3 minute read
Allergy, Asthma and COVID-19
from PediMag Spring 20
By Sergei Belenky, M.D., Ph.D. : AHN Pediatrics — Pediatric Alliance : Specialty Health Services
As you may have noticed, this spring pollen season has been gaining speed at a very fast clip. In 2-3 weeks we should anticipate the peak of tree pollen season followed in close sequence by the grass pollen season, with overlap around mid-May.
Allergy attacks are very common manifestations of seasonal allergy, with ocular and nasal symptoms being most prominent. “Eyes swelled shut”, deafening rounds of sneezing, unstoppable rhinorrhea, and sore throat — and, yes, decreased sense of smell or complete anosmia (an early sign of COVID-19 infection as well) — are all frequent complaints of seasonal allergies. Dysgeusia (loss of taste), a common early symptom of COVID-19, is not a feature of seasonal allergy.
Clearly, differential diagnosis is always an issue between upper respiratory viral infections and allergic rhinitis, but it is even more ominously important now. History of seasonal allergy or other allergic conditions like asthma, eczema, and food allergy is indicative of seasonal allergic rhinitis, along with lack of fever, profuse sweating, and profound weakness associated with COVID-19 virus. Shortness of breath (dyspnea) is another feature of this scourge, usually as a sign of viral pneumonia or pneumonitis. Of course, dyspnea is part and parcel of allergic asthma, whose seasonal exacerbations are quite commonly seen in spring along with allergic rhinitis flares.
However, such typical asthma features as wheezing and chest tightness are not described in COVID-19. Cough is very common in this viral disease and is frequently violent. It should be attributed to it when other signs and symptoms are present. Diarrhea is observed in almost 1/3 of all COVID-19 patients as a precursor of respiratory illness, and never is a characteristic symptom of allergic rhinitis or asthma. Persistent cough — one of the presentations of asthma and post-nasal drip caused by upper airway allergic inflammation — should be differentiated from cough in COVID-19. An aggressive therapeutic approach to asthma and allergy usually leads to cough resolution in appropriate settings and thus informs diagnostic conclusions.
One of the challenges of this spring pollen season is educational emphasis on the use of inhaled steroids — both oral and intra-nasal — for the management of asthma and allergic rhinitis, respectively.
Inherent steroid-phobia in parents of many of our patients is made worse by the presumed risk of steroid use as a predisposing factor to COVID-19. Again, we are using the same strategy of explaining to our patients the cardinal differences between inhaled and systemic steroids while continuing to use short, 5-10 day courses of prednisone for the treatment of both asthma and allergy attacks when necessary.
As we all know, COVID-19 is not a pediatric infection, at least in its severe variants, and that serves as great reassurance for us and parents alike.
Allergy and seasonal asthma, as well as possible outbreaks of “strange itchy rashes” are on the march, and their early recognition and treatment are paramount to the mitigation of suffering in our patients.
Many of us, including myself, are now doing telemedicine, which I am finding very conducive to achieving good results in the management of allergic conditions. I am wide open, using hockey lingo, for telehealth (video or phone) consultations, so please let us relieve ourselves of the burden of overwhelming allergy season by grappling with it early on.
Stay healthy and stay safe.
