What is the management and treatment for a patient experiencing taste aversion?

Management and Treatment for Taste Aversion

For patients experiencing taste aversion, switching to a different formulation of the same medication class is recommended as the first-line approach when taste aversion is medication-related, particularly with intranasal antihistamines. 1

Identifying the Cause of Taste Aversion

• Taste aversion can be medication-induced, particularly with intranasal antihistamines which commonly cause bitter taste as a side effect 1
• Other potential causes include viral infections (including COVID-19), neurological disorders, nutritional deficiencies, and systemic conditions like diabetes mellitus 2
• Determine if taste aversion is related to specific medications by reviewing medication history and temporal relationship between medication initiation and taste changes 3
• Assess if taste aversion is associated with recent viral illness, as many viral infections including COVID-19 can cause taste disturbances 1

Management Algorithm for Taste Aversion

For Medication-Induced Taste Aversion:

1. For intranasal antihistamines:

   • Try a different formulation of intranasal antihistamine if symptomatic benefit was achieved despite taste aversion 1
   • Consider switching between available options such as olopatadine, azelastine 0.1%, or azelastine 0.15% which have different taste profiles 1

2. For other medications:

   • Consider tapering and discontinuing the suspected medication if clinically appropriate 3
   • Consult with prescribing physician about alternative medications with lower risk of taste disturbance 2

For Post-Viral Taste Aversion:

1. Implement olfactory training:

   • Begin immediately and continue for at least 3-6 months 4
   • Protocol: Sniff and focus on four different strong-smelling substances (typically essential oils like rose, eucalyptus, lemon, and clove) for 20 seconds each, twice daily 4

2. Dietary modifications:

   • Refer to a registered dietitian for dietary counseling 5
   • Use flavor enhancers to promote food intake 5
   • Experiment with additional seasonings and avoid unpleasant foods 5

For Idiopathic Taste Aversion:

• Consider zinc supplementation for idiopathic dysgeusia 6
• Objective taste testing using standardized methods may help quantify the severity 5

Follow-up Recommendations

• Re-evaluate patients at 1 month, 3 months, and 6 months after initiating treatment 4
• If no improvement after 3-6 months of treatment, consider referral to an otolaryngologist or specialized smell and taste clinic 4, 5
• For medication-induced taste aversion, reassess taste perception after medication change or discontinuation 3

Safety Considerations

• Install gas alarms and smoke detectors in the home for patients with persistent taste/smell disorders 4
• Be vigilant about food expiration dates to prevent consumption of spoiled food 4
• Direct patients to support resources such as smell and taste disorder organizations 4

Common Pitfalls to Avoid

• Overlooking medication side effects as a cause of taste aversion 3
• Failing to recognize that taste aversion can lead to malnutrition, decreased quality of life, and loss of muscle mass, particularly in elderly patients 2, 7
• Ordering unnecessary neuroimaging when there is a clear temporal relationship to medication use or viral infection 4
• Underestimating the impact of taste disorders on quality of life and nutritional status 7