Large Study Links Asthma, Allergic Rhinitis to Severe COVID-19

By Reuters Staff

August 27, 2020

NEW YORK (Reuters Health) - People with allergic rhinitis and asthma may be slightly more prone to contracting COVID-19 and considerably more to developing severe disease when infected, according to a nationwide cohort study from South Korea.

The risk was especially high for individuals with non-allergic asthma, who were more than four times as likely to have severe COVID-19 as those without asthma, Dr. Jee Myung Yang of the University of Ulsan College of Medicine, in Seoul, and colleagues found.

The team says their study provides strong evidence of a link between respiratory allergic diseases and the risk of contracting COVID-19 and/or having worse clinical outcomes of the infection.

Studies of COVID-19 and asthma to date have had mixed results, and small sample sizes, the authors note in the Journal of Allergy and Clinical Immunology.

They looked at data from South Korea's Health Insurance Review and Assessment Service for more than 219,000 adults who underwent COVID testing between January 1 and May 15, including 14.9% diagnosed with asthma, 63.1% with allergic rhinitis and 3.9% with atopic dermatitis.

A total of 7,340 tested positive for SARS-CoV-2, including 725 with asthma (9.9%), 4,210 with allergic rhinitis (57.4%) and 136 with atopic dermatitis (1.9%).

The rate of SARS-CoV-2 positivity was 2.3% for people with asthma and 2.2% for those without asthma (adjusted odds ratio 1.08; 95% confidence interval, 1.01 to 1.17) and 3.3% and 2.8% for those with and without allergic rhinitis, respectively (aOR, 1.18; 95% CI, 1.11 to 1.25).

The increase was greater for those with non-allergic asthma (aOR, 1.34; 95% CI, 1.07 to 1.71) than those with allergic asthma (aOR, 1.06; 95% CI, 0.97 to 1.17).

Severe clinical outcomes occurred in 6.9% of patients with asthma and 4.5% of those without (aOR, 1.62; 95% CI, 1.01 to 2.67), and in 4.7% of patients with allergic rhinitis and 3.7% of those with no allergic rhinitis (aOR, 1.27; 95% CI, 1.00 to 1.64).

The odds of developing severe COVID-19 was more than quadrupled for patients with non-allergic asthma (aOR, 4.09; 95% CI, 1.69 to 10.52), while the risk increase was less pronounced for those with allergic asthma (aOR, 1.40; 95% CI, 0.83 to 2.41).

Average hospital stay was 22.8 days for patients with allergic rhinitis and 21.8 days for those without allergic rhinitis (adjusted mean difference, 0.71; 95% CI, 0.02-1.40). Patients with asthma spent a mean of 24.6 days in the hospital, versus 22.1 days for those without (adjusted mean difference, 0.89; 95% CI, -0.25 to 2.3).

"Because the immunological profile of COVID-19 patients is polarized toward a classic Th1 response, patients with non-allergic asthma might manifest an aggravated Th1 immune response. Thus, they are predisposed to severe clinical outcomes of COVID-19," the authors write "Given these potential associations, patients with non-allergic asthma should be aware of the severe clinical outcomes of COVID-19, and careful monitoring of inflammatory status in this population should be emphasized."

SOURCE: Journal of Allergy and Clinical Immunology, online August 15, 2020.