Prevalence and severity of allergic asthma in children with COVID-19: a cross-sectional study

Document Type : Original Article


1 Pediatric Department, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran

2 Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran

3 School of Medicine, Kashan University of Medical Sciences, Kashan, Iran


Objectives: The objective of this research was to evaluate the occurrence of allergic asthma symptoms in children between the ages of 3 and 15 years who tested positive for COVID-19 through PCR testing and were admitted to an educational hospital in Iran.
Methods: In 2021, we conducted a cross-sectional study that included 75 pediatric patients who tested positive for COVID-19 through PCR testing and were admitted to the Shahid Beheshti Hospital in Kashan, Iran. We used telephone interviews to complete the International Study of Asthma and Allergies in Childhood questionnaire to gather information on the frequency of allergic asthma symptoms and the demographic characteristics of the patients.
Results: The results showed that 12% of the children with COVID-19 had a history of wheezing, and 77.8% had mild wheezing in the past 12 months. Logistic regression analysis revealed that children with smoking fathers were 6.3 times more likely to wheeze than children with non-smoking fathers, and the likelihood of wheezing increased with age. The wheezing history of nine children revealed one allergy history in the family, one pet care in the home, seven home heaters, and two boilers. Nine children lived in personal houses and two lived in apartments, none of which were associated with wheezing.
Conclusion: The child's age and father's smoking behavior were found to have an impact on wheezing in asthmatic children with COVID-19. Further research is needed to better understand the impact of COVID-19 on pediatric populations, and the public health community should focus on studying this area more thoroughly.


Main Subjects

  1. Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species Severe acute respiratory syndrome related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol 2020;5:536-44 doi:10.1038/s41564-020-0695-z PMid:32123347 PMCid:PMC7095448
  2. World Health Organization. Coronavirus disease (COVID-19) dashboard: USA. Available from: https://covid19. who. int/region/amro/country/us. Accessibility verified June. 2020;4.
  3. Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. Harrison's principles of internal medicine, 19e: Mcgraw-hill New York, NY, USA:; 2015.
  4. Corne JM, Marshall C, Smith S, Schreiber J, Sanderson G, Holgate ST, et al. Frequency, severity, and duration of rhinovirus infections in asthmatic and non-asthmatic individuals: a longitudinal cohort study. Lancet. 2002;359(9309):831-4. doi:10.1016/S0140-6736(02)07953-9 PMid:11897281
  5. Jackson DJ, Trujillo-Torralbo M-B, del-Rosario J, Bartlett NW, Edwards MR, Mallia P, et al. The influence of asthma control on the severity of virus-induced asthma exacerbations. J Allergy Clin Immunol. 2015;136:497-500. e3 doi:10.1016/j.jaci.2015.01.028 PMid:25772596
  6. Southampion U. HLA class II genotype, HLA-DR B cell surface expression and allergen specific IgE production in atopic and non-atopic members of asthmatic family pedigrees. Clin Exp Allergy. 1999;29:35-8.
  7. Woszczek G, Kowalski M, Borowiec M. Association of asthma and total IgE levels with human leucocyte antigen-DR in patients with grass allergy. Eur Respir J. 2002;20:79-85 doi:10.1183/09031936.02.01002001 PMid:12166586
  8. CDC COVID-19 Response Team, CDC COVID-19 Response Team, CDC COVID-19 Response Team, Bialek S, Gierke R, Hughes M, McNamara LA, Pilishvili T, Skoff T. Coronavirus disease 2019 in children-United States, february 12–april 2, 2020. Morbidity and Mortality Weekly Report. 2020;69(14):422-6. doi:10.15585/mmwr.mm6914e4 PMid:32271728 PMCid:PMC7147903
  9. Brough HA, Kalayci O, Sediva A, Untersmayr E, Munblit D, Rodriguez del Rio P, et al. Managing childhood allergies and immunodeficiencies during respiratory virus epidemics-the 2020 COVID‐19 pandemic: a statement from the EAACI‐section on pediatrics. Pediatr Allergy Immunol. 2020;31:442-8 doi:10.1111/pai.13262 PMid:32319129 PMCid:PMC7264548
  10. Castro‐Rodriguez JA, Forno E. Asthma and COVID‐19 in children: a systematic review and call for data. Pediatr Pulmonol. 2020;55:2412-8 doi:10.1002/ppul.24909 PMid:32558360 PMCid:PMC7323291
  11. Ruano FJ, Álvarez MLS, Haroun-Díaz E, de la Torre MV, González PL, Prieto-Moreno A, et al. Impact of the COVID-19 pandemic in children with allergic asthma. J Allergy Clin Immunol Pract. 2020;8:3172-4. e1. doi:10.1016/j.jaip.2020.07.019 PMid:32730834 PMCid:PMC7384405
  12. Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19). People who are at increased risk for severe illness. Available from:
  13. Fedaizadeh L, Saeedfar K, Masjidi M. Evaluation of the agreement of written and video questionnaires in the international study of asthma and allergy in children of Tehran. J Shahid Sadoughi Univ Med Sci Healthc Serv, Yazd. 2007;16.
  14. Qarghazlou SK, Hallaj Mofard M, Karimi B, Honarmand M, Jafari H. Frequency and severity of asthma, allergic rhinitis and eczema symptoms in 6-7 year old children in Kashan city. Tehran Univ Med J. 2002;60:416-22.
  15. Shakurnia A, Assar S, Afra M, Latifi M. Prevalence of Symptoms of Asthma, Allergic Rhinitis and Eczema in 6-7 and 13-14 years old Ahvazian School children. East Mediterr Health J. 2011.
  16. Ansari H, Payandeh A, Arbabi Sarjou A, Soleimani G, Meshkinian A. Prevalence and Determinants of Eczema Among Elementary School Children, Southeast of Iran, 2019. J Arak Univ Med Sci. 2021;24:438-49 doi:10.32598/jams.24.3.6370.1
  17. Oreskovic NM, Kinane TB, Aryee E, Kuhlthau KA, Perrin JM. The unexpected risks of COVID-19 on asthma control in children. J Allergy Clin Immunol Pract. 2020;8:2489-91.
    doi:10.1016/j.jaip.2020.05.027 PMid:32497662 PMCid:PMC7263244
  18. Sohrabi C, Alsafi Z, O'neill N, Khan M, Kerwan A, Al-Jabir A, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg. 2020;76:71-6 doi:10.1016/j.ijsu.2020.02.034
    PMid:32112977 PMCid:PMC7105032
  19. Zimmermann P, Curtis N. Coronavirus Infections in Children Including COVID-19: An Overview of the Epidemiology, Clinical Features, Diagnosis, Treatment and Prevention Options in Children. Pediatr Infect Dis J. 2020;39(5):355-368 doi:10.1097/INF.0000000000002660 PMid:32310621 PMCid:PMC7158880
  20. Li Z, Yi Y, Luo X, Xiong N, Liu Y, Li S, et al. Development and clinical application of a rapid IgM‐IgG combined antibody test for SARS‐CoV‐2 infection diagnosis. J Med Virol. 2020;92:1518-24.
    doi:10.1002/jmv.25727 PMid:32104917 PMCid:PMC7228300
  21. Naseri F Incidence of children with chest wheezing during one year referred to the Children's Emergency Clinic of Qaim Hospital (AJ): Mashhad Univ Med Sci; 1992.
  22. Behrman RE, Kliegman RM, Jenson H. Nelson textbook of pediatrics. 16th editions. Wash ington: WB Saunders Company. 2000.
  23. Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. 2020;146:110-8 doi:10.1016/j.jaci.2020.04.006 PMid:32294485 PMCid:PMC7152876         
  24. Caminati M, Lombardi C, Micheletto C, Roca E, Bigni B, Furci F, et al. Asthmatic patients in COVID-19 outbreak: few cases despite many cases. J Allergy Clin Immunol. 2020;146:541-2 doi:10.1016/j.jaci.2020.05.049 PMid:32620309 PMCid:PMC7306702
  25. Gémes K, Talbäck M, Modig K, Ahlbom A, Berglund A, Feychting M, et al. Burden and prevalence of prognostic factors for severe COVID-19 in Sweden. Eur J Epidemiol. 2020;35:401-9.
    doi:10.1007/s10654-020-00646-z PMid:32424571 PMCid:PMC7233678
  26. Rezende LF, Thome B, Schveitzer MC, Souza-Júnior PR, Szwarcwald CL. Adults at high-risk of severe coronavirus disease-2019 (Covid-19) in Brazil. Rev Saúde Publ. 2020;54.
    PMid:32491091 PMCid:PMC7234208
  27. Borobia AM, Carcas AJ, Arnalich F, Álvarez-Sala R, Monserrat-Villatoro J, Quintana M, et al. A cohort of patients with COVID-19 in a major teaching hospital in Europe. J Clin Med. 2020;9:1733.
    doi:10.3390/jcm9061733 PMid:32512688 PMCid:PMC7356883
  28. Butler MW, O'Reilly A, Dunican EM, Mallon P, Feeney ER, Keane MP, et al. Prevalence of comorbid asthma in COVID-19 patients. J Allergy Clin Immunol. 2020;146:334-5 doi:10.1016/j.jaci.2020.04.061 PMid:32553599 PMCid:PMC7284278
  29. Khawaja AP, Warwick AN, Hysi PG, Kastner A, Dick A, Khaw PT, et al. Associations with covid-19 hospitalisation amongst 406,793 adults: the UK Biobank prospective cohort study. MedRxiv. 2020.
  30. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323:2052-9 doi:10.1001/jama.2020.6775 PMid:32320003 PMCid:PMC7177629
  31. Chhiba KD, Patel GB, Vu THT, Chen MM, Guo A, Kudlaty E, et al. Prevalence and characterization of asthma in hospitalized and nonhospitalized patients with COVID-19. J Allergy Clin Immunol. 2020;146:307-14. doi:10.1016/j.jaci.2020.06.010
    PMid:32554082 PMCid:PMC7295471
  32. Ibrahim LF, Tosif S, McNab S, Hall S, Lee HJ, Lewena S, et al. SARS‐CoV‐2 testing and outcomes in the first 30 days after the first case of COVID‐19 at an Australian children's hospital. Emerg Med Aust 2020;32:801-8 doi:10.1111/1742-6723.13550 PMid:32390285 PMCid:PMC7273066
  33. Yasuhara J, Kuno T, Takagi H, Sumitomo N. Clinical characteristics of COVID‐19 in children: a systematic review. Pediatr Pulmonol. 2020;55:2565-75 doi:10.1002/ppul.24991 PMid:32725955
  34. Abrams EM, Sinha I, Fernandes RM, Hawcutt DB. Pediatric asthma and COVID‐19: The known, the unknown, and the controversial. Pediatr Pulmonol. 2020;55:3573-8 doi:10.1002/ppul.25117 PMid:33058493 PMCid:PMC7675412
  35. Zappala C. Predicting a worse COVID-19 outcome [accessed 2 Sept 2020]. Available from:
  36. Petrakis D, Margină D, Tsarouhas K, Tekos F, Stan M, Nikitovic D, et al. Obesity‑a risk factor for increased COVID‑19 prevalence, severity and lethality. Mol Med Rep. 2020;22:9-19 doi:10.3892/mmr.2020.11127 PMid:32377709 PMCid:PMC7248467
  37. Zhang JJ, Cao YY, Tan G, Dong X, Wang BC, Lin J, et al. Clinical, radiological, and laboratory characteristics and risk factors for severity and mortality of 289 hospitalized COVID-19 patients. Allergy. 2021;76 (2):533-550. doi:10.1111/all.14496 PMid:32662525 PMCid:PMC7404752
  38. Beken B, Ozturk GK, Aygun FD, Aydogmus C, Akar HH. Asthma and allergic diseases are not risk factors for hospitalization in children with coronavirus disease 2019. Ann Allergy Asthma Immuno. 2021;126:569-75 doi:10.1016/j.anai.2021.01.018 PMid:33493639 PMCid:PMC7825986
  39. Centers for Disease Control and Prevention. COVID-19 and animals [accessed 9 Nov 2020]. Available from: