What is the recommended treatment for rhinitis in patients with COVID-19 (Coronavirus Disease 2019)?

Treatment of Rhinitis in COVID-19 Patients

For patients with rhinitis and COVID-19, intranasal corticosteroids remain the standard treatment and can be safely continued during SARS-CoV-2 infection. 1

Understanding Rhinitis in COVID-19 Context

Rhinitis symptoms during COVID-19 can be challenging to differentiate from typical COVID-19 symptoms. However, management approaches differ based on whether the rhinitis is:

• COVID-19 related: Nasal symptoms as part of viral infection
• Pre-existing allergic rhinitis: Coinciding with COVID-19 infection

First-Line Treatment Options

Intranasal Corticosteroids

• Primary recommendation: Continue or initiate intranasal corticosteroids for rhinitis symptoms
• Safety: Evidence supports continued use during COVID-19 infection 1
• Mechanism: Reduces local inflammation without significant systemic effects

Saline Nasal Irrigation/Sprays

• Highly recommended adjunctive therapy for both allergic rhinitis and COVID-19 symptoms
• Benefits:
  • Improves mucociliary clearance
  • Moisturizes respiratory epithelia
  • May reduce viral load and bio-aerosols
  • Promotes ciliary beating (important as SARS-CoV-2 damages ciliated epithelium) 2
  • Most effective when initiated within 48 hours of symptom onset 2

Treatment Algorithm

1. For mild-moderate rhinitis symptoms:

   • Intranasal corticosteroids (standard dose)
   • Saline nasal irrigation/spray (3-4 times daily)

2. For more severe symptoms:

   • Continue intranasal corticosteroids
   • Increase frequency of saline irrigation
   • Consider adding antihistamines if allergic component is suspected

Important Considerations

Medications to AVOID

• Systemic corticosteroids: Should be avoided for treating rhinitis during COVID-19 1
  • Exception: Only use if specifically indicated for COVID-19 treatment in patients requiring oxygen or ventilatory support 3

Special Populations

• Patients with pre-existing allergic rhinitis:
  • Continue regular allergic rhinitis treatment
  • Evidence suggests allergic rhinitis patients may not have increased risk of poor COVID-19 outcomes 4, 5
  • Treating allergic rhinitis adequately is strongly recommended during the pandemic 4

Surgical Interventions

• Surgical treatments for rhinitis/sinusitis should be minimized during COVID-19
• Reserve surgery only for:
  • Patients with local complications
  • Those with no other treatment options 1

Supportive Care

• Maintain adequate hydration
• Use paracetamol for fever if present
• For patients with hypoxemia, follow respiratory support guidelines based on severity 3

Follow-up Recommendations

• Virtual follow-up 1-2 weeks after diagnosis
• Monitor for worsening respiratory symptoms that may require escalation of care

Key Cautions

• Distinguish between allergic rhinitis symptoms and COVID-19 symptoms when possible
• Avoid unnecessary polypharmacy
• Biologics for allergic conditions can be continued with careful monitoring in non-infected patients but should be temporarily interrupted during active COVID-19 infection 1