The COVID-19 pandemic has shaped the year 2020 like no other event in recent decades. The significance of this well-known virus-related disease is enormous, both in health as well as social and economic terms, and also on a global level. For patients with allergies, this has resulted in some special aspects that will be briefly described below. Of course, the general rules of conduct recommended by the FOPH (www.bag.admin.ch) also apply to allergy sufferers and carers.
Patients with pollen allergies often suffer seasonally from sneezing attacks, scratching in the throat and, if the lower respiratory tract is involved, also from coughing and, in all cases, shortness of breath – all symptoms that can also occur with an acute corona infection. On the one hand, the medical history helps, since pollinosis symptoms have often occurred in recent years and are more pronounced in sunny, windy weather. In the case of an infection with SARS-CoV-2, fever and, as a very typical symptom, a sudden loss of the sense of smell and taste are often observed (in up to 50% of cases).
In case of doubt, a rapid and reliable test for the corona virus (e.g. by means of PCR) is therefore certainly useful in order to obtain clarification in this regard.
THERAPY OF ALLERGIES AND ASTHMA AND COVID-19
Previous studies indicate that patients with pre-existing respiratory allergies and also with well-controlled bronchial asthma do not suffer from an increased risk of a more severe course in the case of a possible Corona infection; these therefore probably do not belong to the actual risk groups. The most recent studies even show that high-dose inhaled cortisone asthma sprays can have favourable effects on the course of COVID-19 infection and can prevent or mitigate severe sales.
In severe asthma that is difficult to treat and may even require cortisone tablets or injections to prevent exacerbations, there is probably an increased risk of a more severe course of possible infection with the SARS-Co2 virus.
If patients are undergoing therapy with biologics (such as benralizumab, dupilumab, mepolizumab or omalizumab) because of severe asthma, this can and should also be continued according to current knowledge. Caution is advised with the use of systemic cortisone products or immunosuppressive drugs (such as cyclosporine, azathiprim or methotrexate), as these could increase the susceptibility or complications of corona infection. In these cases, it is advisable to weigh up the benefits against any risks with the doctor treating the patient.
Wearing a protective mask may be unpleasant, but it does not reduce the oxygen supply to the respiratory tract to any measurable extent. Especially if the necessary distance of 1.5 metres cannot be maintained indoors, wearing masks is therefore reasonable and possible even for patients with impaired nasal breathing or asthma. In addition, there are indications that wearing a mask can also provide some protection against pollen exposure.
In a recent study, areas where pollen levels are very high were also found to have a higher incidence of SARS-Co-V2 infections, including in the general population, not just those affected by pollen allergies. This raises the question of whether pollen also contains substances that may make people more sensitive to respiratory viruses.
DESENSIBILISATION DURING COVID 19 RESTRICTIONS
Any allergen-specific immunotherapy/desensitisation (SIT) already in progress, especially with bee or wasp venom, should be continued whenever possible. SIT with inhalation allergens (pollen, mites) can also be continued. In lock-down phases, the intervals between injections (subcutaneous application) can be extended somewhat in order to reduce the number of visits to the doctor.
In the case of a manifest Covid-19 infection, however, any SIT should be interrupted in any case, as in the case of other febrile infections, until healing has taken place.
COVID-19 VACCINATION AND ALLERGIES
Many questions have also arisen in connection with the question of whether patients with allergies can be vaccinated against the corona virus with the vaccines that are now available. Fortunately, it can be stated that the vast majority of patients with allergies can be vaccinated with the currently available m-RNA-based vaccines (Pfizer and Moderna) without increased risk.
Patients with urticaria can also undergo these vaccinations; in this case, the preventive use of an antihistamine is recommended. Only if very severe allergic reactions to components of these vaccines with shortness of breath or shock have occurred in the past, for example after laxatives or infusions/vaccinations without a recognisable trigger, is a specialist allergological clarification advisable, as then an allergy to one of the ingredients (such as polyethylene glycol PEG or tromethamine) could be present, although this is very rare. Skin rashes at the injection site or on the whole body after a few days of COVID-19 vaccination unfortunately occur occasionally; however, these usually respond well to symptom-related treatment and also allow a second vaccination to be administered if necessary.
Fortunately, severe or even life-threatening allergic reactions to the current COVID-19 vaccines are very rare (approx. 1 per 50,000 to 100,000 vaccinated persons).