Systemic corticosteroids in coronavirus disease 2019 (COVID-19)-related smell dysfunction: an international view

Caroline Huart; Carl M Philpott; Aytug Altundag; Alexander W Fjaeldstad; Johannes Frasnelli; Simon Gane; Julien W Hsieh; Eric H Holbrook; Iordanis Konstantinidis; Basile N Landis; Alberto Macchi; Christian A Mueller; Simona Negoias; Jayant M Pinto; Sophia C Poletti; Vijay R Ramakrishnan; Philippe Rombaux; Jan Vodicka; Antje Welge-Lüessen; Katherine L Whitcroft; Thomas Hummel

doi:10.1002/alr.22788

Systemic corticosteroids in coronavirus disease 2019 (COVID-19)-related smell dysfunction: an international view

Int Forum Allergy Rhinol. 2021 Jul;11(7):1041-1046. doi: 10.1002/alr.22788. Epub 2021 Mar 16.

Authors

Caroline Huart^{1

2}, Carl M Philpott^{3

4}, Aytug Altundag⁵, Alexander W Fjaeldstad^{6

7}, Johannes Frasnelli⁸, Simon Gane^{9

10}, Julien W Hsieh¹¹, Eric H Holbrook¹², Iordanis Konstantinidis¹³, Basile N Landis¹¹, Alberto Macchi¹⁴, Christian A Mueller¹⁵, Simona Negoias¹⁶, Jayant M Pinto¹⁷, Sophia C Poletti¹⁸, Vijay R Ramakrishnan¹⁹, Philippe Rombaux^{1

2}, Jan Vodicka²⁰, Antje Welge-Lüessen¹⁶, Katherine L Whitcroft^{10

21}, Thomas Hummel²²

Affiliations

¹ Department of Otorhinolaryngology, Cliniques universitaires Saint-Luc, Brussels, Belgium.
² Institute of Neuroscience, Univeristé catholique de Louvain, Brussels, Belgium.
³ The Norfolk Smell and Taste Clinic, Norfolk and Waveney ENT Service, Gorleston, UK.
⁴ Norwich Medical School, University of East Anglia, Norwich, UK.
⁵ Department of Otorhinolaryngology, Biruni University, Istanbul, Turkey.
⁶ Flavour Clinic, Department of Otorhinolaryngology, Regional Hospital West Jutland, Holstebro, Denmark.
⁷ Flavour Institute, Aarhus University, Aarhus, Denmark.
⁸ Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada.
⁹ Department of Rhinology, Royal National ENT Hospital, University College London Hospitals NHS Foundation Trust, London, UK.
¹⁰ UCL Ear Institute, University College London, London, UK.
¹¹ Department of Otorhinolaryngology-Head and Neck Surgery, Rhinology-Olfactory Unit, Geneva University Hospitals, Geneva, Switzerland.
¹² Massachusetts Eye and Ear, Harvard University, Boston, Massachusetts.
¹³ 2nd Academic ORL Department, Papageorgiou Hospital, Aristotle University, Thessaloniki, Greece.
¹⁴ ENT clinic Asst-Settelaghi-University of Insubriae, Varese, Italy.
¹⁵ Department of Otorhinolaryngology, Medical University of Vienna, Vienna, Austria.
¹⁶ Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Basel, CH-4051, Basel, Switzerland.
¹⁷ Section of Otolaryngology-Head and Neck Surgery, The University of Chicago, Chicago, Illinois.
¹⁸ Department of Otorhinolaryngology, Inselspital University Hospital Bern, Bern, Switzerland.
¹⁹ Department of Otolaryngology-Head and Neck Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
²⁰ Department of Otorhinolaryngology and Head and Neck Surgery, Hospital of Pardubice, Pardubice, Czech Republic.
²¹ The Centre for Olfactory Research and Applications, Institute of Philosophy, School of Advanced Study, London, UK.
²² Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany.

Abstract

The frequent association between coronavirus disease 2019 (COVID-19) and olfactory dysfunction is creating an unprecedented demand for a treatment of the olfactory loss. Systemic corticosteroids have been considered as a therapeutic option. However, based on current literature, we call for caution using these treatments in early COVID-19-related olfactory dysfunction because: (1) evidence supporting their usefulness is weak; (2) the rate of spontaneous recovery of COVID-19-related olfactory dysfunction is high; and (3) corticosteroids have well-known potential adverse effects. We encourage randomized placebo-controlled trials investigating the efficacy of systemic steroids in this indication and strongly emphasize to initially consider smell training, which is supported by a robust evidence base and has no known side effects.

Keywords: COVID-19; SARS-CoV-2; corticosteroids; olfaction disorder; smell.

MeSH terms

Adrenal Cortex Hormones / pharmacology*
COVID-19* / complications
COVID-19* / physiopathology
Drug-Related Side Effects and Adverse Reactions / diagnosis
Drug-Related Side Effects and Adverse Reactions / etiology
Drug-Related Side Effects and Adverse Reactions / prevention & control
Global Health
Humans
Medication Therapy Management / standards
Medication Therapy Management / statistics & numerical data*
Needs Assessment
Olfaction Disorders* / drug therapy
Olfaction Disorders* / epidemiology
Olfaction Disorders* / etiology
Olfactory Mucosa / drug effects
Olfactory Mucosa / virology
Remission, Spontaneous
Research Design
SARS-CoV-2 / pathogenicity

Substances

Adrenal Cortex Hormones