Loss of smell and taste validated as COVID-19 symptoms in patients with high recovery rate

Loss of smell and taste has been anecdotally linked to COVID-19 infections. In a study published April 12, 2020 in the journal International Forum of Allergy & Rhinology, researchers at UC San Diego Health report the first empirical findings that strongly associate sensory loss with COVID-19, the respiratory disease caused by the novel coronavirus.

"Based on our study, if you have smell and taste loss, you are more than 10 times more likely to have COVID-19 infection than other causes of infection. The most common first sign of a COVID-19 infection remains fever, but fatigue and loss of smell and taste follow as other very common initial symptoms," said Carol Yan, MD, an otolaryngologist and head and neck surgeon at UC San Diego Health. "We know COVID-19 is an extremely contagious virus. This study supports the need to be aware of smell and taste loss as early signs of COVID-19."

Yan and colleagues surveyed 1,480 patients with flu-like symptoms and concerns regarding potential COVID-19 infection who underwent testing at UC San Diego Health from March 3 through March 29, 2020. Within that total, 102 patients tested positive for the virus and 1,378 tested negative. The study included responses from 59 COVID-19-positive patients and 203 COVID-19-negative patients.

Yan said the study demonstrated the high prevalence and unique presentation of certain sensory impairments in patients positive with COVID-19. Of those who reported loss of smell and taste, the loss was typically profound, not mild. But encouragingly, the rate of recovery of smell and taste was high and occurred usually within two to four weeks of infection.

"Our study not only showed that the high incidence of smell and taste is specific to COVID-19 infection, but we fortunately also found that for the majority of people sensory recovery was generally rapid," said Yan. "Among the Covid-19 patients with smell loss, more than 70 percent had reported improvement of smell at the time of survey and of those who hadn't reported improvement, many had only been diagnosed recently."

Sensory return typically matched the timing of disease recovery. Interestingly, the researchers found that persons who reported experiencing a sore throat more often tested negative for COVID-19.

In an effort to decrease risk of virus transmission, UC San Diego Health now includes loss of smell and taste as a screening requirement for visitors and staff, as well as a marker for testing patients who may be positive for the virus.

Other known symptoms of COVID-19 include fever, fatigue, cough and difficulty breathing. Respondents in Yan's study were most often persons with milder forms of COVID-19 infection who did not require hospitalization or intubation. The findings, she said, underline the importance of identifying early or subtle symptoms of COVID-19 infection in people who may be at risk of transmitting the disease as they recuperate within the community.

"It is our hope that with these findings other institutions will follow suit and not only list smell and taste loss as a symptom of COVID-19, but use it as a screening measure for the virus across the world," Yan said.

Co-authors include: Farhoud Faraji, Divya P. Prajapti, Christine E. Boone and Adam S. DeConde, all at UC San Diego.

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Materials provided by University of California - San Diego. Original written by Jeanna Vazquez. Note: Content may be edited for style and length.

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Journal Reference:

1. Carol H. Yan, Farhoud Faraji, Divya P. Prajapati, Christine E. Boone, Adam S DeConde. Association of chemosensory dysfunction and Covid-19 in patients presenting with influenza-like symptoms. International Forum of Allergy & Rhinology, 2020; DOI: 10.1002/alr.22579

Cracks in the skin of eczema patients promote allergic diseases

Infants who develop eczema are more likely to develop food allergies, hay fever and asthma as they grow older, a progression known as the atopic march. Donald Leung, MD, PhD, head of Pediatric Allergy & Clinical Immunology at National Jewish Health, has identified itching and dry cracked skin of eczema patients as a significant promoter of the atopic march. Moisturizers, especially early in a child's life, may help prevent eczema, food allergies and other allergic diseases.

"When food particles are introduced through the skin rather than the digestive system, they are much more likely to cause allergies," said Dr. Leung. "Cracks in the skin of those with eczema often set off a chain of allergic diseases that develop over several years."

Seventeen-year-old Ava Segur experienced the atopic march first hand. It started with eczema when she was just six weeks old. Her mother, Stephanie, says they were trying to get her skin inflammation under control, when they were suddenly confronted with another problem. "She had hives all over her arms and neck," she said. "So we took her to the hospital and found out she is allergic to peanuts, pine nuts and shellfish." A few years later, Ava developed exercise-induced asthma.

Ava has participated in numerous clinical trials seeking better treatments for eczema and a better understanding of the atopic march. "If we can find a solution that will work to stop this before it starts, it will be very rewarding to know that I was able to be a part of that," said Ava.

"Restoring the skin barrier as soon as eczema develops is the best way to stop the atopic march in its tracks and prevent allergic diseases from developing," said Dr. Leung.

The skin forms an important barrier, keeping moisture in and external allergens or microbes out. Research by Dr. Leung has shown that patients with eczema lack important proteins and lipids in the outer layers of their skin. As a result of eczema patients' defective skin barrier, water escapes from the skin, drying it out and leading to cracking and itching. Cracked, itchy skin is a hallmark of eczema.

Scratching the dry, itchy skin of eczema patients can further damage the skin barrier and activate the immune system. Increasing evidence compiled by Dr. Leung and others indicates that food particles entering the body through cracks in the skin can trigger an allergic response that leads to food allergy. Once that allergic response has been triggered, the immune system is primed to develop not only eczema and food allergies, but also hay fever and asthma.

To do this, experts recommend what they call "soak and seal," which involves thoroughly moisturizing the skin in a warm bath, then trapping the moisture in with a moisturizing ointment. It's a method Kriston Kline says helped her 19-month-old son's skin begin to heal within a week.

"It provided him with immediate relief, and each time we do a soak-and-seal treatment, his skin looks so much better," said Kline. "Not only is this making him more comfortable now, but if it can help protect him from allergies and asthma, that is a huge benefit for his future."

Dr. Leung believes that careful care of a baby's skin right from birth could prevent eczema and other allergic diseases. A baby's skin is particularly susceptible to drying out when it first emerges from the warm, watery environment of the womb into the dry air of the outside world. A few small studies have suggested that regular treatment with skin moisturizers can help reduce an infant's chances of developing eczema and the other diseases in the atopic march. Dr. Leung is currently working to confirm those studies and identify the ideal moisturizer components to prevent eczema and the other diseases of the atopic march.

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Materials provided by National Jewish Health. Note: Content may be edited for style and length.

Exercise: Psych patients' new natural prescription

Psych patients' new natural prescription

When it comes to inpatient treatment of a range of mental health and mood disorders -- from anxiety and depression to schizophrenia, suicidality and acute psychotic episodes -- a new study suggest that physical exercise is so effective at alleviating patient symptoms that it could reduce patients' time admitted to acute facilities and reliance on psychotropic medications.

"The general attitude of medicine is that you treat the primary problem first, and exercise was never considered to be a life or death treatment option. Now that we know it's so effective, it can become as fundamental as pharmacological intervention," explains David Tomasi, a lecturer at the University of Vermont, psychotherapist and inpatient psychiatry group therapist at the University of Vermont Medical Center and lead researcher of the study.

Practitioners at inpatient psychiatric facilities -- often crowded, acute settings in which patients experience severe distress and discomfort -- typically prescribe psychotropic medications first, rather than natural remedies like physical exercise, to alleviate patients' symptoms such as anger, anxiety and depression. In fact, Tomasi estimates that only a handful of inpatient psychiatric hospitals in the U.S. provide psychotherapist-supported gym facilities exclusively for these patients. Instead, practitioners rely on classical psychotherapeutic and pharmacological frameworks to treat psychiatric symptoms, which they monitor to determine when a patient is ready to be discharged from the facility.

Tomasi, in collaboration with UVMMC's Sheri Gates and Emily Reyns, built a gym exclusively for roughly 100 patients in the medical center's inpatient psychiatry unit, and led and introduced 60-minute structured exercise and nutrition education programs into their treatment plans. The psychotherapists surveyed patients on their mood, self-esteem and self-image both before and after the exercise sessions to gauge the effects of exercise on psychiatric symptoms.

Patients reported lower levels of anger, anxiety and depression, higher self-esteem, and overall improved moods. Tomasi, Gates and Reyns found an average of 95 percent of patients reported that their moods improved after doing the structured exercises, while 63 percent of the patients reported being happy or very happy, as opposed to neutral, sad or very sad, after the exercises. An average of 91.8 of patients also reported that they were pleased with the way their bodies felt after doing the structured exercises.

"The fantastic thing about these results is that, if you're in a psychotic state, you're sort of limited with what you can do in terms of talk therapy or psychotherapy. It's hard to receive a message through talk therapy in that state, whereas with exercise, you can use your body and not rely on emotional intelligence alone" explains Tomasi.

"The priority is to provide more natural strategies for the treatment of mood disorders, depression and anxiety," he adds. "In practice, we hope that every psychiatric facility will include integrative therapies -- in our case, exercise in particular -- as the primary resource for their patients' psycho-physical wellbeing."

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Materials provided by University of Vermont. Note: Content may be edited for style and length.