COVID-19 in the Asia-Pacific region: Rise of allergies and contact dermatitis

The APAAACI Task Force on COVID-19 recognized most common atopic conditions and skin allergies in healthcare workers during the pandemic.

Allergies flourish among clinical personnel during the pandemic

Using Survey Monkey, the APAAACI Task Force on COVID-19 recognized most common atopic conditions and skin allergies among healthcare workers during the coronavirus pandemic.

In May 2020, both adult and pediatric allergists from 14 Asia-Pacific countries took part in a survey by APAAACI, concerning the rapid display of allergies in response to COVID-19. The study received data from Australia, China, India, Hongkong, Indonesia, Japan, Korea, Malaysia, Mongolia, the Philippines, Vietnam, Singapore, Taiwan, and Thailand.

Safety measures against coronavirus infection may trigger allergies

Most countries in the Asia-Pacific region are characterized by a comparably hot and humid climate. This in combination with safety measures against coronavirus infection, such as wearing of facial masks throughout the day, caused a rise in different atopic and allergic reactions.

Increased effort to breath, rebreathing previously exhaled air in a humid and hot atmosphere together with a constant physical pressure on the ears and face – that is the main impact of daily prolonged use of FFP2 and/or FFP3 masks. And it has measurable consequences such as triggering serious skin irritations and contact allergies.

One example from the study survey indicated that 62.5 % of healthcare workers showed symptoms of allergic rhinitis, the most common atopic condition among them. This was followed by asthma (50 %), chronic rhinosinusitis (25 %), and ocular allergy (25 %).

Interestingly, constant use of face masks and eye protection worsened these allergic conditions. The repeated inhalation of fabric dust that was trapped inside the mask did cause additional nasal and/or bronchial mucosal irritation.

Furthermore, healthcare workers also suffered serious skin allergies due to extended use of gloves and PPE in combination with frequent hand washing. The study indicated that the most common skin allergy was contact dermatitis (88.9 %), followed by atopic dermatitis (44.4 %), natural rubber latex allergy (22.2 %) and urticaria/angioedema (22.2 %).

Successful role of masks and PPE in controlling the COVID-19 pandemic

Despite the obvious side-effects on atopic conditions in healthcare personnel, masks and PPE have been proven very successful in controlling the first wave of the pandemic in the Asia-Pacific region, especially in Australia, Taiwan, New Zealand, Singapore, and Thailand with comparably low mortality.

However, other countries with dense urban populations, e.g. India, Malaysia, Indonesia or the Philippines, were facing second and third waves of the coronavirus pandemic. Following the vaccination rollout programs since February 2021, these communities have since relied more on herd immunity to complement the prevention of COVID-19, together with physical protection equipment.

Concluding remarks

In total, parts of the Asia-Pacific region seemed to be quite successful in preventing repeated and widespread community outbreaks of COVID-19 due to the implementation of additional measures, such as wearing face masks, public health policies, contact tracing via mobile apps, rapid testing, and isolation of infected individuals.
Nonetheless, especially healthcare workers also experienced higher rates of allergic and atopic conditions in daily practice due to prolonged wearing of masks and PPE in a tropical environment.

Pawankar R. et al. (APAAACI COVID-19 Working Group), Asia-Pacific perspectives on COVID-19 pandemic, 2021 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd., Allergy. 2021. DOI: 10.1111/all.14894