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. 2025 Dec;15(4):255-262.
doi: 10.5415/apallergy.0000000000000245. Epub 2025 Dec 2.

The impact of COVID-19 on the incidence of allergic diseases in the pediatric population: A retrospective cohort study from TriNetX United States collaborative network

Su-Boon Yong  1   2   3 , Yu-Feng Chang  4 , Hao-Yun Chen  5 , Yu-Jen Chen  6 , Chi-Ya Yang  7   8 , Pei-Lun Liao  9 , Pei-Chi Chen  10 , Lawrence Shih-Hsin Wu  11 , James Cheng-Chung Wei  12   13   14 , Jiu-Yao Wang  3   15
Affiliations

The impact of COVID-19 on the incidence of allergic diseases in the pediatric population: A retrospective cohort study from TriNetX United States collaborative network

Su-Boon Yong et al. Asia Pac Allergy. 2025 Dec.

Abstract

Background: Allergic diseases, including asthma, allergic rhinitis (AR), and atopic dermatitis (AD), affect nearly 20% of the global population and are influenced by complex immune mechanisms. The COVID-19 pandemic, driven by SARS-CoV-2 and its evolving variants, has reshaped clinical and immunological landscapes. Previous evidence regarding the interaction between COVID-19 and allergic diseases remains inconsistent, necessitating large-scale real-world investigations.

Objective: This study aimed to investigate the association between COVID-19 infection and the subsequent development of allergic diseases (AD, AR, and asthma) in pediatric populations, while exploring subgroup variations and testing robustness through sensitivity analyses.

Methods: We performed a retrospective cohort study using TriNetX electronic health records from 56 U.S. healthcare facilities. Children <18 years with ≥2 visits and Polymerase chain reaction (PCR) testing (2020-2022) were included, excluding those with prior allergic disease. COVID-19 was defined by ICD-10 U07.1 and RNA positivity. Propensity score matching (1:1) balanced baseline characteristics. The primary outcome was the incident allergic disease within 1 year, assessed using Cox models; subgroup and sensitivity analyses tested robustness.

Results: After matching, 412,017 patients were included in each cohort (COVID-19 vs non-COVID-19). Children with COVID-19 exhibited a significantly higher risk of developing allergic diseases (Hazard ratio (HR) = 1.211, 95% confidence interval [CI]: 1.189-1.235; P < 0.001). Elevated risks were observed across all categories: AD (HR = 1.179, 95% CI: 1.140-1.219), asthma (HR = 1.252, 95% CI: 1.216-1.290), and AR (HR = 1.223, 95% CI: 1.188-1.259). Kaplan-Meier curves demonstrated consistently higher cumulative incidence in the COVID-19 cohort. Subgroup analyses stratified by sex, age, and race yielded concordant results, while sensitivity analyses-including competing risks, extended follow-up to 2-3 years, stricter visit definitions, and exclusion of vaccinated individuals-confirmed robustness.

Conclusion: COVID-19 infection was linked to a higher risk of allergic diseases in children, suggesting postviral immune dysregulation and microbiome changes as possible mechanisms. Further studies are needed to clarify causality and guide prevention and management.

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

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Conflict of interest statement

The authors have no financial conflicts of interest.

Figures

Figure 1.
Figure 1.
Flow chart of the study.
Figure 2.
Figure 2.
Kaplan–Meier curves of cumulative probability (%) of allergic disease, comparing COVID-19 and non-COVID-19 groups.
Figure 3.
Figure 3.
Study design.
Figure 4.
Figure 4.
Hazard ratio and 95% CIs for the risk of allergic disease by subgroup. CIs, confidence intervals.
See this image and copyright information in PMC

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