Allergic rhinitis symptoms worsened during COVID-19 lockdown

17th February 2022

Allergic rhinitis symptoms worsened for nearly 40% of patients during the pandemic possibly due to increased exposure to indoor allergens

Allergic rhinitis (AR) symptoms were worse for some patients during the COVID-19 lockdown and this was most likely due to increased exposure to indoor allergens according to a study by researchers from Fundacion Santa Fe de Bogotá, Columbia.

Allergic rhinitis is characterised by one or more symptoms, including sneezing, itching, nasal congestion and rhinorrhoea and affects 15 to 25% of the population. Allergy avoidance is an effective management strategy for those with seasonal allergic rhinitis and hayfever sufferers are usually symptom-free outside the pollen season. In contrast, allergy avoidance for individuals with house dust mite-sensitive AR is more difficult given that the mites are present in the home. In fact, an Italian study has shown that the first COVID-19 lockdown ordered by the Italian government, negatively influenced the clinical history of patients with dust mite allergy. In terms of management, allergen-specific immunotherapy (allergen-SIT) is the only known treatment able to alter the natural course of allergic rhinitis.

But to what extent did the COVID-19 national lockdown and the abrupt cessation of SIT impact on symptom control in patients with AR was the subject of the present study by the Columbian researchers. They performed an observational study between March and May 2020 to assess any changes in AR symptoms in patients with a clinical diagnosis of AR and who were treated with monthly depot SIT injections for at least 6 months. The team used a visual analogue scale (VAS) from 0 (no symptoms) to 10 (severe symptoms) to assess the main AR symptoms including nasal obstruction, pruritus, rhinorrhoea and ocular symptoms. In addition, trained researchers used a sociodemographic questionnaire to collect further information on participants, for instance, age, education level, income, floor material in the household, number of household members etc.

Allergic rhinitis and symptom control

A total of 318 individuals with a mean age of 18.9 years (55.1% female) were included in the analysis. The median number of immunotherapy doses before the lockdown was 11 with a median of 3 doses missed during isolation.

Overall, 38.4% reported that their symptoms worsened during the lockdown period and this was apparent for all AR symptoms. For example, for nasal obstruction, 69.6% stated that their symptoms worsened compared to 30.4% who reported that their symptoms improved or remained the same. A pre-post mean difference in the VAS of 0.5 was found for nasal obstruction (p = 0.01) and pruritus (p < 0.001), a 0.7 difference for rhinorrhoea (p < 0.001) and 0.8 for ocular symptoms (p < 0.001).

Factors associated with a reduction in the final VAS scores were the presence of dogs and cats in the house, atopic dermatitis, lower levels of education and a lower number of immunotherapy doses prior to the lockdown.

The authors concluded that the worsening of AR symptoms during the COVID-19 lockdown was likely to be attributable to a higher exposure to indoor allergens and the interruption of immunotherapy, highlighting the importance of environmental factors in the pathogenesis of the disease.

Citation
Pérez-Herrera LC et al. Impact of the COVID‐19 national lockdown in the allergic rhinitis symptoms in patients treated with immunotherapy at two allergy referral centers in Bogotá, Colombia Laryngoscope Investig. Otolaryngol 2022

Latest REACT-1 data show no decline in COVID-19 prevalence in England

25th January 2021

REACT-1 study is an ongoing COVID-19 prevalence study in England and round 8a suggests there was no evidence of a decline in the prevalence of COVID-19 during the third national lockdown.

The Real-time Assessment of Community Transmission (REACT-1) is a longitudinal study of the community prevalence of COVID-19, led by a team from Imperial College, London. The study regularly reports on the prevalence of COVID-19 collected from a random sample of more than 120,000 people in England, identified from national health service records linked to a patient’s GP. Invited participants, who vary in age from 5 years to over 65, are sent a nasopharyngeal swab kit for home testing and which is then collected and analysed for COVID-19. The study has been collecting data since June 2020 and provides an important snapshot of the prevalence of COVID-19 in the community.

Findings

The REACT-1 (8a) covers the period 6-15 January 2021. Researchers found a total of 1962 positive swabs from 142,909 individuals giving a weighted prevalence of 1.58% (95% CI 1.49-1.68%). Interestingly, they note that this represents the highest prevalence since the study began in May 2020, when the prevalence was 0.16%. Moreover, it is more than 50% higher than round 7 (the previous data collection period), between November to December 2020). However, using a growth model, the team could not find any evidence of either a growth or decay in prevalence and estimated the transmission rate, R to be 1.04. In analysing mobility data from the Facebook app, the team found a decreased activity at the end of December 2020 that began to rise again in January 2021. As a result, they speculated that this increased activity might have caused the rise in cases. Across the country, the prevalence more than doubled in the London area from last round 7 (1.21%-2.47%) and in the East of England (0.59%-1.74%). However, infection rates decreased in Yorkshire and The Humber and remained broadly similar to round 7 in the East Midlands. The age-related prevalence showed an increase among those aged 18 to 24 (0.99%-2.51%) and among those aged 65 years and over (0.41%-0.94%). In discussing their findings, the authors noted that there was no continued decline in prevalence during the third national lockdown but rather a slight initial decline followed by a plateau or possible increase. They also cautioned that if rates do not fall there will be an increase in hospitalisations, which will negatively impact on healthcare delivery.

Citation
REACT-1 round 8 interim report; SARS-CoV-2 prevalence during the initial stages of the third national lockdown in England.