Differentiation of COVID-19 signs and symptoms from allergic rhinitis and common cold: An ARIA-EAACI-GA2LEN consensus

Jan Hagemann; Gabrielle L. Onorato; Marek Jutel; Cezmi A. Akdis; Ioana Agache; Torsten Zuberbier; Wienczyslawa Czarlewski; Joaquim Mullol; Anna Bedbrook; Claus Bachert; Kazi S. Bennoor; Karl Christian Bergmann; Fulvio Braido; Paulo Camargos; Luis Caraballo; Victoria Cardona; Thomas Casale; Lorenzo Cecchi; Tomas Chivato; Derek K. Chu; Cemal Cingi; Jaime Correia-de-Sousa; Stefano del Giacco; Dejan Dokic; Mark Dykewicz; Motohiro Ebisawa; Yehia El-Gamal✝; Regina Emuzyte; Jean Luc Fauquert; Alessandro Fiocchi; Wytske J. Fokkens; Joao A. Fonseca; Bilun Gemicioglu; René Maximiliano Gomez; Maia Gotua; Tari Haahtela; Eckard Hamelmann; Tomohisa Iinuma; Juan Carlos Ivancevich; Ewa Jassem; Omer Kalayci; Przemyslaw Kardas; Musa Khaitov; Piotr Kuna; Violeta Kvedariene; Desiree E. Larenas-Linnemann; Brian Lipworth; Michael Makris; Francesca Puggioni; Antonino Romano

doi:10.1111/all.14815

Differentiation of COVID-19 signs and symptoms from allergic rhinitis and common cold: An ARIA-EAACI-GA²LEN consensus

Jan Hagemann, Gabrielle L. Onorato, Marek Jutel, Cezmi A. Akdis, Ioana Agache, Torsten Zuberbier, Wienczyslawa Czarlewski, Joaquim Mullol, Anna Bedbrook, Claus Bachert, Kazi S. Bennoor, Karl Christian Bergmann, Fulvio Braido, Paulo Camargos, Luis Caraballo, Victoria Cardona, Thomas Casale, Lorenzo Cecchi, Tomas Chivato, Derek K. ChuCemal Cingi, Jaime Correia-de-Sousa, Stefano del Giacco, Dejan Dokic, Mark Dykewicz, Motohiro Ebisawa, Yehia El-Gamal✝, Regina Emuzyte, Jean Luc Fauquert, Alessandro Fiocchi, Wytske J. Fokkens, Joao A. Fonseca, Bilun Gemicioglu, René Maximiliano Gomez, Maia Gotua, Tari Haahtela, Eckard Hamelmann, Tomohisa Iinuma, Juan Carlos Ivancevich, Ewa Jassem, Omer Kalayci, Przemyslaw Kardas, Musa Khaitov, Piotr Kuna, Violeta Kvedariene, Desiree E. Larenas-Linnemann, Brian Lipworth, Michael Makris, Francesca Puggioni, Antonino Romano

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Although there are many asymptomatic patients, one of the problems of COVID-19 is early recognition of the disease. COVID-19 symptoms are polymorphic and may include upper respiratory symptoms. However, COVID-19 symptoms may be mistaken with the common cold or allergic rhinitis. An ARIA-EAACI study group attempted to differentiate upper respiratory symptoms between the three diseases. Methods: A modified Delphi process was used. The ARIA members who were seeing COVID-19 patients were asked to fill in a questionnaire on the upper airway symptoms of COVID-19, common cold and allergic rhinitis. Results: Among the 192 ARIA members who were invited to respond to the questionnaire, 89 responded and 87 questionnaires were analysed. The consensus was then reported. A two-way ANOVA revealed significant differences in the symptom intensity between the three diseases (p <.001). Conclusions: This modified Delphi approach enabled the differentiation of upper respiratory symptoms between COVID-19, the common cold and allergic rhinitis. An electronic algorithm will be devised using the questionnaire.

Original language	English
Journal	Allergy: European Journal of Allergy and Clinical Immunology
DOIs	https://doi.org/10.1111/all.14815
Publication status	Accepted/In press - 2021

Keywords

allergic rhinitis
common cold
cough
COVID-19
smell

ASJC Scopus subject areas

Immunology and Allergy
Immunology

Access to Document

10.1111/all.14815

Cite this

Hagemann, J., Onorato, G. L., Jutel, M., Akdis, C. A., Agache, I., Zuberbier, T., Czarlewski, W., Mullol, J., Bedbrook, A., Bachert, C., Bennoor, K. S., Bergmann, K. C., Braido, F., Camargos, P., Caraballo, L., Cardona, V., Casale, T., Cecchi, L., Chivato, T., ... Romano, A. (Accepted/In press). Differentiation of COVID-19 signs and symptoms from allergic rhinitis and common cold: An ARIA-EAACI-GA²LEN consensus. Allergy: European Journal of Allergy and Clinical Immunology. https://doi.org/10.1111/all.14815

Hagemann, J, Onorato, GL, Jutel, M, Akdis, CA, Agache, I, Zuberbier, T, Czarlewski, W, Mullol, J, Bedbrook, A, Bachert, C, Bennoor, KS, Bergmann, KC, Braido, F, Camargos, P, Caraballo, L, Cardona, V, Casale, T, Cecchi, L, Chivato, T, Chu, DK, Cingi, C, Correia-de-Sousa, J, del Giacco, S, Dokic, D, Dykewicz, M, Ebisawa, M, El-Gamal✝, Y, Emuzyte, R, Fauquert, JL, Fiocchi, A, Fokkens, WJ, Fonseca, JA, Gemicioglu, B, Gomez, RM, Gotua, M, Haahtela, T, Hamelmann, E, Iinuma, T, Ivancevich, JC, Jassem, E, Kalayci, O, Kardas, P, Khaitov, M, Kuna, P, Kvedariene, V, Larenas-Linnemann, DE, Lipworth, B, Makris, M, Puggioni, F & Romano, A 2021, 'Differentiation of COVID-19 signs and symptoms from allergic rhinitis and common cold: An ARIA-EAACI-GA²LEN consensus', Allergy: European Journal of Allergy and Clinical Immunology. https://doi.org/10.1111/all.14815

@article{fdb106f74e164f06b76f85b61dc89d21,

title = "Differentiation of COVID-19 signs and symptoms from allergic rhinitis and common cold: An ARIA-EAACI-GA2LEN consensus",

abstract = "Background: Although there are many asymptomatic patients, one of the problems of COVID-19 is early recognition of the disease. COVID-19 symptoms are polymorphic and may include upper respiratory symptoms. However, COVID-19 symptoms may be mistaken with the common cold or allergic rhinitis. An ARIA-EAACI study group attempted to differentiate upper respiratory symptoms between the three diseases. Methods: A modified Delphi process was used. The ARIA members who were seeing COVID-19 patients were asked to fill in a questionnaire on the upper airway symptoms of COVID-19, common cold and allergic rhinitis. Results: Among the 192 ARIA members who were invited to respond to the questionnaire, 89 responded and 87 questionnaires were analysed. The consensus was then reported. A two-way ANOVA revealed significant differences in the symptom intensity between the three diseases (p <.001). Conclusions: This modified Delphi approach enabled the differentiation of upper respiratory symptoms between COVID-19, the common cold and allergic rhinitis. An electronic algorithm will be devised using the questionnaire.",

keywords = "allergic rhinitis, common cold, cough, COVID-19, smell",

author = "Jan Hagemann and Onorato, {Gabrielle L.} and Marek Jutel and Akdis, {Cezmi A.} and Ioana Agache and Torsten Zuberbier and Wienczyslawa Czarlewski and Joaquim Mullol and Anna Bedbrook and Claus Bachert and Bennoor, {Kazi S.} and Bergmann, {Karl Christian} and Fulvio Braido and Paulo Camargos and Luis Caraballo and Victoria Cardona and Thomas Casale and Lorenzo Cecchi and Tomas Chivato and Chu, {Derek K.} and Cemal Cingi and Jaime Correia-de-Sousa and {del Giacco}, Stefano and Dejan Dokic and Mark Dykewicz and Motohiro Ebisawa and Yehia El-Gamal✝ and Regina Emuzyte and Fauquert, {Jean Luc} and Alessandro Fiocchi and Fokkens, {Wytske J.} and Fonseca, {Joao A.} and Bilun Gemicioglu and Gomez, {Ren{\'e} Maximiliano} and Maia Gotua and Tari Haahtela and Eckard Hamelmann and Tomohisa Iinuma and Ivancevich, {Juan Carlos} and Ewa Jassem and Omer Kalayci and Przemyslaw Kardas and Musa Khaitov and Piotr Kuna and Violeta Kvedariene and Larenas-Linnemann, {Desiree E.} and Brian Lipworth and Michael Makris and Francesca Puggioni and Antonino Romano",

note = "Funding Information: CA reports grants from Allergopharma, Idorsia, Swiss National Science Foundation, Christine K{\"u}hne‐Center for Allergy Research and Education, European Commission's Horison's 2020 Framework Programme, Cure, Novartis Research Institutes, Astra Zeneca, Scibase, advisory role in Sanofi/Regeneron, grants from Glakso Smith‐Kline, advisory role in Scibase. JB reports personal fees from Chiesi, Cipla, Hikma, Menarini, Mundipharma, Mylan, Novartis, Purina, Sanofi‐Aventis, Takeda, Teva, Uriach, other from KYomed‐Innov. VC reports personal fees from ALK, Allergy Therapeutics, LETI, Thermofisher, Merck, Astrazeneca, GSK. JCS reports Advisory Board from Boheringer Ingelheim, personal fees and Advisory Board from GSK, Bial, grants, personal fees and Advisory Board from AstraZeneca, non‐financial support from Mundipharma, personal fees from Sanofi, Advisory Board from Novartis. JCI reports personal fees from Faes Farma, Abbott Ecuador, Laboratorios Casasco, Laboratorios Bago Bolivia, Eurofarma Argentina, Sanofi. PK reports personal fees from Adamed, AstraZeneca, Berlin Chemie Menarini, Boehringer Ingelheim, Hal Allergy, Lekam, Mylan, Novartis, Polpharma, Sanofi, Teva, Chiesi, USP Pharmacia. VK reports personal fees from GSK, non‐financial support from AstraZeneca, DIMUNA, DLL reports personal fees from Allakos, Amstrong, Astrazeneca, Boehringer Ingelheim, Chiesi, DBV Technologies, Grunenthal, GSK, MEDA, Menarini, MSD, Novartis, Pfizer, Novartis, Sanofi, Siegfried, UCB, Alakos, Gossamer, grants from Sanofi, Astrazeneca, Novartis, UCB, GSK, TEVA, Boehringer Ingelheim, Chiesi, Purina institute. BL reports grants and personal fees from Mylan, Glenmark. JM reports personal fees and other from SANOFI‐GENZYME & REGENERON, NOVARTIS, ALLAKOS, grants and personal fees from MYLAN‐MEDA Pharma, URIACH Group, personal fees from MITSUBISHI‐TANABE, MENARINI, UCB, ASTRAZENECA, personal fees from GSK, MSD. NP reports personal fees from Novartis, Nutricia, HAL, MENARINI/FAES FARMA, SANOFI, MYLAN/MEDA, BIOMAY, AstraZeneca, GSK, MSD, ASIT BIOTECH, Boehringer Ingelheim, grants from Gerolymatos International SA, Capricare. OP reports grants and personal fees from ALK‐Abell{\'o}, Allergopharma, Stallergenes Greer, HAL Allergy Holding B.V./HAL Allergie GmbH, Bencard Allergie GmbH/Allergy Therapeutics, Lofarma, ASIT Biotech Tools S.A., Laboratorios LETI/LETI Pharma, Anergis S.A., Glaxo Smith Kline, personal fees Astellas Pharma Global, EUFOREA, ROXALL Medizin, Novartis, Sanofi‐Aventis and Sanofi‐Genzyme, Med Update Europe GmbH, streamedup! GmbH, grants from Pohl‐Boskamp, Inmunotek S.L.,personal fees from John Wiley and Sons, AS, personal fees from MEDA Pharma/MYLAN, Mobile Chamber Experts (a GALEN Partner), Indoor Biotechnologies. DP reports grants and personal fees from GlaxoSmithKline, personal fees from Menarini, Pliva, Belupo, AbbVie, Novartis, MSD, Chiesi, Revenio, AbbVie, Novartis, MSD, Chiesi, Revenio, non‐financial support from Philips, personal fees and non‐financial support from Boehringer Ingelheim, FP reports personal fees from SANOFI, ASTRAZENECA, NOVARTIS, GLAXO SMITHKLINE, STALLERGENES, ALLERGY THERAPEUTICS, HAL ALLERGY, MENARINI, MALESCI, GUIDOTTI, VALEAS, BOEHRINGER INGELHEIM, ALMIRALL, MUNDIPHARMA. NR reports and Advisory Board: Sanofi, Mylan, AstraZeneca, Speaker: Sanofi, Mylan, Chiesi. JS reports grants and personal fees from SANOFI, personal fees from GSK, NOVARTIS, ASTRA ZENECA, MUNDIPHARMA, FAES FARMA. Dr. Tsiligianni reports grants from GSK Hellas, ELPEN, Astra Zeneca Hellas, personal fees from GSK, Boehringer Ingelheim, Novartis, Astra Zeneca. DW reports personal fees from Optinose, ALK, Sanofi, and was co‐chair of Joint Task Force on Practice Parameters until July 2020. author of Rhinitis GRADE document (2017) and Rhinitis practice parameter update (2020). TZ reports personal fees from Bayer Health Care, FAES, Novartis, Henkel, AstraZeneca, AbbVie, ALK, Almirall, Astellas, Bayer Health Care, Bencard, Berlin Chemie, HAL, Leti, Meda, Menarini, Merck, MSD, Novartis, Pfizer, Sanofi, Stallergenes, Takeda, Teva, UCB, Kryolan L'Or{\'e}al. 2 Publisher Copyright: {\textcopyright} 2021 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.",

year = "2021",

doi = "10.1111/all.14815",

language = "English",

journal = "Allergy: European Journal of Allergy and Clinical Immunology",

issn = "0105-4538",

publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Differentiation of COVID-19 signs and symptoms from allergic rhinitis and common cold

T2 - An ARIA-EAACI-GA2LEN consensus

AU - Hagemann, Jan

AU - Onorato, Gabrielle L.

AU - Jutel, Marek

AU - Akdis, Cezmi A.

AU - Agache, Ioana

AU - Zuberbier, Torsten

AU - Czarlewski, Wienczyslawa

AU - Mullol, Joaquim

AU - Bedbrook, Anna

AU - Bachert, Claus

AU - Bennoor, Kazi S.

AU - Bergmann, Karl Christian

AU - Braido, Fulvio

AU - Camargos, Paulo

AU - Caraballo, Luis

AU - Cardona, Victoria

AU - Casale, Thomas

AU - Cecchi, Lorenzo

AU - Chivato, Tomas

AU - Chu, Derek K.

AU - Cingi, Cemal

AU - Correia-de-Sousa, Jaime

AU - del Giacco, Stefano

AU - Dokic, Dejan

AU - Dykewicz, Mark

AU - Ebisawa, Motohiro

AU - El-Gamal✝, Yehia

AU - Emuzyte, Regina

AU - Fauquert, Jean Luc

AU - Fiocchi, Alessandro

AU - Fokkens, Wytske J.

AU - Fonseca, Joao A.

AU - Gemicioglu, Bilun

AU - Gomez, René Maximiliano

AU - Gotua, Maia

AU - Haahtela, Tari

AU - Hamelmann, Eckard

AU - Iinuma, Tomohisa

AU - Ivancevich, Juan Carlos

AU - Jassem, Ewa

AU - Kalayci, Omer

AU - Kardas, Przemyslaw

AU - Khaitov, Musa

AU - Kuna, Piotr

AU - Kvedariene, Violeta

AU - Larenas-Linnemann, Desiree E.

AU - Lipworth, Brian

AU - Makris, Michael

AU - Puggioni, Francesca

AU - Romano, Antonino

N1 - Funding Information: CA reports grants from Allergopharma, Idorsia, Swiss National Science Foundation, Christine Kühne‐Center for Allergy Research and Education, European Commission's Horison's 2020 Framework Programme, Cure, Novartis Research Institutes, Astra Zeneca, Scibase, advisory role in Sanofi/Regeneron, grants from Glakso Smith‐Kline, advisory role in Scibase. JB reports personal fees from Chiesi, Cipla, Hikma, Menarini, Mundipharma, Mylan, Novartis, Purina, Sanofi‐Aventis, Takeda, Teva, Uriach, other from KYomed‐Innov. VC reports personal fees from ALK, Allergy Therapeutics, LETI, Thermofisher, Merck, Astrazeneca, GSK. JCS reports Advisory Board from Boheringer Ingelheim, personal fees and Advisory Board from GSK, Bial, grants, personal fees and Advisory Board from AstraZeneca, non‐financial support from Mundipharma, personal fees from Sanofi, Advisory Board from Novartis. JCI reports personal fees from Faes Farma, Abbott Ecuador, Laboratorios Casasco, Laboratorios Bago Bolivia, Eurofarma Argentina, Sanofi. PK reports personal fees from Adamed, AstraZeneca, Berlin Chemie Menarini, Boehringer Ingelheim, Hal Allergy, Lekam, Mylan, Novartis, Polpharma, Sanofi, Teva, Chiesi, USP Pharmacia. VK reports personal fees from GSK, non‐financial support from AstraZeneca, DIMUNA, DLL reports personal fees from Allakos, Amstrong, Astrazeneca, Boehringer Ingelheim, Chiesi, DBV Technologies, Grunenthal, GSK, MEDA, Menarini, MSD, Novartis, Pfizer, Novartis, Sanofi, Siegfried, UCB, Alakos, Gossamer, grants from Sanofi, Astrazeneca, Novartis, UCB, GSK, TEVA, Boehringer Ingelheim, Chiesi, Purina institute. BL reports grants and personal fees from Mylan, Glenmark. JM reports personal fees and other from SANOFI‐GENZYME & REGENERON, NOVARTIS, ALLAKOS, grants and personal fees from MYLAN‐MEDA Pharma, URIACH Group, personal fees from MITSUBISHI‐TANABE, MENARINI, UCB, ASTRAZENECA, personal fees from GSK, MSD. NP reports personal fees from Novartis, Nutricia, HAL, MENARINI/FAES FARMA, SANOFI, MYLAN/MEDA, BIOMAY, AstraZeneca, GSK, MSD, ASIT BIOTECH, Boehringer Ingelheim, grants from Gerolymatos International SA, Capricare. OP reports grants and personal fees from ALK‐Abelló, Allergopharma, Stallergenes Greer, HAL Allergy Holding B.V./HAL Allergie GmbH, Bencard Allergie GmbH/Allergy Therapeutics, Lofarma, ASIT Biotech Tools S.A., Laboratorios LETI/LETI Pharma, Anergis S.A., Glaxo Smith Kline, personal fees Astellas Pharma Global, EUFOREA, ROXALL Medizin, Novartis, Sanofi‐Aventis and Sanofi‐Genzyme, Med Update Europe GmbH, streamedup! GmbH, grants from Pohl‐Boskamp, Inmunotek S.L.,personal fees from John Wiley and Sons, AS, personal fees from MEDA Pharma/MYLAN, Mobile Chamber Experts (a GALEN Partner), Indoor Biotechnologies. DP reports grants and personal fees from GlaxoSmithKline, personal fees from Menarini, Pliva, Belupo, AbbVie, Novartis, MSD, Chiesi, Revenio, AbbVie, Novartis, MSD, Chiesi, Revenio, non‐financial support from Philips, personal fees and non‐financial support from Boehringer Ingelheim, FP reports personal fees from SANOFI, ASTRAZENECA, NOVARTIS, GLAXO SMITHKLINE, STALLERGENES, ALLERGY THERAPEUTICS, HAL ALLERGY, MENARINI, MALESCI, GUIDOTTI, VALEAS, BOEHRINGER INGELHEIM, ALMIRALL, MUNDIPHARMA. NR reports and Advisory Board: Sanofi, Mylan, AstraZeneca, Speaker: Sanofi, Mylan, Chiesi. JS reports grants and personal fees from SANOFI, personal fees from GSK, NOVARTIS, ASTRA ZENECA, MUNDIPHARMA, FAES FARMA. Dr. Tsiligianni reports grants from GSK Hellas, ELPEN, Astra Zeneca Hellas, personal fees from GSK, Boehringer Ingelheim, Novartis, Astra Zeneca. DW reports personal fees from Optinose, ALK, Sanofi, and was co‐chair of Joint Task Force on Practice Parameters until July 2020. author of Rhinitis GRADE document (2017) and Rhinitis practice parameter update (2020). TZ reports personal fees from Bayer Health Care, FAES, Novartis, Henkel, AstraZeneca, AbbVie, ALK, Almirall, Astellas, Bayer Health Care, Bencard, Berlin Chemie, HAL, Leti, Meda, Menarini, Merck, MSD, Novartis, Pfizer, Sanofi, Stallergenes, Takeda, Teva, UCB, Kryolan L'Oréal. 2 Publisher Copyright: © 2021 European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.

PY - 2021

Y1 - 2021

N2 - Background: Although there are many asymptomatic patients, one of the problems of COVID-19 is early recognition of the disease. COVID-19 symptoms are polymorphic and may include upper respiratory symptoms. However, COVID-19 symptoms may be mistaken with the common cold or allergic rhinitis. An ARIA-EAACI study group attempted to differentiate upper respiratory symptoms between the three diseases. Methods: A modified Delphi process was used. The ARIA members who were seeing COVID-19 patients were asked to fill in a questionnaire on the upper airway symptoms of COVID-19, common cold and allergic rhinitis. Results: Among the 192 ARIA members who were invited to respond to the questionnaire, 89 responded and 87 questionnaires were analysed. The consensus was then reported. A two-way ANOVA revealed significant differences in the symptom intensity between the three diseases (p <.001). Conclusions: This modified Delphi approach enabled the differentiation of upper respiratory symptoms between COVID-19, the common cold and allergic rhinitis. An electronic algorithm will be devised using the questionnaire.

AB - Background: Although there are many asymptomatic patients, one of the problems of COVID-19 is early recognition of the disease. COVID-19 symptoms are polymorphic and may include upper respiratory symptoms. However, COVID-19 symptoms may be mistaken with the common cold or allergic rhinitis. An ARIA-EAACI study group attempted to differentiate upper respiratory symptoms between the three diseases. Methods: A modified Delphi process was used. The ARIA members who were seeing COVID-19 patients were asked to fill in a questionnaire on the upper airway symptoms of COVID-19, common cold and allergic rhinitis. Results: Among the 192 ARIA members who were invited to respond to the questionnaire, 89 responded and 87 questionnaires were analysed. The consensus was then reported. A two-way ANOVA revealed significant differences in the symptom intensity between the three diseases (p <.001). Conclusions: This modified Delphi approach enabled the differentiation of upper respiratory symptoms between COVID-19, the common cold and allergic rhinitis. An electronic algorithm will be devised using the questionnaire.

KW - allergic rhinitis

KW - common cold

KW - cough

KW - COVID-19

KW - smell

UR - http://www.scopus.com/inward/record.url?scp=85105287881&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85105287881&partnerID=8YFLogxK

U2 - 10.1111/all.14815

DO - 10.1111/all.14815

M3 - Article

C2 - 33730365

AN - SCOPUS:85105287881

SN - 0105-4538

JO - Allergy: European Journal of Allergy and Clinical Immunology

JF - Allergy: European Journal of Allergy and Clinical Immunology

ER -