Determinants of persistence and recovery of chronic coronavirus disease 2019 chemosensory dysfunction

Dante G Minichetti; Amelia Boyd; Evan Lemire; Jonathan Hacker; Adam L Haber; Rachel E Roditi; Mark W Albers; Stella Lee; Kathleen M Buchheit; Tanya M Laidlaw; Lora G Bankova

doi:10.1016/j.jaci.2024.08.027

Determinants of persistence and recovery of chronic coronavirus disease 2019 chemosensory dysfunction

J Allergy Clin Immunol. 2024 Sep 11:S0091-6749(24)00913-8. doi: 10.1016/j.jaci.2024.08.027. Online ahead of print.

Authors

Affiliations

¹ 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.
² Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Mass.
³ Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital, Boston, Mass.
⁴ Department of Neurology, Massachusetts General Hospital, Boston, Mass.
⁵ 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. Electronic address: lbankova@bwh.harvard.edu.

PMID: 39270802
DOI: 10.1016/j.jaci.2024.08.027

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.

Keywords: COVID-19; Chemosensory dysfunction; smell disruption; taste disruption.