key: cord-0971416-4066lfs1
authors: Dror, Amiel A.; Eisenbach, Netanel; Marshak, Tal; Layous, Eli; Zigron, Asaf; Shivatzki, Shaked; Morozov, Nicole G.; Taiber, Shahar; Alon, Eran E.; Ronen, Ohad; Eyal, Zusman; Srouji, Samer; Sela, Eyal
title: Reduction of Allergic Rhinitis Symptoms with Face Mask Usage During the COVID-19 Pandemic
date: 2020-09-02
journal: J Allergy Clin Immunol Pract
DOI: 10.1016/j.jaip.2020.08.035
sha: bf8e3fa460c12aec9125dfeb1c6368d6376cc910
doc_id: 971416
cord_uid: 4066lfs1

nan

reported by nurses with chronic allergic rhinitis. A decrease in symptom severity with mask usage 27 highlights the potential benefit of face masks for patients with allergic rhinitis. 28 29 Keywords: face mask; allergic rhinitis; COVID-19; allergens; outbreak prevention 30 31

The COVID-19 pandemic demanded widespread adoption of personal protective equipment (PPE) for 32 viral transmission prevention. The prevalence of allergic rhinitis, ranging from 10-20% of the general 33 population [1] , together with extensive use of face masks during the pandemic, provided an 34 opportunity to study the effects of face masks on rhinitis symptoms. We utilized questionnaire data to 35 characterize Israeli nurses' symptomatology while wearing face masks when working 8-12 hour shifts 36 during the COVID-19 pandemic. 37 38 Ethical approval was granted by the Institutional Review Board before initiation of this longitudinal 39 study. All participants provided informed consent on the introductory web page prior to the survey 40 enrolment. The web-based survey was created with the Qualtrics platform and the American 41

Association for Public Opinion Research (AAPOR) reporting guidelines. The survey was anonymous 42 and confidential and participants could terminate the survey at any time. The survey was distributed 43 electronically over a two-week period across medical centers in Israel to full time nurses (8-12 hours 44 shift) in respiratory wards or dedicated departments for suspected or confirmed COVID-19. The 45 survey was distributed on April 5 th , 2020 for two weeks during the early spring in Israel where 46 seasonal allergens are widely dispersed. This period also corresponds to when initial social distancing 47 and quarantine regulations were implemented in Israel. 48

Demographic data were self-reported by 1,824 participants, including sex, age, and geographic 49 location of responders' affiliated medical center, including 301 nurses with reported AR, further self-50 classified as intermittent (n=233) or persistent (n=68) (Figure 1 ). The nurses scored their allergic 51 J o u r n a l P r e -p r o o f rhinitis symptom severity before and after wearing face masks for one week at work; symptomatology 52 data was collected once upon enrolment in the study and again after the nurse had worn one of the 53 mask configurations for one week. Of 301 nurses, the minority typically use only one type of mask, 54 either a surgical (n=47) or N95 mask (n=39) while the majority (n=215), for the purposes of this 55 study, used two types of face mask (surgical mask and N95) for one week each ( Figure 1 ). This group 56 reported their symptoms after two consecutive weeks of wearing one mask type for one week and 57 then the other mask type for the second week. The participant scored the severity of their individual 58 allergic rhinitis symptoms (none, mild, moderate, or severe) of watery rhinorrhea, sneezing, nasal 59 obstruction, and itchy nose and eyes. Additionally, nurses ranked a separate score of overall perceived 60 symptom burden of rhinitis as either mild, moderate, or severe (Fig 1) . 61

To assess the difference in the distribution of symptom severity with the use of masks we performed 62

Chi-square tests in Prism 8 software (Graphpad, CA). Other behavioral modifications during the lockdown potentially contributed to reported decreases in 104 allergic rhinitis symptoms. Recommendations by health authorities to stay home and avoid crowded 105 places likely reduced exposure to allergens and other environmental pathogens, especially during the 106 spring season of the survey enrolment period. Therefore, the observed improvement in symptoms 107 among nurses with intermittent (i.e. seasonal) allergic rhinitis could be due to reduced exposure to 108 seasonal provoking allergens and not due to mask wearing. On the other hand, the lack of ophthalmic 109 symptom improvement in the presence of significant improvement of nasal symptoms among nurses 110 with intermittent allergic rhinitis highlight the potential contribution of face masks in lowering 111 exposure of allergens to the upper airway even though the eye's conjunctiva remains exposed to 112 provoking allergens. To further investigate the potential contribution of face masks for allergic rhinitis 113 symptom improvement, a larger study with a substantial control group is required. 

Clinical practice 133 guideline: Allergic rhinitis

Effectiveness of face masks 136 used to protect Beijing residents against particulate air pollution

Clinical relevance of spore and pollen counts

Mite faeces are a major source of house dust allergens

Surgical mask filter and fit performance

Respiratory performance offered by N95 respirators and 145 surgical masks: Human subject evaluation with NaCl aerosol representing bacterial and viral particle 146 size range

Performance of an N95 148 filtering facepiece particulate respirator and a surgical mask during human breathing: two pathways 149 for particle penetration

Used both surgical and N95 masks interchangeably ‡ 215 nurses typically use both masks at work while 86 use one type exclusively; the 215 nurses used one mask type for one week each for the purposes of this study