Clinical Olfactory Working Group consensus statement on the treatment of postinfectious olfactory dysfunction

J Allergy Clin Immunol. 2021 May;147(5):1704-1719. doi: 10.1016/j.jaci.2020.12.641. Epub 2021 Jan 13.

Abstract

Background: Respiratory tract viruses are the second most common cause of olfactory dysfunction. As we learn more about the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with the recognition that olfactory dysfunction is a key symptom of this disease process, there is a greater need than ever for evidence-based management of postinfectious olfactory dysfunction (PIOD).

Objective: Our aim was to provide an evidence-based practical guide to the management of PIOD (including post-coronavirus 2019 cases) for both primary care practitioners and hospital specialists.

Methods: A systematic review of the treatment options available for the management of PIOD was performed. The written systematic review was then circulated among the members of the Clinical Olfactory Working Group for their perusal before roundtable expert discussion of the treatment options. The group also undertook a survey to determine their current clinical practice with regard to treatment of PIOD.

Results: The search resulted in 467 citations, of which 107 articles were fully reviewed and analyzed for eligibility; 40 citations fulfilled the inclusion criteria, 11 of which were randomized controlled trials. In total, 15 of the articles specifically looked at PIOD whereas the other 25 included other etiologies for olfactory dysfunction.

Conclusions: The Clinical Olfactory Working Group members made an overwhelming recommendation for olfactory training; none recommended monocycline antibiotics. The diagnostic role of oral steroids was discussed; some group members were in favor of vitamin A drops. Further research is needed to confirm the place of other therapeutic options.

Keywords: COVID-19; Olfaction; anosmia; hyposmia; olfactory disorders; parosmia therapy; viral infections.

Publication types

  • Review

MeSH terms

  • COVID-19* / complications
  • COVID-19* / drug therapy
  • COVID-19* / epidemiology
  • COVID-19* / immunology
  • Consensus
  • Evidence-Based Medicine
  • Olfaction Disorders* / drug therapy
  • Olfaction Disorders* / epidemiology
  • Olfaction Disorders* / etiology
  • Olfaction Disorders* / immunology
  • Practice Guidelines as Topic
  • SARS-CoV-2 / immunology*
  • Steroids / therapeutic use*
  • Vitamin A / therapeutic use*

Substances

  • Steroids
  • Vitamin A