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.

THE LOSS OF smell and taste is common (60%-70% of cases) in Recommendations in Covid-19 outbreak 1. More than 90% of patients improve 3. isolated loss of smell Olfactory training could be started after SARS-CoV-2-infected patients. within the first month one month or immediately. One in five patients with Covid-19, loss 2. Intranasal corticosteroids can be of smell and taste can present as sudden, recommended at regular doses in severe, and isolated from other nasal or concomitant upper airway disease systemic symptoms. Loss of smell is more (allergic rhinitis, CRS, CRSwNP) but are frequently diagnosed (70%-80%) when not recommended in sudden, severe, and 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. The trinity of Covid-19 is: Immunity – Inflammation – Intervention Prevention: 1. Vaccination (Ab) 2. Receptor blockers 3. Vaccination (T-cells) 4. Mechanical filtration.

To watch a replay of this presentation and earn a CPD point, go to: https://bit.

ly/3dmumbA

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