FAQS: Allergy Of The Nose In The Time Of Covid19

10 questions on Allergic Rhinitis in the time of Covid19
  1. Why is it important to treat allergic rhinitis during Covid19 time?
    • Allergic rhinitis (AR) increases anxiety, depression, sinus infections, headache, snoring and obstructive sleep apnea. It may negatively impact learning and growth longer term. With COVID-19, the anxiety for both the patient and the people around the patient is heightened. AR symptoms may mimic COVID-19 symptoms and cause anxiety and confusion. Reducing the blowing of nose and sneezing help ti reduce transmission of COVID-19. Our amazing sneezes can expel 40,000 moisture droplets at 100 miles/hour that make landfall over 200 feet away!

      Most studies done thus far do not show that AR leads to poorer outcomes in cases of COVID-19 infection. Some studies have even shown that AR and rhinosinusitis are associated with a lower risk of hospitalization. However, in a Korean study, AR was associated with increased COVID-19 test positivity and worse clinical outcomes. More research is needed.
  1. What are the symptoms of allergic rhinitis?
    • Although allergic rhinitis is also known as hay fever, there is no fever! The hallmark symptoms of allergic rhinitis include sneezing and itching, but not all who have allergic rhinitis sneeze nor itch. Pink eye is more common in allergic rhinitis than COVID-19. There are either a nose block and runny nose.
  1. Why are my allergic rhinitis symptoms worse in the nights and mornings especially during this Covid19 pandemic?
    • Singapore has no seasons, and perennial allergic rhinitis manifest all year round due to air-borne allergens like the ubiquitous house dust mite. Patients have nose block or runny nose, with or without itch, worse in the morning and night as soft furnishings like bed, carpet, sofa, curtains; and dusty, crowded shelves are favourite hide outs for house dust mites. With a lot more time spent indoors and cleaning our homes, those with dust mite, pet dander and cockroach allergies may suffer more from allergic rhinitis.
  1. What can I do to reduce use of steroid nasal spray and allergy medications for my allergic rhinitis in the longer term?
    • To reduce use of the nasal medications, it is important to identify the offending allergen so that the allergen can be avoided as much as possible. Our clinic performs skin prick tests (SPT) in-clinic for both children and adults. The results are known in 20 minutes. The “Prick” in SPT makes it sound painful, but it feels less than an ant bite. Do call ahead for the SPT, as we will need to advise on foods, vitamins and drugs that should be avoided before the test. The skin prick test can determine both inhalant allergens like dust mite, pet dander, cockroach, grass and tree pollen and mould. It can determine select food allergens if interpreted carefully. A blood test is done if more unusual allergies are suspected or if the SPT cannot be done. For certain patients with significant and certain types of allergies, immunotherapy can also help to reduce the use of nasal sprays and medications.
  1. How do I know the nose symptoms are that of Covid19 and not allergic rhinitis?
    • If you have fever, headache, body ache, sore-throat, cough or diarrhoea in addition to the nose symptoms, the main suspect during this time is Covid19 till proven otherwise. The hallmark nose symptoms at the start of the Covid19 pandemic included a sudden and significant loss of smell (anosmia) despite there being no nasal block in many cases. Some patients also lose their sense of taste. A loss of the sense of smell and taste have been found to be symptoms with higher odds ratios of 6 and 2.4 for COVID-19 positivity. However, with different variants of Covid19, anosmia may not be seen as frequently.
  1. How do I confirm a Covid19 diagnosis?
    • Follow government guidelines and keep current as they need to evolve to best mitigate the situation at any given time. If in doubt, check with your family doctor. During the pandemic, telemedicine consultations are also helpful if it is simply a case of allergic rhinitis. At home, the Antigen Rapid Test is easy to do, and currently used to detect Covid19 infection. ARTs may miss Covid19 infection and show false negative results. The accuracy is dependent on the quality of the test kit, quality and site of the swabbing, which day and severity of illness when performed; and possibly different for different Covid19 variants. The Polymerase Chain Reaction (PCR) swab remains the gold standard test. There are dedicated clinics and support sites listed on the government website resourced to administer these tests if needed.
  1. I have severe house dust mite allergy, can I take the Covid19 vaccine?
    • In general, COVID19 vaccines help to reduce the risk of severe disease and death, reduce the duration of infectivity, reduce symptoms and reduce viral loads during infection. Most of the time, AR is not a contraindication for the COVID-19 vaccine, except for those with severe allergic reactions to an ingredient in COVID19 or other vaccines. If in doubt, check with your doctor. Those who need to carry an Epipen for severe allergic reactions should also check with their doctors before taking the COVID19 vaccines. The treatment of COVID-19 is supportive, with ongoing efforts to create drugs that lessen the severity. The usual AR medications, antibiotics and antivirals are not treatment for COVID-19 .
  1. I am on sublingual immunotherapy for allergic rhinitis dust mite and dog allergens. Can I take the Covid19 vaccine?
    • In general, COVID19 vaccines help to reduce the risk of severe disease and death, reduce the duration of infectivity, reduce symptoms and reduce viral loads during infection. The Ministry of Health does not consider allergic rhinitis a contraindication for the COVID19 vaccine, except for those with severe allergic reactions to an ingredient in COVID19 or other vaccines. If in doubt, check with your doctor. Those who need to carry an Epipen for severe allergic reactions should also check with their doctors before taking the COVID-19 vaccines. Being on sublingual immunotherapy for allergic rhinitis does not mean that a patient is immunocompromise. Allergic rhinitis happens when the body over-reacts to a certain allergen. Sublingual immunotherapy is not cancer chemotherapy nor cancer immunotherapy.

      Patients using injectable immunotherapy for AR should check with their doctors with regards to when to stop using their immunotherapy before and after the Covid vaccine. For oral and sublingual immunotherapy for AR, most doctors will recommend to stop one day before the Covid vaccination, and between 2 to 7 days after the vaccination. When in doubt, check with your doctor.