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Multicenter Study
. 2025 Nov;156(5):1379-1389.e10.
doi: 10.1016/j.jaci.2025.07.006. Epub 2025 Jul 21.

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
Multicenter Study

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

Christian Rosas-Salazar et al. J Allergy Clin Immunol. 2025 Nov.

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.

Figures

FIG 1.
FIG 1.
Effect modification of age on the association of using topical airway corticosteroids (NCS and ICS) with the risk of SARS-CoV-2 infection. (A) Log relative hazard of SARS-CoV-2 infection among participants with a prior health care provider diagnosis of allergic rhinitis by age and NCS use at study entry. (B) Log relative hazard of SARS-CoV-2 infection among participants with a prior health care provider diagnosis of asthma by age and ICS use at study entry.
FIG 2.
FIG 2.
Risk of SARS-CoV-2 infection among children by use of topical airway corticosteroids (NCS and ICS). (A) Kaplan-Meier curve of the cumulative probability of SARS-CoV-2 infection among children with a prior health care provider diagnosis of allergic rhinitis by NCS use at study entry. (B) Kaplan-Meier curve of the cumulative probability of SARS-CoV-2 infection among children with a prior health care provider diagnosis of asthma by ICS use at study entry. The x-axis represents the time from the start of the study to the first SARS-CoV-2–positive quantitative PCR testing or the last available nasal swab in days.
FIG 3.
FIG 3.
Risk of SARS-CoV-2 infection among adults by use of topical airway corticosteroids (NCS and ICS). (A) Kaplan-Meier curve of the cumulative probability of SARS-CoV-2 infection among adults with a prior health care provider diagnosis of allergic rhinitis by NCS use at study entry. (B) Kaplan-Meier curve of the cumulative probability of SARS-CoV-2 infection among adults with a prior health care provider diagnosis of asthma by ICS use at study entry. The x-axis represents the time from the start of the study to the first SARS-CoV-2–positive quantitative PCR testing or the last available nasal swab in days.
See this image and copyright information in PMC

References

    1. Gallo O, Locatello LG, Mazzoni A, Novelli L, Annunziato F. The central role of the nasal microenvironment in the transmission, modulation, and clinical progression of SARS-CoV-2 infection. Mucosal Immunol 2021;14:305–16. - PMC - PubMed
    1. Jackson CB, Farzan M, Chen B, Choe H. Mechanisms of SARS-CoV-2 entry into cells. Nat Rev Mol Cell Biol 2022;23:3–20. - PMC - PubMed
    1. Alu A, Chen L, Lei H, Wei Y, Tian X, Wei X. Intranasal COVID-19 vaccines: from bench to bed. EBioMedicine 2022;76:103841. - PMC - PubMed
    1. Hou YJ, Okuda K, Edwards CE, Martinez DR, Asakura T, Dinnon KH 3rd, et al. SARS-CoV-2 reverse genetics reveals a variable infection gradient in the respiratory tract. Cell 2020;182:429–46.e14. - PMC - PubMed
    1. Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, et al. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol 2020;146:721–67. - PubMed

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