A new form of irritant rhinitis to filtering facepiece particle (FFP) masks (FFP2/N95/KN95 respirators) during COVID-19 pandemic

• Published in: The World Allergy Organization journal Vol. 13; no. 10; p. 100474
• Main Authors: Klimek, Ludger, Huppertz, Tilman, Alali, Ali, Spielhaupter, Magdalena, Hörmann, Karl, Matthias, Christoph, Hagemann, Jan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2020; Elsevier BV; World Allergy Organization; Elsevier
• Subjects: Aerosols; Allergies; Allergy; COVID-19; Disease transmission; Edema; Endoscopy; FFP2-Mask; Filtering facepiece masks; Infections; Irritant rhinitis; KN95-Mask; Lavage; Masks; N95-mask; Nose; Pandemics; Patients; Personal protective equipment; Regulation; Rhinitis; Severe acute respiratory syndrome coronavirus 2; Viruses; United States > US; China; Japan; Germany; KN95-Mask; Allergy; CE; PPE; Filtering facepiece masks; Irritant rhinitis; VAS; COVID-19; FFP; SD / SEM; N95-mask; ECP; N95 / KN95; FFP2-Mask; WHO; VAS, visual analogue scale; FFP, filtering facepiece particle; CE, conformité européenne label indicating conformity to the EU-regulation 765/2008; COVID-19, coronavirus disease from the year 2019; N95 / KN95, technical / physical standard for filtering face masks (not penetrated by particles larger 0.3 μm, N/KN indicating that aqueous, but not oily aerosols are filtered; SD / SEM, standard deviation / standard error of the mean; PPE, personal protective equipment; WHO, World Health Organization; ECP, eosinophilic cationic protein
• ISSN: 1939-4551; 1939-4551
• DOI: 10.1016/j.waojou.2020.100474

Filtering facepiece particle (FFP) masks are important items of personal protective equipment in fighting COVID-19 pandemic. They shall protect the wearer of the mask from particles, droplets, and aerosols, but they also can prevent the spread of aerosol-transmitted viruses if the wearer becomes infected. Most often, FFP respirators consist of multiple layers of non-woven fabric made from polypropylene. Worldwide, FFP respirators are subject to various regulatory standards that specify physical properties and performance characteristics. During the SARS-CoV-2 pandemic, health authorities have temporarily repealed standards for respirators. We report on 46 patients that presented with rhinitis-like symptoms strongly associated to the use of FFP masks. Some of them were obliged to use FFP masks in their work environment. Nasal endoscopy showed edemata of the nasal mucosa that significantly decreased after a period of non-use of FFP masks. Subjectively reported symptom levels decreased after cessation of FFP use for 3 or more days. The presence of polypropylene fibres isolated from nasal rinsing solution was significantly associated with the use of FFP masks in our patients. Material safety and performance deregulation of FFP masks can pose a health risk. Thus, especially health care professionals and other individuals with occupational need for FFP masks should be aware of possible hazards that come with COVID-19 pandemic protection measures.