key: cord-0957806-vgst39cu
authors: Bruno, Chiara; Locatello, Luca Giovanni; Cilona, Maria; Fancello, Giuseppe; Vultaggio, Alessandra; Maltagliati, Lucia; Rossi, Oliviero; Vivarelli, Emanuele; Almerigogna, Fabio; Piccica, Matteo; Lagi, Filippo; Maggiore, Giandomenico; Matucci, Andrea; Trotta, Michele; Gallo, Oreste
title: Seasonal Allergic Rhinitis Symptoms in Relation to COVID-19
date: 2020-11-19
journal: Allergy Rhinol (Providence)
DOI: 10.1177/2152656720968804
sha: 47d7bfe1c613215336ff33151a543f7a4133d36b
doc_id: 957806
cord_uid: vgst39cu

nan

In Italy, the SARS-CoV-2 infection had its peak of contagion between March and April 2020, at the height of the pollen season. We currently recognize that despite olfactory dysfunction (hyposmia or anosmia) 1 is a major symptom of COVID-19, other nasal manifestations (rhinorrhea, obstruction) are reported; 2 these symptoms are similar to those of seasonal allergic rhinitis (AR). To avoid misdiagnosis that would lead to unnecessary anxiety and invasive diagnostic tests, we wanted to directly compare the clinical differences in terms of nasal symptoms between AR and SARS-CoV-2, in order to better differentiate the two conditions. After Institutional review board request, we have administered the SNOT-22 tool 3 to a cohort of 50 patients in the care of the Immunoallergology Unit of the Careggi University Hospital, with spring seasonal AR and history of SARS-CoV-2 negative swab or serology. As a comparison, we used the same tool to analyze patients hospitalized in the Infectious and Tropical Disease Unit with a positive SARS-CoV-2 pharyngeal swab and sinonasal symptoms. From the 121 patients hospitalized for SARS-CoV-2 in our institution, we excluded patients who not reported sinonasal symptomatology during the hospitalization (36 cases), patients affected by cognitive disorder (5 cases), deceased patients (19 cases), patients with a history of allergic rhinitis or another sinonasal disease (4 cases), and anyone who didn't want to take part in the study (14 cases), obtaining a COVID-19 group of 43 patients with mild-moderate disease. We compared, in the two groups, the mean score for each answer of SNOT-22 with unpaired two-tailed Student's t-test while the prevalence of the single symptom (non-zero value) was compared by Fisher's exact test. P values of less than 0.05 were regarded as statistically significant. Among AR patients, 47 (94%) used intranasal steroids, 27 (54%) antihistamines and 3 (6%) anti-leukotrienes. All the AR patients had an intermittent form, 34 (68%) mild and 16 (32%) moderate-severe disease. As can be seen in Table 1 , the mean overall score was significantly higher in COVID-19 patients compared to AR patients. Analyzing the single items, the AR patients most frequently reported having to blow the nose and sneezing compared to COVID-19 patients, while cough, dizziness, and olfactory disorders were more prevalent in the latter group. The need to blow the nose, rhinorrhea, and sneezing were also significantly more severe in AR patients than in COVID-19 patients, while cough and olfactory disorders were worse in the COVID-19 group. As expected, almost all the items in the "psychological" and "sleep dysfunction" domains were reported to be significantly less frequent and milder in the AR population, thus emphasizing the impressive emotional component that afflicts the COVID-19 infected patients.

From a practical and clinical viewpoint, our data suggest that, even though there are some coinciding and potentially confounding features, the nasal symptoms of AR and COVID-19 can be differentiated on clinical grounds. Therefore, also in the case of future undesirable COVID-19 outbreaks in concomitance with pollen season, clinicians and patients with AR should be reassured and appropriately taught to recognize and to discriminate between the two conditions.

Bruno: Conceptualization, data curation, formal analysis, investigation, figure, resources, and writing -review and editing; Locatello: Conceptualization, data curation, resources, supervision, and writing -review and editing; Cilona: data curation, resources; Fancello: data curation, resources; Vultaggio: data curation, supervision and editing; Maltagliati: data curation, resources; Rossi: data curation, supervision and editing; Vivarelli: data curation, resources; Almerigogna: data curation, supervision and editing; Piccica: data curation, supervision and editing; Lagi: data curation, supervision and editing; Maggiore: data curation, supervision and editing; Matucci: data curation, supervision and editing; Trotta: data curation, supervision and editing; Gallo: Conceptualization, supervision and writing -review and editing.

This study was approved by our institutional review board.

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The author(s) received no financial support for the research, authorship, and/or publication of this article.

This article does not contain any studies with human or animal subjects.

Verbal informed consent was obtained from the patients for their anonymized information to be published in this article. 

Olfactory and gustatory dysfunction in coronavirus disease 19 (COVID-19)

COVID-19 in otolaryngologist practice: a review of current knowledge

Cross-cultural adaptation and validation of the SNOT-22 into Italian