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Determinants of persistence and recovery of chronic coronavirus disease 2019 chemosensory dysfunction - 03/01/25

Doi : 10.1016/j.jaci.2024.08.027 
Dante G. Minichetti, BA a, Amelia Boyd, BA a, Evan Lemire, MS b, Jonathan Hacker, BA a, Adam L. Haber, PhD b, Rachel E. Roditi, MD c, Mark W. Albers, MD, PhD d, Stella Lee, MD c, Kathleen M. Buchheit, MD a, Tanya M. Laidlaw, MD a, Lora G. Bankova, MD a,
a Division of Allergy and Clinical Immunology, Jeff and Penny Vinik Center for Allergic Disease Research, Brigham and Women’s Hospital and Department of Medicine, Harvard Medical School, Boston, Mass 
b Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Mass 
c Division of Otolaryngology–Head and Neck Surgery, Brigham and Women’s Hospital, Boston, Mass 
d Department of Neurology, Massachusetts General Hospital, Boston, Mass 

Corresponding author: Lora G. Bankova, MD, Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Hale Building for Transformative Medicine, 60 Fenwood Rd, Rm 5002W, Boston, MA 02115.Division of Allergy and Clinical ImmunologyDepartment of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolHale Building for Transformative Medicine60 Fenwood RdRm 5002WBostonMA02115

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Graphical abstract




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Abstract

Background

In 2% to 4% of patients, coronavirus disease 2019 (COVID-19) chemosensory dysfunction (CSD) persists beyond 6 months, accounting for up to 4 million people in the United States. The predictors of persistence and recovery require further exploration.

Objective

We sought to define the predictors of recovery and assess the quality of CSD in registry subjects with self-reported persistent smell and taste dysfunction after COVID-19.

Methods

COVID-19 CSD participants (n = 408) from the 4 major waves of the pandemic completed questionnaires at 4 time points between 2021 and 2023, assessing demographics, sinonasal symptoms, and self-assessed recovery. Objective measurements of smell (UPSIT) and taste (BWETT) were performed on a subcohort (n = 108).

Results

In this chronic CSD cohort, the average symptom duration was 24 ± 5 months, with 70% of those who contracted COVID-19 in 2020 report ongoing dysfunction. Phantosmia and dysgeusia were most prevalent in the early waves of COVID-19, while most participants reported disrupted ability to distinguish scents and flavors as well as undulating chemosensory function. Subjects reported low incidence of subjective sinonasal symptoms but high prevalence of sleep and mood disturbance. Cigarette smoke phantosmia was predictive of persistence of CSD. Conversely, self-reported environmental allergies and hypertension were predictive of recovery, and dust mite allergies specifically were negative predictors of cigarette smoke phantosmia. Finally, no treatment resolved CSD, but nasal steroids were reported to be effective by recovered CSD subjects. Objective measures of both smell and taste were significantly reduced in patients with chronic CSD compared to controls.

Conclusions

Chronic COVID-19 CSD is a syndrome resistant to standard anti-inflammatory therapy. Preexisting environmental allergies and hypertension predict recovery, while cigarette smoke phantosmia predicts persistence.

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Key words : Chemosensory dysfunction, smell disruption, taste disruption, COVID-19

Abbreviations used : BWETT, COVID-19, CRS, CSD, IQR, SD, SNOT-22, UPSIT


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 The first 2 authors contributed equally to this article, and both should be considered first author.


© 2024  The Authors. Publicado por Elsevier Masson SAS. Todos los derechos reservados.
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Vol 155 - N° 1

P. 120-134 - janvier 2025 Regresar al número
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