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BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m406 (Published 31 January 2020) Cite this as: BMJ 2020;368:m406

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Re: Response to the emerging novel coronavirus outbreak

Loss of smell and taste in the course of COVID-19 infection may be related to angiotensin converting enzyme (ACE) inhibition

Dear Editor,
Very recently, there has been reports of loss of smell and taste in the course of COVID-19 infection. The report from the presidents of the British Association of Otorhinolaryngology and British Rhinological Society noted that there has been growing number of reports of a significant increase in COVID-19 patients presenting with loss of smell in the absence of other symptoms [1]. Moreover, they suggested anosmia can be added to the current symptom criteria to trigger quarantine and/or self-isolation to limit dissemination of the COVID-19 [1].
In the former report [2], we suggested that there seems to be some ongoing ACE inhibition during COVID-19 infectious process because AngII is shown as increased in patients with COVID-19 and increased AngII causes decreased ACE mRNA levels in the lung and decrease in pulmonary ACE activity [3]. The dry cough, which is a very common presentation of COVID-19 infection, may be related to this ACE inhibition [2]. Of note, loss of smell and taste is a well-known effect of ACE inhibitors [4]. While post-viral anosmia is a common causes of loss of smell sensation, loss of smell/taste may be more common in COVID-19 infections regarding this pathophysiological process. We suggest that the ACE inhibition that is present in COVID-19 infections may be the cause of the loss of smell/taste symptomatology, which seems to be specifically common in COVID-19 infections.

References

1. https://www.entuk.org/loss-sense-smell-marker-covid-19-infection
2. https://www.bmj.com/content/368/bmj.m406/rr-23
3. Schunkert H, Ingelfinger JR, Hirsch AT, Pinto Y, Remme WJ, Jacob H, Dzau VJ. Feedback regulation of angiotensin converting enzyme activity and mRNA levels by angiotensin II. Circ Res. 1993;72:312-8.
4. Bromley SM. Smell and taste disorders: a primary care approach. Am Fam
Physician. 2000;61:427-36, 438.

Competing interests: No competing interests

21 March 2020
Gulistan Bahat
MD, Professor, Internal Medicine, Geriatrics
Istanbul University Istanbul Medical School Department of Internal Medicine Division of Geriatrics
Capa, 34093 Istanbul, TURKEY