Asthma as a risk factor and allergic rhinitis as a protective factor for COVID-19 severity: a case-control study

• Published in: European archives of oto-rhino-laryngology 2024-12, Vol.281 (12), p.6677-6686
• Main Authors: Lira Tenório, Martha Débora, dos Santos Menezes Siqueira, Gabriel Valentim, Costa Caldas, Gustavo, Pacheco de Almeida, Roque, Ribeiro de Jesus, Amélia, Martins-Filho, Paulo Ricardo
• Format: Article
• Language: English
• Subjects: Adult; Aged; Asthma - epidemiology; Case-Control Studies; COVID-19 - complications; COVID-19 - epidemiology; Female; Head and Neck Surgery; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Miscellaneous; Neurosurgery; Otorhinolaryngology; Protective Factors; Rhinitis, Allergic - complications; Rhinitis, Allergic - epidemiology; Risk Factors; SARS-CoV-2; Severity of Illness Index
• ISSN: 0937-4477; 1434-4726; 1434-4726
• DOI: 10.1007/s00405-024-08893-6

Purpose The COVID-19 pandemic has resulted in significant global morbidity and mortality. The disease presents a broad clinical spectrum, significantly influenced by underlying comorbidities. While certain conditions are known to exacerbate COVID-19 outcomes, the role of chronic inflammatory airway diseases such as asthma and rhinitis in influencing disease severity remains controversial. This study investigates the association between asthma and allergic rhinitis and the severity of COVID-19 outcomes in a specific geographical region prior to widespread vaccine deployment. Methods We conducted a case-control study with unvaccinated adult patients who had laboratory-confirmed COVID-19 by polymerase chain reaction (PCR). Cases were defined as severe or critical COVID-19 patients requiring intensive care unit (ICU) admission, and controls were non-severe patients without signs of viral pneumonia or hypoxia. We utilized the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire to assess the presence of asthma and allergic rhinitis. The association between these chronic inflammatory airway diseases and the severity of COVID-19 was evaluated using multivariate logistic regression analysis. Results A total of 122 patients were analyzed, with 61 in each group. The presence of asthma (9 patients) was associated with an increased likelihood of severe COVID-19 (OR = 13.0; 95% CI 1.27-133.74), while rhinitis (39 patients) was associated with a protective effect against severe outcomes (OR = 0.36; 95% CI 0.13–0.99). No significant association was found between the frequency of asthmatic episodes or the severity of rhinitis and the severity of COVID-19 outcomes. Conclusion This study underscores the divergent effects of chronic inflammatory airway diseases on COVID-19 severity, with asthma associated with a higher likelihood of severe outcomes and rhinitis potentially offering protective effects. These findings enhance our understanding of the complex interactions between respiratory allergies and COVID-19, emphasizing the importance of targeted clinical management and public health strategies. Key message • Asthma increases the likelihood of severe COVID-19 outcomes. • Allergic rhinitis may provide protection against severe COVID-19. • Comorbidities strongly influence COVID-19 severity.