Impact of Nasal and Inhaled Corticosteroids on SARS-CoV-2 Infection Susceptibility

Christian Rosas-Salazar, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.
Tebeb Gebretsadik, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.
Max A. Seibold, National Jewish Health, Denver, Colorado, United States of America.
Camille M. Moore, National Jewish Health, Denver, Colorado, United States of America.
Samuel J. Arbes, Rho, Inc., Chapel Hill, North Carolina, United States of America.
Leonard B. Bacharier, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.
Steven M. Brunwasser, Rowan University, Glassboro, New Jersey, United States of America.
Carlos A. Camargo, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
William D. Dupont, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.
Glenn T. Furuta, University of Colorado School of Medicine, Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado, United States of America.
Rebecca S. Gruchalla, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America.
Ruchi S. Gupta, Northwestern University, Chicago, Illinois, United States of America.
Daniel J. Jackson, University of Wisconsin-Madison, Madison, Wisconsin, United States of America.
Christine C. Johnson, Henry Ford Health System, Detroit, Michigan, United States of America.
Meyer Kattan, Columbia University, New York, New York, United States of America.
Gurjit K. Khurana Hershey, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America.
Andrew H. Liu, University of Colorado School of Medicine, Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado, United States of America.
George T. O'Connor, Boston University, Boston, Massachusetts, United States of America.
Wanda Phipatanakul, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States of America.
Sima K. Ramratnam, University of Wisconsin-Madison, Madison, Wisconsin, United States of America.
Marc E. Rothenberg, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America.
Satria P. Sajuthi, National Jewish Health, Denver, Colorado, United States of America.
Joshua Sanders, Rho, Inc., Chapel Hill, North Carolina, United States of America.
Christine M. Seroogy, University of Wisconsin-Madison, Madison, Wisconsin, United States of America.
Brittney M. Snyder, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America.
Lia Stelzig, Rho, Inc., Chapel Hill, North Carolina, United States of America.
Stephen J. Teach, George Washington University, Washington, District of Columbia, United States of America.
Edward M. Zoratti, Henry Ford Health System, Detroit, Michigan, United States of America.
Alkis Togias, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America.
Patricia C. Fulkerson, National Institute of Allergy and Infectious Diseases, Rockville, Maryland, United States of America.
Tina V. Hartert, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America. Electronic address: tina.hartert@vumc.org.

Document Type

Journal Article

Publication Date

7-21-2025

Journal

The Journal of allergy and clinical immunology

DOI

10.1016/j.jaci.2025.07.006

Keywords

Airway; COVID-19; SARS-CoV-2; allergic rhinitis; asthma; inhaled corticosteroids; nasal corticosteroids

Abstract

BACKGROUND: It is unknown whether nasal (NCS) or inhaled corticosteroid (ICS) use impacts the susceptibility to SARS-CoV-2 infection. OBJECTIVES: To examine the associations of NCS and ICS use with the risk of SARS-CoV-2 infection among individuals with allergic rhinitis or asthma. METHODS: This is a prospective, multicenter, SARS-CoV-2 surveillance study of households with children. Nasal swabs were obtained from participants every two weeks with additional collections based on COVID-19-related symptoms. In our primary adjusted models, we examined the association of NCS or ICS use at study entry (in participants with allergic rhinitis or asthma, respectively) with the time to the first SARS-CoV-2 positive quantitative PCR testing using Cox proportional hazard regression. RESULTS: There were 2,211 participants in 1,113 households included. The associations of NCS and ICS use with the risk of SARS-CoV-2 infection were modified by age (p for both interactions<0.05). NCS and ICS use were individually associated with higher risks of SARS-CoV-2 infection among adults (adjusted hazard ratio [aHR]=1.88, 95% CI=1.14-3.12, p=0.01, and aHR=2.15, 95% CI=1.003-4.63, p=0.049, respectively). The association of NCS use with the risk of SARS-CoV-2 infection in adults was consistent in a series of sensitivity analyses. There was no association of NCS or ICS use with the risk of SARS-CoV-2 infection in children. CONCLUSIONS: Our findings suggest that the risk of SARS-CoV-2 infection is increased in adults who use NCS but not in children. Similar, albeit less consistent, age-dependent findings were observed for ICS use. While the results of this observational study should be interpreted with caution, they emphasize the need to conduct studies to understand potential mechanisms that could explain these findings.

Department

Pediatrics

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