. In the absence of effective drugs, olfactory training is a valid, effective, and recommended therapy to recover the sense of smell in Covid-19 patients that should be started as soon as possible. However, patients with respiratory type 2 diseases, the regular use of first-line therapeutic drugs (anti-H1, corticosteroids, allergen immunotherapy or biologicals) should not be discontinued. CRITICISM OF METHODOLOGY Most studies provide only qualitative (surveys and questionnaires) but no quantitative (smell test, VAS) data on the loss of smell or taste. There is also no distinction between flavour (smell + taste) and real taste. CRITICISM OF RESULTS There is a high variability in the frequency of loss of smell (from 5% to 85%) and high variability in the frequency of loss of taste (from 5% to 88%). Data on loss of smell and taste seems to confirm ‘flavour = taste’. FINAL CONCLUSIONS Most Covid-19 patients (>60%) present loss of smell and/or loss/ distortion of taste as additional symptoms in Covid-19. Some Covid-19 patients (15-20%) present a sudden-severe-isolated loss of smell/taste. Most patients (>90%) recover the sense of smell/taste within the first month. Olfactory training is recommended.
Recommendations in Covid-19 outbreak 1. More than 90% of patients improve within the first month 2. Intranasal corticosteroids can be recommended at regular doses in concomitant upper airway disease (allergic rhinitis, CRS, CRSwNP) but are not recommended in sudden, severe, and
isolated loss of smell 3. Olfactory training could be started after one month or immediately.
2. Receptor blockers 3. Vaccination (T-cells) 4. Mechanical filtration.
The trinity of Covid-19 is: Immunity – Inflammation – Intervention Prevention: 1. Vaccination (Ab)
To watch a replay of this presentation and earn a CPD point, go to: https://bit. ly/3dmumbA
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MEDICAL CHRONICLE | April 2021 33