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. 2025 Jul 21:S0091-6749(25)00778-X.
doi: 10.1016/j.jaci.2025.07.006. Online ahead of print.

Impact of nasal and inhaled corticosteroids on SARS-CoV-2 infection susceptibility

Christian Rosas-Salazar  1 , Tebeb Gebretsadik  1 , Max A Seibold  2 , Camille M Moore  2 , Samuel J Arbes  3 , Leonard B Bacharier  1 , Steven M Brunwasser  4 , Carlos A Camargo Jr  5 , William D Dupont  1 , Glenn T Furuta  6 , Rebecca S Gruchalla  7 , Ruchi S Gupta  8 , Daniel J Jackson  9 , Christine C Johnson  10 , Meyer Kattan  11 , Gurjit K Khurana Hershey  12 , Andrew H Liu  6 , George T O'Connor  13 , Wanda Phipatanakul  5 , Sima K Ramratnam  9 , Marc E Rothenberg  12 , Satria P Sajuthi  2 , Joshua Sanders  3 , Christine M Seroogy  9 , Brittney M Snyder  1 , Lia Stelzig  3 , Stephen J Teach  14 , Edward M Zoratti  10 , Alkis Togias  15 , Patricia C Fulkerson  15 , Tina V Hartert  16 ; HEROS Study Group
Affiliations
Free article

Impact of nasal and inhaled corticosteroids on SARS-CoV-2 infection susceptibility

Christian Rosas-Salazar et al. J Allergy Clin Immunol. .
Free article

Abstract

Background: It is unknown whether nasal corticosteroid (NCS) or inhaled corticosteroid (ICS) use impacts the susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Objectives: We sought 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 2 weeks with additional collections based on coronavirus disease 2019-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 2211 participants in the 1113 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 <.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 = .01, and aHR = 2.15, 95% CI: 1.003-4.63, P = .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.

Conclusion: 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.

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

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Conflict of interest statement

Disclosure statement This work was supported with funds from the US National Institutes of Health under award numbers U19AI095227-S1, U19AI095227-S2, R01AI024156, R01AI051598, UG3OD023282, U19AI070235-14S1, U54AI117804-06S1, U54AI117804-07S1, R01AI127507, U19AI104317, PO1HL70381, U01AI110397, R01HL137192, K24AI106822, U10HL109172, R01AI130348-04S1, UL1TR001430, UL1TR002243, UM1AI114271, UM1AI114271-06S1, UM1AI114271-07S1, PO1AI089473, PO1AI089473-07S1, UM1AI151958-01S1, UM1AI151958-02S1, UM2AI117870, K23HL148638, R56AI050681, and UH3OD023282. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. Disclosure of potential conflict of interest: Drs Togias and Fulkerson’s coauthorship of this manuscript does not constitute an endorsement by the National Institute of Allergy and Infectious Diseases, the National Institutes of Health, or any other agency of the United States government. C. Rosas-Salazar has served as a consultant for AstraZeneca and The KOL Connection. D. J. Jackson reports personal fees from AstraZeneca, GlaxoSmithKline, Vifor Pharma, Sanofi, Regeneron, and Pfizer, as well as grant funding from GlaxoSmithKline. S. K. Ramratnam has served as a consultant for Sanofi. M. E. Rothenberg has served as a consultant for Pulm One, Spoon Guru, ClostraBio, Serpin Pharm, Allakos, Celldex, Nexstone One, Santa Ana Bio, EnZen Therapeutics, Bristol Myers Squibb, Astra Zeneca, Pfizer, GlaxoSmithKline, Regeneron/Sanofi, Revolo Biotherapeutics, and Guidepoint; he has an equity interest in the first 6 listed and receives royalties from reslizumab (Teva Pharmaceuticals), PEESSv2 (Mapi Research Trust), and UpToDate; and is an inventor of patents owned by Cincinnati Children’s Hospital. T.V. Hartert has received royalties from UpToDate. The rest of the authors declare that they have no relevant conflicts of interest.

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