Regio: allergy, allergic asthma and corona: symptoms can also be classified by laypersons ++ Review of the reader’s phone of May 20

For pollen allergy sufferers and people with allergic asthma, respiratory problems are part of their illness. However, the corona pandemic causes great uncertainty when symptoms such as cough, hoarseness, runny nose or shortness of breath occur. Immediately the thought is in the room, it could possibly be signs of a corona infection. But can complaints be classified safely? Is there an increased risk of infection or a severe course of the disease? And what should people with a pollen allergy or allergic asthma pay special attention to now? Experts provided the answers on the reader phone of the German Allergy and Asthma Association (DAAB). Here are the most important tips for reading.

Can I see for myself whether my symptoms are caused by the allergy or by a corona infection?

Prof. Dr. med. Ludger Klimek: Apparently it is difficult even for “experienced” inhalation allergy sufferers to distinguish known symptoms such as dry cough, shortness of breath, sneezing and runny nose from those of a COVID-19 infection. Different inflammatory respiratory diseases such as allergies and viral infections can cause similar symptoms, but there are quite reliable distinguishing features that can be assessed by those affected themselves: While infections with the SARS CoV-2 virus are usually characterized by fever and dry cough, allergy sufferers do not have a fever, but often itchy eyes and nasal mucous membranes, watery eyes, sneezing and runny nose. We have summarized the differences and similarities between respiratory allergies and various viral diseases in an overview ( Infographic symptoms).

Do I have an increased risk of a severe course of COVID-19 infection with allergic asthma?

Prof. Dr. med. Ludger Klimek: So far, it can be said that patients with chronic respiratory diseases are considered risk patients for COVID-19. With asthma, however, we are increasingly realizing that well-treated and well-controlled asthma does not pose an increased risk. This is due to the fact that the Sars-CoV-2 coronavirus attacks human cells by using a receptor that is involved, among other things, in regulating blood pressure, the angiotensin converting enzyme 2 (ACE2). Through this portal of entry into the cells, Sars-CoV-2 infiltrates its genetic material and uses the cell metabolism to produce viruses. According to the results of two studies, well-treated asthma patients have fewer of these ACE2 receptors – and therefore fewer targets for Sars-CoV-2.

Do the medications I take for my allergy and asthma affect my immune system?

Prof. Dr. med. Ludger Klimek: This definitely does not apply to common nasal and asthma sprays. On the contrary: they seem to have a certain protective function, although – or precisely because – they contain cortisone. The situation could be different with cortisone in tablet or syringe form. This could have an immunosuppressive effect if taken for a long time. But here too, a single cortisone tablet does not significantly affect the immune system.

How can I tell if my asthma is well adjusted?

Anja Schwalfenberg: By taking a self-critical look at how well your symptoms are under control: in the past four weeks, adult patients should not have had respiratory problems such as coughing, wheezing or chest tightness more than twice a day during the past four weeks. You should also not be awakened by asthma at night. The spray needed to expand the bronchi in case of shortness of breath should not be used too often and the activity of the patients should not be restricted by the asthma. If even one of these points does not apply, a medical consultation is recommended to clarify whether the treatment can be optimized.

Is there some kind of self-control for my asthma?

Anja Schwalfenberg: Controlling your symptoms yourself is what we call self-management – an essential part of asthma therapy. This includes regular measurement of the airflow rate in liters of air per minute using a so-called peak flow meter. With a regular measurement, deteriorations can be detected early using a traffic light system. First, the “green phase” is determined over a few weeks, i.e. the range from 80 to 100 percent of the personal best. This then results in the yellow and red phases in which, for example, the medication is adjusted accordingly or other measures have to be taken.

Do special protective measures apply to asthmatic children, as they may be at greater risk of contracting infection?

Prof. Dr. med. Eckard Hamelmann: The risk of infection is the same for all children and adolescents regardless of asthma. This does not apply to patients who have an immunodeficiency. The risk of a more severe course of CoVid-19 disease is higher in patients who have poorly controlled, uncontrolled asthma or suffer from congenital lung disease such as cystic fibrosis. It is therefore imperative to ensure that continued anti-inflammatory therapy or the cessation of biologics in severe asthma; Allergy-specific immunotherapy should also be continued to keep the symptoms as low as possible. Good symptom control is the best protection against a complicated course after a corona infection.

My daughter, twelve years old, has allergic asthma. Should she currently go to class when the school opens again?

Prof. Dr. med. Eckard Hamelmann: Children and adolescents suffer significantly less from corona infections than adults, especially the elderly. Many children and adolescents have gone through an infection without noticing it or have developed only minor symptoms in the sense of a small cold. Congenital or severe acquired lung diseases are considered risk factors for a severe course. With a well-adjusted bronchial asthma with correspondingly good symptom control, normal school attendance and the other normal activities in daily life are to be regarded as unproblematic.

My eight-year-old son has had a grass pollen allergy for three years. I would like to start hyposensitization with him. When would be the right time?

Prof. Dr. med. Eckard Hamelmann: If the grass pollen allergy has lasted for such a long time, specific immunotherapy is certainly indicated, not least to prevent the development of bronchial asthma. Sublingual immunotherapy, for example with tablets, can always be started at any time. The subcutaneous immunotherapy, in which injections are administered, is different: it should only start after the current grass season in order to keep pollen exposure and the associated complaints as low as possible.

Can I currently carry out an allergy test or does this put too much strain on my immune system?

Prof. Dr. med. Randolf Brehler: In principle, an allergy test can also be carried out now. The amounts of allergens are so small that a strain on the immune system is not expected. However, it is recommended to currently only carry out tests that are really necessary for medical reasons. This applies, for example, to food allergies, drug intolerance and insect bite reactions. Tests may also be indicated in patients with asthma and rhinoconjunctivitis if the current question is whether special allergens need to be avoided. Tests that are not absolutely necessary should be postponed due to the pandemic.

Do I, as a neurodermatitis sufferer, have a higher risk of becoming infected with Sars-Cov-2?

Prof. Dr. med. Randolf Brehler: Basically, people with eczema do not have a higher risk of coming into contact with the virus and becoming infected if the recommended hygiene measures are followed. As far as the course of infection is concerned, obesity, diabetes and high blood pressure as well as lung diseases, especially COPD, are risk factors for a severe course of the disease. Diseases and drugs that suppress the immune system are important for viral diseases because the immune system is less able to ward off viruses. Patients with eczema are recommended to continue all therapies unchanged. If a neurodermatitis sufferer gets Covid-19 under system therapy, an interdisciplinary decision must be made as to how the therapy will be continued.

Can a pollen allergy also trigger hives or make the symptoms worse?

Prof. Dr. med. Randolf Brehler: Hives, in the technical term urticaria, is rarely due to so-called immediate type allergies. However, some patients report urticaria during the pollen season. Skin contact with higher amounts of allergens in the air may also lead to the formation of a wheal. However, other causes such as food intolerance, chronic infections and occasionally other underlying diseases are much more common. Most of the time, however, the cause of chronic spontaneous urticaria is not found, but it must be treated adequately.

If I have a pollen allergy, what else can I do besides medication to alleviate my symptoms?

Anja Schwalfenberg: The less pollen contact, the less allergic symptoms – but it is difficult to avoid pollen in everyday life. Additional measures such as washing your hair in the evening or daily use of a so-called nasal douche can reduce the pollen load. When using a nasal douche with isotonic saline, the nasal mucosa is additionally moistened and nasal mucus is loosened.

Statement Andrea Wallrafen, Managing Director DAAB e.V.

The DAAB as a contact point for people with allergies and asthma – also and especially in corona times

“People with allergies and asthma are identified as a risk group for Corona. But is that true and what do those affected need to know now? This is where the work of the DAAB comes in: We research all important aspects – with medical experts, at the Robert Koch Institute and with our international partner associations. We offer information in online seminars – so-called webinars – as well as in expert videos and our Corona blog. On June 21, the DAAB is also organizing an online allergy day. The lectures will later be available for DAAB members in the closed member area. We maintain our advisory services as usual during the Corona pandemic. The DAAB works neutral and non-partisan and depends on donations and membership fees to survive this time with you. “
Andrea Wallrafen, Managing Director of the German Allergy and Asthma Association (DAAB)

– Further information at www.daab.de.

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About the DAAB

The German Allergy and Asthma Association (DAAB) – founded in 1897 – is the oldest and largest patient and consumer protection association for children and adults with allergies, asthma, COPD, urticaria and neurodermatitis. His engagement includes individual advice and an independent, unbureaucratic commitment to the interests of members and those seeking advice.
The DAAB provides extensive information and tips on many allergy, respiratory and skin issues as well as nutrition.

– More information at www.daab.de.

The experts on the reader’s phone were *:

Prof. Dr. med. Randolf Brehler; Specialist in dermatology, allergology, phlebology and environmental medicine, senior physician at the Clinic for Skin Diseases, Allergology, Occupational Dermatology and Environmental Medicine, University Hospital Münster
Prof. Dr. med. Eckard Hamelmann; Specialist for pediatric and adolescent medicine, pediatric pneumology, allergology and infectiology, chief physician clinic for pediatric and adolescent medicine Evangelisches Klinikum Bethel, Vice President of the German Society for Allergology and Clinical Immunology (DGAKI), President of the German Asthma Net (GAN) e.V., Bielefeld
Prof. Dr. med. Ludger Klimek; Specialist in Otolaryngology, Allergology, Environmental Medicine, Natural Medicine, Head of the Center for Rhinology and Allergology in Wiesbaden, President of the Medical Association of German Allergists, Wiesbaden
Dipl.-Biologist Anja Schwalfenberg; Scientific assistant in the DAAB advisory team on asthma, German Allergy and Asthma Association, Mönchengladbach

*in alphabetic order

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