John Carew, MD, is board-certified in otolaryngology and is an adjunct assistant professor at New York University Medical Center.

Nasal polyps are benign growths that occur in the nasal and sinus passageways. Given that COVID-19 is a respiratory illness, it is logical to wonder what the implications of nasal polyps might be as a risk factor or exacerbating feature in people infected with COVID-19.

You may wonder whether a condition that can cause chronic congestion and narrowed nasal and sinus passageways might make the breathing problems associated with COVID-19 worse.

There is also speculation that corticosteroid medications that are commonly used to treat nasal polyps and the associated condition, chronic rhinosinusitis, affect your immune system and may decrease your ability to fight infection, including COVID-19.

It is a well-known fact that these types of medications are capable of suppressing immunity. It is also interesting to note that steroids are sometimes used to treat COVID-19 in certain clinical situations.

Currently, these speculations are just that. More research is needed to verify how nasal polyps or the medications that treat them might increase your risk of getting COVID-19 or change the way the virus affects you. Here's what we do know.

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We now know that in individuals infected with COVID-19, the viral load tends to be highest in the nasal passageways and this is most likely where initial infection occurs and is spread.

An interesting finding in preliminary studies is that the virus that causes COVID-19 requires the presence of angiotensin-converting enzyme 2 (ACE2) to replicate. Samples of nasal polyp tissue were found to have a lower amount of ACE2 than in control tissue.

This finding could be used to hypothesize that people with nasal polyps might actually be less likely to get COVID-19. More research is needed.

Nasal polyps and COVID-19 share a few overlapping symptoms. These include decreased sense of smell and taste, a feeling of congestion or stuffiness, and, in rare cases, difficulty breathing. However, a key difference between nasal polyps and COVID-19 is that with nasal polyps, these symptoms are likely to come on slowly over a long time.

It is possible that if you already experience these symptoms from a chronic condition like nasal polyps that COVID-19 will exacerbate them. However, current research does not confirm that individuals with nasal polyps are more likely to be hospitalized or experience breathing problems from COVID-19.

It is unknown how nasal polyps and COVID-19 may affect your sense of smell or other symptoms. It is not known at this time if nasal polyps contribute to the possibility that you will experience lingering effects of COVID-19.

Medications that affect the immune response are frequently used in the treatment of nasal polyps. These include corticosteroids and biologic medications such as dupilumab.

Some people have hypothesized that since corticosteroids are known to suppress your immune response, it is logical to assume that using these medications would increase your risk of catching COVID-19 or affect your body's ability to fight off COVID-19. However, science isn't exactly bearing this theory out.

A case report of COVID-19 in a patient who was taking dupilumab for nasal polyps showed a very mild case of COVID-19, but this is hardly evidence for all individuals who might be using this medication.

A study conducted on chronic obstructive pulmonary disease (COPD) and asthma patients using inhaled corticosteroids seemed to suggest a slightly increased risk of death of COVID-19 that correlated with higher doses of inhaled corticosteroids.

Ultimately, however, the study authors could not be certain that this was directly caused by the medication and not the underlying illness since higher doses of corticosteroids were mainly used in patients with more severe respiratory disease.

Interestingly, one inhaled steroid used to treat asthma and allergic rhinitis (the condition that commonly leads to nasal polyps), ciclesonide, has been shown in some studies to inhibit the replication of coronaviruses.

There have also been a few case reports of COVID-19-related pneumonia being successfully treated using this medication. More research is needed.

You are not alone if you are still confused after reading the outcomes of these studies. It's safe to say that the jury is still out when it comes to the various medications used to treat nasal polyps and their likely effects on the risk of contracting or becoming seriously ill from COVID-19.

If you are concerned about the medications you are using to treat your nasal polyps, it's highly recommended that you discuss this with your healthcare provider.

There is currently no indication that individuals with nasal polyps cannot safely receive the COVID-19 vaccination. Even people with underlying allergies (common in people who suffer from nasal polyposis) can safely get the shot as long as they are not allergic to any specific vaccine component.

If you take dupilumab for your nasal polyps, you have likely been advised not to receive any live vaccination. However, the current COVID-19 vaccinations (Pfizer, Moderna, and Johnson & Johnson) do not fall under this category, as they contain no actual live virus.

There is currently no indication that people with nasal polyps cannot safely wear a face mask during the COVID-19 pandemic.

If you experience increased symptoms such as congestion or post-nasal drip, try different masks (switching from a surgical mask to a fabric mask, for example). If possible, take frequent breaks from your mask (away from other people, of course).

If you experience any concerning symptoms such as feeling light-headed or dizzy or having difficulty breathing, remove the mask immediately and consult a healthcare professional.

The current evidence does not support discontinuing medications for nasal polyps to decrease your risk of getting COVID-19 or becoming seriously ill from COVID-19. However, if you are worried about this, discuss it with your healthcare provider.

Information on this is limited right now. However, we were able to identify at least one source that mentions upper airway obstruction, congestion, mucositis, bleeding disorders, facial trauma, or recent surgery as contraindications for nasal swab testing.

Since many of these conditions are present in people with nasal polyps, it may be wise to opt for another type of test (for example, saliva testing).

The following tips can help to reduce your risk of getting COVID-19:

While it is perfectly understandable to be nervous that underlying health conditions such as nasal polyps may increase your risk of becoming seriously ill from COVID-19, it is important to remember that current evidence has not made this conclusion.

The best way to protect yourself is to follow the public health guidelines listed above and work closely with your healthcare professional to manage your nasal polyps.

The information in this article is current as of the date listed. As new research becomes available, we’ll update this article. For the latest on COVID-19, visit our coronavirus news page.

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Jian L, Yi W, Zhang N, et al. Perspective: COVID-19, implications of nasal diseases and consequences for their management. J Allergy Clin Immunol. 2020;146(1):67-69. doi:10.1016/j.jaci.2020.04.030

Johns Hopkins Medicine. Nasal polyps.

Förster-Ruhrmann U, Szczepek AJ, Bachert C, Olze H. COVID-19 in a patient with severe chronic rhinosinusitis with nasal polyps during therapy with dupilumab. J Allergy Clin Immunol. 2020;146(1):218-220.e2. doi:10.1016/j.jaci.2020.05.005

Jordan A, Sivapalan P, Jensen J-U. Does inhaled corticosteroid use affect the risk of COVID-19-related death? Breathe. 2021;17(1):200275. doi:10.1183/20734735.0275-2020

Matsuyama S, Kawase M, Nao N, Shirato K, Ujike M, Kamitani W, Shimojima M, Fukushi S. The inhaled steroid ciclesonide blocks SARS-CoV-2 RNA replication by targeting the viral replication-transcription complex in cultured cells. J Virol. 2020 Dec 9;95(1):e01648-20. doi:10.1128/JVI.01648-2010

American Academy of Otolaryngology Head and Neck Surgery. Allergic reactions related to COVID-19 vaccinations in allergic patients.

The Royal Children's Hospital Melbourne. COVID-19 swabbing.

Centers for Disease Control and Prevention. How to protect yourself and others.

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