Allergic disorders and susceptibility to and severity of COVID-19: A nationwide cohort study

J Allergy Clin Immunol. 2020 Oct;146(4):790-798. doi: 10.1016/j.jaci.2020.08.008. Epub 2020 Aug 15.


Background: There is inconclusive and controversial evidence of the association between allergic diseases and the risk of adverse clinical outcomes of coronavirus disease 2019 (COVID-19).

Objective: We sought to determine the association of allergic disorders with the likelihood of a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test result and with clinical outcomes of COVID-19 (admission to intensive care unit, administration of invasive ventilation, and death).

Methods: A propensity-score-matched nationwide cohort study was performed in South Korea. Data obtained from the Health Insurance Review & Assessment Service of Korea from all adult patients (age, >20 years) who were tested for SARS-CoV-2 in South Korea between January 1, 2020, and May 15, 2020, were analyzed. The association of SARS-CoV-2 test positivity and allergic diseases in the entire cohort (n = 219,959) and the difference in clinical outcomes of COVID-19 were evaluated in patients with allergic diseases and SARS-CoV-2 positivity (n = 7,340).

Results: In the entire cohort, patients who underwent SARS-CoV-2 testing were evaluated to ascertain whether asthma and allergic rhinitis were associated with an increased likelihood of SARS-CoV-2 test positivity. After propensity score matching, we found that asthma and allergic rhinitis were associated with worse clinical outcomes of COVID-19 in patients with SARS-CoV-2 test positivity. Patients with nonallergic asthma had a greater risk of SARS-CoV-2 test positivity and worse clinical outcomes of COVID-19 than patients with allergic asthma.

Conclusions: In a Korean nationwide cohort, allergic rhinitis and asthma, especially nonallergic asthma, confers a greater risk of susceptibility to SARS-CoV-2 infection and severe clinical outcomes of COVID-19.

Keywords: COVID-19; allergic rhinitis; asthma; atopic dermatitis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Asthma / complications*
  • Asthma / diagnosis
  • Asthma / immunology
  • Asthma / mortality
  • Betacoronavirus / immunology
  • Betacoronavirus / pathogenicity*
  • COVID-19
  • COVID-19 Testing
  • Cardiovascular Diseases / complications*
  • Cardiovascular Diseases / diagnosis
  • Cardiovascular Diseases / immunology
  • Cardiovascular Diseases / mortality
  • Clinical Laboratory Techniques
  • Cohort Studies
  • Coronavirus Infections / complications*
  • Coronavirus Infections / diagnosis
  • Coronavirus Infections / immunology
  • Coronavirus Infections / mortality
  • Dermatitis, Atopic / complications*
  • Dermatitis, Atopic / diagnosis
  • Dermatitis, Atopic / immunology
  • Dermatitis, Atopic / mortality
  • Diabetes Complications / diagnosis*
  • Diabetes Complications / immunology
  • Diabetes Complications / mortality
  • Diabetes Mellitus / diagnosis
  • Diabetes Mellitus / immunology
  • Diabetes Mellitus / mortality
  • Disease Susceptibility
  • Female
  • Humans
  • Length of Stay / statistics & numerical data
  • Male
  • Middle Aged
  • Odds Ratio
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / diagnosis
  • Pneumonia, Viral / immunology
  • Pneumonia, Viral / mortality
  • Rhinitis, Allergic / complications*
  • Rhinitis, Allergic / diagnosis
  • Rhinitis, Allergic / immunology
  • Rhinitis, Allergic / mortality
  • SARS-CoV-2
  • Severity of Illness Index
  • Survival Analysis