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Gouveia J, Rodrigues MA, Fernandes I, Cabral R, Falcão H. Safety of a mRNA COVID-19 Vaccine in Patients with Indolent Systemic Mastocytosis. ACTA MEDICA PORT 2024; 37:224-225. [PMID: 38430469 DOI: 10.20344/amp.20851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/11/2023] [Indexed: 03/03/2024]
Affiliation(s)
- Joana Gouveia
- Serviço de Imunoalergologia. Centro Hospitalar Universitário de Santo António. Porto. Portugal
| | | | - Iolanda Fernandes
- Serviço de Dermatologia. Centro Hospitalar Universitário de Santo António. Porto; Consulta Multidisciplinar de Linfomas Cutâneos e Mastocitoses. Centro Hospitalar Universitário de Santo António. Porto; Unidade Multidisciplinar de Investigação Biomédica. Instituto de Ciências Biomédicas Abel Salazar. Universidade do Porto. Porto. Portugal
| | - Renata Cabral
- Serviço de Imunoalergologia. Centro Hospitalar Universitário de Santo António. Porto. Portugal
| | - Helena Falcão
- Serviço de Imunoalergologia. Centro Hospitalar Universitário de Santo António. Porto. Portugal
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2
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Giannetti MP, Nicoloro-SantaBarbara J, Godwin G, Middlesworth J, Espeland A, Douvas JL, Castells MC. Challenges in Drug and Hymenoptera Venom Hypersensitivity Diagnosis and Management in Mastocytosis. Diagnostics (Basel) 2024; 14:123. [PMID: 38247999 PMCID: PMC10814166 DOI: 10.3390/diagnostics14020123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/26/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Mastocytosis is a myeloproliferative neoplasm characterized by abnormal proliferation and activation of clonal mast cells typically bearing the KITD816V mutation. Symptoms manifest due to the release of bioactive mediators and the tissue infiltration by neoplastic mast cells. Mast cell activation symptoms include flushing, pruritus, urticaria, abdominal cramping, diarrhea, wheezing, neuropsychiatric symptoms, and anaphylaxis. Up to 50% of patients with mastocytosis report a history of provoked and unprovoked anaphylaxis, with Hymenoptera venom and drugs the most common culprits. NSAIDs, antibiotics, vaccines, perioperative medications, and radiocontrast media are often empirically avoided without evidence of reactions, depriving patients of needed medications and placing them at risk for unfavorable outcomes. The purpose of this review is to highlight the most common agents responsible for adverse drug reactions in patients with mastocytosis, with a review of current epidemiology, diagnosis, and management of drug hypersensitivity and Hymenoptera venom allergy.
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Affiliation(s)
- Matthew P. Giannetti
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Jennifer Nicoloro-SantaBarbara
- Harvard Medical School, Boston, MA 02115, USA
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Grace Godwin
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Julia Middlesworth
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Andrew Espeland
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Julia L. Douvas
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Mariana C. Castells
- Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Boston, MA 02115, USA
- Harvard Medical School, Boston, MA 02115, USA
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3
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Khalid MB, Frischmeyer-Guerrerio PA. The conundrum of COVID-19 mRNA vaccine-induced anaphylaxis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:1-13. [PMID: 36532656 PMCID: PMC9746073 DOI: 10.1016/j.jacig.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 12/14/2022]
Abstract
Novel messenger RNA (mRNA) vaccines have proven to be effective tools against coronavirus disease 2019, and they have changed the course of the pandemic. However, early reports of mRNA vaccine-induced anaphylaxis resulted in public alarm, contributing toward vaccine hesitancy. Although initial reports were concerning for an unusually high rate of anaphylaxis to the mRNA vaccines, the true incidence is likely comparable with other vaccines. These reactions occurred predominantly in young to middle-aged females, and many had a history of allergies. Although initially thought to be triggered by polyethylene glycol (PEG), lack of reproducibility of these reactions with subsequent dosing and absent PEG sensitization point away from an IgE-mediated PEG allergy in most. PEG skin testing has poor posttest probability and should be reserved for evaluating non-vaccine-related PEG allergy without influencing decisions for subsequent mRNA vaccination. Immunization stress-related response can closely mimic vaccine-induced anaphylaxis and warrants consideration as a potential etiology. Current evidence suggests that many individuals who developed anaphylaxis to the first dose of an mRNA vaccine can likely receive a subsequent dose after careful evaluation. The need to understand these reactions mechanistically remains critical because the mRNA platform is rapidly finding its way into other vaccinations and therapeutics.
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Key Words
- AE, Adverse event
- BAT, Basophil activation test
- CARPA, Complement activation–related pseudoallergy
- COVID-19
- COVID-19, Coronavirus disease 2019
- ISRR
- ISRR, Immunization stress–related response
- LNP, Lipid nanoparticle
- PAF, Platelet-activating factor
- PEG
- PEG, Polyethylene glycol
- SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2
- VAERS, Vaccine adverse event reporting system
- allergic reaction
- allergy
- anaphylaxis
- immunization stress–related response
- mRNA
- mRNA, Messenger RNA
- polyethylene glycol
- vaccine
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Affiliation(s)
| | - Pamela A. Frischmeyer-Guerrerio
- Corresponding author: Pamela A. Frischmeyer-Guerrerio, MD, PhD, Laboratory of Allergic Diseases, Food Allergy Research Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, MSC 1881, 10 Center Dr, Bethesda, MD 20892
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4
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Giannetti MP, Olivieri F, Godwin G, Weller E, Nicoloro‐SantaBarbara J, Bonadonna P, Zanotti R, Zanoni G, Hartmann K, Castells M. Outcomes of COVID-19 vaccination in 323 patients with clonal and non-clonal mast cell activation disorders. Allergy 2022; 78:301-304. [PMID: 35962620 PMCID: PMC9538600 DOI: 10.1111/all.15476] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/02/2022] [Accepted: 08/10/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Matthew P. Giannetti
- Division of Allergy and Clinical ImmunologyBrigham and Women's HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | | | - Grace Godwin
- Division of Allergy and Clinical ImmunologyBrigham and Women's HospitalBostonMassachusettsUSA
| | - Emma Weller
- Division of Allergy and Clinical ImmunologyBrigham and Women's HospitalBostonMassachusettsUSA
| | | | | | | | | | - Karin Hartmann
- Division of AllergyUniversity Hospital Basel and University of BaselBaselSwitzerland,Department of BiomedicineUniversity Hospital Basel and University of BaselBaselSwitzerland
| | - Mariana Castells
- Division of Allergy and Clinical ImmunologyBrigham and Women's HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
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5
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Tuyls S, Van Der Brempt X, Faber M, Gadisseur R, Dezfoulian B, Schrijvers R, Froidure A. Allergic reactions to COVID-19 vaccines: statement of the Belgian Society for Allergy and Clinical Immunology (BelSACI). Acta Clin Belg 2022; 77:552-557. [PMID: 33792500 DOI: 10.1080/17843286.2021.1909447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Vaccination against COVID-19 constitutes a huge hope and a major challenge. For the first time in modern history, a global vaccination campaign has started worldwide in a short period of time and with products that were recently developed. Consequently, legitimate concerns regarding the safety and tolerability of COVID-19 vaccines arise.In line with international allergy societies, the Belgian Society for Allergy and Clinical Immunology (BelSACI) provides this statement to guide health care providers (general practitioners, specialists including allergists) and stakeholders.In this statement, we first review current evidence on allergic reactions to vaccines and the potential risk factors that have been identified.Second, we provide a risk stratification method that may be used as a worksheet during the vaccination campaign.Finally, we discuss the management of suspected or confirmed allergic reactions following vaccination.
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Affiliation(s)
- Sebastiaan Tuyls
- Pulmonology Department, Sint Augustinus Ziekenhuis GZA, Antwerpen and UZ Leuven, Leuven, Belgium
| | | | - Margaretha Faber
- Allergology and Immunology Department, World Allergy Organization (WAO) Center of Excellence, Universitaire Ziekenhuizen Antwerpen and Universiteit Antwerpen, Antwerpen, Belgium
| | - Romy Gadisseur
- Clinical Biology Department, CHU Liège and Université de Liège, Liège, Belgium
| | - Bita Dezfoulian
- Dermatology Department, CHU Liège and Université de Liège, Liège, Belgium
| | - Rik Schrijvers
- KU Leuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium
| | - Antoine Froidure
- Pulmonology Department, WAO Center of Excellence, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Bruxelles, Belgium
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6
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Tuncay G, Bostan OC, Damadoglu E, Karakaya G, Kalyoncu AF. SARS-CoV-2 vaccines are well tolerated in patients with mastocytosis. Ann Allergy Asthma Immunol 2022; 128:733-734. [PMID: 35257871 PMCID: PMC8894735 DOI: 10.1016/j.anai.2022.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Gülseren Tuncay
- Division of Allergy and Clinical Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Ozge Can Bostan
- Division of Allergy and Clinical Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ebru Damadoglu
- Division of Allergy and Clinical Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Gül Karakaya
- Division of Allergy and Clinical Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ali Fuat Kalyoncu
- Division of Allergy and Clinical Immunology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Pitlick MM, Gonzalez-Estrada A, Park MA. Graded coronavirus disease 2019 vaccine administration: A safe alternative to vaccine avoidance. Ann Allergy Asthma Immunol 2022; 128:731-733. [PMID: 35257875 PMCID: PMC8894737 DOI: 10.1016/j.anai.2022.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 01/31/2023]
Affiliation(s)
| | | | - Miguel A Park
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota
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8
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Rama TA, Miranda J, Silva D, Amaral L, Castro E, Coimbra A, Moreira A, Plácido JL. COVID-19 Vaccination Is Safe among Mast Cell Disorder Patients, under Adequate Premedication. Vaccines (Basel) 2022; 10:718. [PMID: 35632474 PMCID: PMC9146268 DOI: 10.3390/vaccines10050718] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
Reported cases of anaphylaxis following COVID-19 vaccination raised concerns about the safety of these vaccines, namely in patients suffering from clonal mast cell (MC) disorders-a heterogenous group of disorders in which patients may be prone to anaphylaxis caused by vaccination. This study aimed to assess the safety of COVID-19 vaccines in patients with clonal MC disorders. We performed an ambidirectional cohort study with 30 clonal MC disorder patients (n = 26 in the prospective arm and n = 4 in the retrospective arm), that were submitted to COVID-19 vaccination. Among these, 11 (37%) were males, and median age at vaccination date was 41 years (range: 5y to 76y). One patient had prior history of anaphylaxis following vaccination. Those in the prospective arm received a premedication protocol including H1- and H2-antihistamines and montelukast, while those in the retrospective arm did not premedicate. Overall, patients received a total of 81 doses, 73 under premedication and 8 without premedication. No MC activation symptoms were reported. COVID-19 vaccination seems to be safe in patients with clonal mast cell disorders, including those with prior anaphylaxis following vaccination. Robust premedication protocols may allow for vaccination in ambulatory settings.
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Affiliation(s)
- Tiago Azenha Rama
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
- EPIUnit—Institute of Public Health, University of Porto, 4050-600 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
| | - Joana Miranda
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
| | - Diana Silva
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
- EPIUnit—Institute of Public Health, University of Porto, 4050-600 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
| | - Luís Amaral
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
| | - Eunice Castro
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
| | - Alice Coimbra
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
| | - André Moreira
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
- EPIUnit—Institute of Public Health, University of Porto, 4050-600 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
| | - José Luís Plácido
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
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9
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Ruano-Zaragoza M, Carpio-Escalona LV, Diaz-Beya M, Piris-Villaespesa M, Castaño-Diez S, Muñoz-Cano R, González-de-Olano D. Safety of COVID-19 vaccination in patients with clonal mast cell disorders. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1374-1376.e3. [PMID: 35121156 PMCID: PMC8806141 DOI: 10.1016/j.jaip.2022.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/21/2021] [Accepted: 01/12/2022] [Indexed: 12/28/2022]
Affiliation(s)
- Maria Ruano-Zaragoza
- Allergy Section, IRCE-Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Hospital Clinic, Barcelona, Spain; ARADyAL, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | | | - Rosa Muñoz-Cano
- Allergy Section, IRCE-Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Hospital Clinic, Barcelona, Spain; ARADyAL, Instituto de Salud Carlos III, Madrid, Spain.
| | - David González-de-Olano
- ARADyAL, Instituto de Salud Carlos III, Madrid, Spain; Allergy Department, Hospital Universitario Ramon y Cajal, IRYCIS, Madrid, Spain.
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10
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Szebeni J, Storm G, Ljubimova JY, Castells M, Phillips EJ, Turjeman K, Barenholz Y, Crommelin DJA, Dobrovolskaia MA. Applying lessons learned from nanomedicines to understand rare hypersensitivity reactions to mRNA-based SARS-CoV-2 vaccines. NATURE NANOTECHNOLOGY 2022; 17:337-346. [PMID: 35393599 DOI: 10.1038/s41565-022-01071-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 01/04/2022] [Indexed: 05/24/2023]
Abstract
After over a billion of vaccinations with messenger RNA-lipid nanoparticle (mRNA-LNP) based SARS-CoV-2 vaccines, anaphylaxis and other manifestations of hypersensitivity can be considered as very rare adverse events. Although current recommendations include avoiding a second dose in those with first-dose anaphylaxis, the underlying mechanisms are unknown; therefore, the risk of a future reaction cannot be predicted. Given how important new mRNA constructs will be to address the emergence of new viral variants and viruses, there is an urgent need for clinical approaches that would allow a safe repeated immunization of high-risk individuals and for reliable predictive tools of adverse reactions to mRNA vaccines. In many aspects, anaphylaxis symptoms experienced by the affected vaccine recipients resemble those of infusion reactions to nanomedicines. Here we share lessons learned over a decade of nanomedicine research and discuss the current knowledge about several factors that individually or collectively contribute to infusion reactions to nanomedicines. We aim to use this knowledge to inform the SARS-CoV-2 lipid-nanoparticle-based mRNA vaccine field.
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Affiliation(s)
- Janos Szebeni
- Nanomedicine Research and Education Center, Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
- SeroScience LCC, Budapest, Hungary
- Department of Nanobiotechnology and Regenerative Medicine, Faculty of Health, Miskolc University, Miskolc, Hungary
| | - Gert Storm
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
- Department of Biomaterials Science and Technology, University of Twente, Enschede, the Netherlands
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Mariana Castells
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth J Phillips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Keren Turjeman
- Laboratory of Membrane and Liposome Research, IMRIC, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Yechezkel Barenholz
- Laboratory of Membrane and Liposome Research, IMRIC, Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Daan J A Crommelin
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences (UIPS), Faculty of Science, Utrecht University, Utrecht, the Netherlands
| | - Marina A Dobrovolskaia
- Nanotechnology Characterization Laboratory, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA.
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11
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Zothantluanga JH, Abdalla M, Rudrapal M, Tian Q, Chetia D, Li J. Computational Investigations for Identification of Bioactive Molecules from Baccaurea ramiflora and Bergenia ciliata as Inhibitors of SARS-CoV-2 M pro. Polycycl Aromat Compd 2022. [DOI: 10.1080/10406638.2022.2046613] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- James H. Zothantluanga
- Department of Pharmaceutical Sciences, Faculty of Science and Engineering, Dibrugarh University, Dibrugarh, Assam, India
| | - Mohnad Abdalla
- Key Laboratory of Chemical Biology (Ministry of Education), Department of Pharmaceutics, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Shandong Province, PR China
| | - Mithun Rudrapal
- Department of Pharmaceutical Chemistry, Rasiklal M. Dhariwal Institute of Pharmaceutical Education Research, Pune, Maharashtra, India
| | - Qiang Tian
- Department of Senile Neurology, The Central Hospital of Taian, Taian, Shandong, PR China
| | - Dipak Chetia
- Department of Pharmaceutical Sciences, Faculty of Science and Engineering, Dibrugarh University, Dibrugarh, Assam, India
| | - Jin Li
- Key Laboratory of Chemical Biology (Ministry of Education), Department of Pharmaceutics, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Shandong Province, PR China
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12
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COVID-19 Vaccination Safety and Tolerability in Patients Allegedly at High Risk for Immediate Hypersensitivity Reactions. Vaccines (Basel) 2022; 10:vaccines10020286. [PMID: 35214744 PMCID: PMC8879861 DOI: 10.3390/vaccines10020286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/17/2022] [Accepted: 02/10/2022] [Indexed: 12/26/2022] Open
Abstract
The reported incidence of immediate hypersensitivity reactions (IHR) including anaphylaxis after COVID-19 vaccination is 10-fold higher than for other vaccines. Several patient groups are theorized to be at particular risk. Since specific vaccination guidelines for these patients are based on expert opinion, we performed a retrospective monocentric analysis of the tolerability of adenoviral vector and mRNA-based COVID-19 vaccines in a cohort of patients allegedly at high risk of IHR. Reactions were assessed immediately on-site by allergists during a monitored vaccination protocol and after 3–7 days through telephone interviews. The cohort included 196 patients (aged 12–84 years) with primary mast cell disease (pMCD, 50.5%), idiopathic anaphylaxis (IA, 19.9%), hereditary angioedema (HAE, 5.1%) or miscellaneous indications (24.5%). Twenty-five immediate reactions were observed in 221 vaccine doses (11.3%). Most occurred in IA or miscellaneous patients. None fulfilled anaphylaxis criteria and most were mild and self-limiting. Reaction occurrence was significantly associated with female sex. In total, 13.5% of pMCD patients reported mast cell activation-like symptoms within 72 h post-vaccination. All pediatric pMCD patients (n = 9, 12–18 years) tolerated both mRNA-based vaccine doses. In summary, adenoviral vector and mRNA-based COVID-19 vaccines were safe and well-tolerated in patients with pMCD, HAE, and IA. No anaphylaxis was observed. The mild and subjective nature of most reactions suggests a nocebo effect associated with vaccination in a medicalized setting. Patients with pMCD could experience mild flare-ups of mast cell activation-like symptoms, supporting antihistamine premedication.
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13
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A naturally hypersensitive porcine model may help understand the mechanism of COVID-19 mRNA vaccine-induced rare (pseudo) allergic reactions: complement activation as a possible contributing factor. GeroScience 2022; 44:597-618. [PMID: 35146583 PMCID: PMC8831099 DOI: 10.1007/s11357-021-00495-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/20/2021] [Indexed: 12/16/2022] Open
Abstract
A tiny fraction of people immunized with lipid nanoparticle (LNP)-enclosed mRNA (LNP-mRNA) vaccines develop allergic symptoms following their first or subsequent vaccinations, including anaphylaxis. These reactions resemble complement (C) activation-related pseudoallergy (CARPA) to i.v. administered liposomes, for which pigs provide a naturally oversensitive model. Using this model, we injected i.v. the human vaccination dose (HVD) of BNT162b2 (Comirnaty, CMT) or its 2-fold (2x) or 5-fold (5x) amounts and measured the hemodynamic changes and other parameters of CARPA. We observed in 6 of 14 pigs transient pulmonary hypertension along with thromboxane A2 release into the blood and other hemodynamic and blood cell changes, including hypertension, granulocytosis, lymphopenia, and thrombocytopenia. One pig injected with 5x CMT developed an anaphylactic shock requiring resuscitation, while a repeat dose failed to induce the reaction, implying tachyphylaxis. These typical CARPA symptoms could not be linked to animal age, sex, prior immune stimulation with zymosan, immunization of animals with Comirnaty i.v., or i.m. 2 weeks before the vaccine challenge, and anti-PEG IgM levels in Comirnaty-immunized pigs. Nevertheless, IgM binding to the whole vaccine, used as antigen in an ELISA, was significantly higher in reactive animals compared to non-reactive ones. Incubation of Comirnaty with pig serum in vitro showed significant elevations of C3a anaphylatoxin and sC5b-9, the C-terminal complex. These data raise the possibility that C activation plays a causal or contributing role in the rare HSRs to Comirnaty and other vaccines with similar side effects. Further studies are needed to uncover the factors controlling these vaccine reactions in pigs and to understand their translational value to humans.
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14
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Tuzer C, Terzioglu K. Evaluation of the Autoimmunity and Preexisting Risky Conditions for Hypersensitivity Reactions to COVID-19 Vaccines. Int Arch Allergy Immunol 2022; 183:651-661. [PMID: 35114667 PMCID: PMC9059002 DOI: 10.1159/000521709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/15/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The role of autoimmunity and other preexisting risky conditions in hypersensitivity reactions (HSRs) to COVID-19 vaccines seems unclear. The aim of the study was to investigate the autoimmunity and preexisting risky conditions in HSRs to COVID-19 vaccines. METHODS The patients aged ≥18 years with a history of HSR to CoronaVac or Pfizer-BioNTech COVID-19 vaccines within 24 h in 2 tertiary centers were assessed. The patients were divided according to the type of vaccine which they showed immediate-type (<4 h) HSR to (group A1 for CoronaVac and group B1 for Pfizer-BioNTech). Equal number of subjects who did not show HSR to two doses of either CoronaVac or Pfizer-BioNTech was recruited into the study as control groups (group A2 for CoronaVac and group B2 for Pfizer-BioNTech). The autologous serum skin test (ASST) was performed on patient and control groups. Later, the demographic, clinical, and laboratory features were compared between groups. RESULTS A total number of 27 patients were included in the study. Subjects with chronic spontaneous urticaria (CSU) were more frequent in group B1 than in group B2 (p:0.041). In addition to CSU, the presence of HSRs to drugs was higher in group A1 than in A2 (both p:0.007). The presence of autoimmunity and autoimmune diseases, positivity of antithyroid peroxidase antibody, and ASST were less in group A2 than in A1 (p:0.015, p:0.048, p:0.048, and p:0.037). Additionally, COVID-19 infection history was less in group A2 than in A1 (p:0.037). DISCUSSION/CONCLUSION Type IIb autoimmunity seems to play a role in immediate type HSRs to the CoronaVac vaccine as previously shown in autoimmune CSU and multidrug hypersensitivity.
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Affiliation(s)
- Can Tuzer
- Adult Immunology and Allergy Clinic, Batman Research and Education Hospital, Batman, Turkey
| | - Kadriye Terzioglu
- Adult Immunology and Allergy Clinic, Kartal Dr. Lütfi Kırdar City Hospital, İstanbul, Turkey
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15
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Al-Musa A, LaBere B, Habiballah S, Nguyen AA, Chou J. Advances in clinical outcomes: what we have learned during the COVID-19 pandemic. J Allergy Clin Immunol 2021; 149:569-578. [PMID: 34958811 PMCID: PMC8704728 DOI: 10.1016/j.jaci.2021.12.775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/12/2021] [Accepted: 12/16/2021] [Indexed: 11/28/2022]
Abstract
Our understanding of risk factors and interventions influencing outcomes from coronavirus disease 2019 (COVID-19) has continued to evolve, revealing advances emerging from hypotheses formed at the start of the pandemic. Epidemiologic studies have shown that asthma control, rather than a diagnosis of asthma, is a determinant of COVID-19 severity. Clinical outcomes in patients with primary immunodeficiencies, even in those with impaired cellular immunity, are variable. IL-6 has emerged as a reliable biomarker of COVID-19 severity, and large clinical trials have shown the potential for improving outcomes through inhibition of IL-6 signaling in some patients. Studies of genetic risk factors for severe COVID-19 have also revealed the importance of interferon homeostasis in the defense against severe acute respiratory syndrome coronavirus 2. Because COVID-19 vaccines constitute the primary tool for ending this pandemic, strategies have been developed to address potential allergic and immune-mediated reactions. Here, we discuss advances in our understanding of COVID-19 risk factors and outcomes within the context of allergic and immunologic mechanisms.
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Affiliation(s)
- Amer Al-Musa
- Division of Immunology, Boston Children's Hospital, Harvard Medical School
| | - Brenna LaBere
- Division of Immunology, Boston Children's Hospital, Harvard Medical School
| | - Saddiq Habiballah
- Division of Immunology, Boston Children's Hospital, Harvard Medical School
| | - Alan A Nguyen
- Division of Immunology, Boston Children's Hospital, Harvard Medical School
| | - Janet Chou
- Division of Immunology, Boston Children's Hospital, Harvard Medical School.
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16
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Castells M, Demoly P, Tanno LK. L'anaphylaxie et les vaccins COVID-19. REVUE FRANÇAISE D'ALLERGOLOGIE 2021; 61:8S30-8S35. [PMID: 34980951 PMCID: PMC8716577 DOI: 10.1016/s1877-0320(21)00439-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Les vaccins contre le COVID-19 sont une intervention essentielle pour contrôler la situation pandémique mondiale actuelle. Des réactions anaphylactiques ont été rapidement rapportées après les vaccins à ARN du SARS-CoV2. Ce risque est maintenant mesuré à 2,5-11/1000 000 dans le cadre des programmes de surveillance de la sécurité des vaccins et un seul cas a été documenté comme étant dû au polyéthylène glycol. Les suggestions pour son rôle sont indirectes. La vaccination contre le COVID-19 est en cours de déploiement et les programmes de surveillance sont essentiels pour observer les effets indésirables graves, tels que l'anaphylaxie. Il est important de restaurer la confiance dans la vaccination avec l'ARNm du COVID-19 et d'autres vaccins et les données actuelles confirment leur innocuité sans plus de mortalité que les vaccins précédents. L'anaphylaxie est une condition qui doit être reconnue immédiatement, être traitée par épinéphrine et qui n'est pas limitative et permet la revaccination de certains patients avec prémédication. Il est important de reconnaître les populations à risque telles que les femmes, les patients ayant des antécédents d'allergies et d'anaphylaxie et de reconnaître les rares patients atteints de maladies activant les mastocytes. L'anaphylaxie due au vaccin est extrêmement rare et les cas spécifiques doivent faire l'objet d'une investigation et d'une prise en charge individualisées, soulignant le rôle clé des allergologues dans les programmes de vaccination.
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Affiliation(s)
- M Castells
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Massachusetts, États-Unis
| | - P Demoly
- Department of Allergy, University Hospital of Montpellier, Montpellier, France
- Institut Desbrest d'épidémiologie et de santé publique, IDESP, University of Montpellier - INSERM, France
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| | - L K Tanno
- Department of Allergy, University Hospital of Montpellier, Montpellier, France
- Institut Desbrest d'épidémiologie et de santé publique, IDESP, University of Montpellier - INSERM, France
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
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17
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Yacoub MR, Cucca V, Asperti C, Ramirez GA, Della-Torre E, Moro M, Zandalasini C, Di Napoli D, Ambrosio A, Signorelli C, Colombo S, Beretta L, Ciceri F, Zangrillo A, Dagna L. Efficacy of a rational algorithm to assess allergy risk in patients receiving the BNT162b2 vaccine. Vaccine 2021; 39:6464-6469. [PMID: 34598820 DOI: 10.1016/j.vaccine.2021.09.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/17/2021] [Accepted: 09/19/2021] [Indexed: 02/02/2023]
Abstract
Among 6146 hospital employees, 118 subjects with severe allergic background were identified through a screening questionnaire and stratified into 3 groups (Low-risk (LR), Intermediate (IR) and High-risk (HR) group), based on their allergic anamnesis. Data reports on hypersensitivity reactions (HypR) have been collected in both allergic and non-allergic subjects. Seventeen patients (14%) in the allergic population had a HypR after the first, the second or both doses. Skin manifestations were the most frequent ones. Allergic events were more frequent in HR (35%) than IR (10%; p = 0.005) or LR (0%; p = 0.074) subjects. No patient had anaphylaxis. All patients completed the vaccination schedule. 13 HypR occurred in patients without severe allergic background (13/6028, 0,2%) including one (1/6148, 0.016% of total population) WAO grade-4 anaphylaxis. Our data suggest that BNT162b2 mRNA Covid-19 vaccine is relatively safe also in patients with severe allergic background; however, some precautions are required for high-risk patients.
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Affiliation(s)
- Mona-Rita Yacoub
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Valentina Cucca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Giuseppe A Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Emanuel Della-Torre
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Moro
- Medical Affairs Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Davide Di Napoli
- Medical Affairs Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Ambrosio
- Medical Affairs Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Carlo Signorelli
- School of Hygiene and Public Health, Vita-Salute San Raffaele University, Milan, Italy
| | - Sergio Colombo
- Vita-Salute San Raffaele University, Milan, Italy; Anaesthesiology and Intensive Care Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luigi Beretta
- Vita-Salute San Raffaele University, Milan, Italy; Anaesthesiology and Intensive Care Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Fabio Ciceri
- Vita-Salute San Raffaele University, Milan, Italy; Haematology and Bone Marrow Transplantation Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Zangrillo
- Vita-Salute San Raffaele University, Milan, Italy; Anaesthesiology and Intensive Care Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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Sriskandarajah P, Hobart J, Radia DH, Whyte AF. A UK Survey Examining the Experience of Adults With Mastocytosis Receiving COVID-19 Vaccination. Hemasphere 2021; 5:e650. [PMID: 34667940 PMCID: PMC8517291 DOI: 10.1097/hs9.0000000000000650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/11/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
| | - Jess Hobart
- UK Masto Support Group, London, United Kingdom
| | - Deepti H Radia
- Department of Haematology, Guy's Hospital, London, United Kingdom
| | - Andrew F Whyte
- Department of Allergy and Immunology, Derriford Hospital, University Hospitals Plymouth NHS Trust, United Kingdom
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Ramirez GA, Asperti C, Cucca V, Yacoub MR. Challenges to Vaccination against SARS-CoV-2 in Patients with Immune-Mediated Diseases. Vaccines (Basel) 2021; 9:1147. [PMID: 34696255 PMCID: PMC8537812 DOI: 10.3390/vaccines9101147] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 12/22/2022] Open
Abstract
Aberrant deployment of the immune response is a hallmark pathogenic feature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related disease (COVID-19), possibly accounting for high morbidity and mortality, especially in patients with comorbidities, including immune-mediated disorders. Immunisation with SARS-COV-2 vaccines successfully instructs the immune system to limit viral spread into tissues, mitigate COVID-19 manifestations and prevent its most detrimental inflammatory complications in the general population. Patients with immune-mediated diseases have been excluded from vaccine registration trials, foreclosing the acquisition of specific efficacy and safety data. In this review, we aimed to summarise and critically discuss evidence from real-world studies addressing this issue to provide a comprehensive view of the impact of vaccination practices in patients with allergy, autoimmunity or immunodeficiency. We analysed clinical and laboratory data from 34 studies involving more than 13,000 subjects with various immune disorders who were vaccinated with mRNA- DNA- or inactivated viral particle-based vaccines. These data globally support the safe and effective use of SARS-CoV-2 vaccines in patients with immune-mediated diseases, although patient-tailored strategies to determine vaccination timing, vaccine choice and background therapy management are warranted to optimise vaccination outcomes. More data are needed regarding patients with primary immunodeficiencies.
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Affiliation(s)
- Giuseppe A. Ramirez
- Division of Immunology, Transplants and Infectious Diseases, Università Vita-Salute San Raffaele, 20132 Milan, Italy; (C.A.); (V.C.); (M.-R.Y.)
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Chiara Asperti
- Division of Immunology, Transplants and Infectious Diseases, Università Vita-Salute San Raffaele, 20132 Milan, Italy; (C.A.); (V.C.); (M.-R.Y.)
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Valentina Cucca
- Division of Immunology, Transplants and Infectious Diseases, Università Vita-Salute San Raffaele, 20132 Milan, Italy; (C.A.); (V.C.); (M.-R.Y.)
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
| | - Mona-Rita Yacoub
- Division of Immunology, Transplants and Infectious Diseases, Università Vita-Salute San Raffaele, 20132 Milan, Italy; (C.A.); (V.C.); (M.-R.Y.)
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
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Anaphylaxis and Coronavirus Disease 2019 vaccine: a danger relationship? Curr Opin Allergy Clin Immunol 2021; 21:411-417. [PMID: 34334663 DOI: 10.1097/aci.0000000000000778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Anaphylactic reactions reported after Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) RNA vaccines were expected to be more frequent in atopic subjects and attributed to its polyethylene glycol component. RECENT FINDINGS Anaphylaxis to SARS-CoV2 RNA vaccines is no more frequent than in any vaccine and direct proofs for the role of its polyethylene glycol component are lacking. SUMMARY Vaccines against coronavirus disease 2019 (COVID-19) are an essential global intervention to control the current pandemic situation. Anaphylactic reactions have rapidly been reported after SARS-CoV2 RNA vaccines. This risk is now measured at 2.5-11/1 000 000 in the context of vaccine safety surveillance programs and only one case was documented to be due to polyethylene glycol. Suggestions for its role are indirect. The COVID-19 vaccination is rolling out vastly and surveillance programs are key to monitor severe adverse reactions, such as anaphylaxis. Anaphylaxis due to vaccine is extremely rare and specific cases should receive individualized investigation and care, highlighting the key role of allergists in the vaccination programmes.
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21
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COVID-19 Vaccines in Children with Cow's Milk and Food Allergies. Nutrients 2021; 13:nu13082637. [PMID: 34444795 PMCID: PMC8401713 DOI: 10.3390/nu13082637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 01/05/2023] Open
Abstract
The COVID-19 pandemic is the most challenging global health crisis of our times. Vaccination against COVID-19 plays a key role to control the current pandemic situation. The risk of allergic reactions to new COVID-19 vaccines is low. However, there is a debate on the safety in allergic patients following post marketing findings by different agencies. Our aim is to understand from current experiences whether children with cow’s milk or food allergy are at higher risk than a general population for allergic reactions to COVID-19 vaccines. Current data indicate that patients with a history of allergy to cow’s milk or other foods, even if severe, should receive COVID-19 vaccine in a setting with availability of treatments for anaphylactic reactions and under medical supervision. Recipients should be discharged after a protracted observation period of 30 min if no reaction developed.
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22
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Risma KA, Edwards KM, Hummell DS, Little FF, Norton AE, Stallings A, Wood RA, Milner JD. Potential mechanisms of anaphylaxis to COVID-19 mRNA vaccines. J Allergy Clin Immunol 2021; 147:2075-2082.e2. [PMID: 33857566 PMCID: PMC8056854 DOI: 10.1016/j.jaci.2021.04.002] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/24/2021] [Accepted: 04/01/2021] [Indexed: 02/07/2023]
Abstract
Anaphylaxis to vaccines is historically a rare event. The coronavirus disease 2019 pandemic drove the need for rapid vaccine production applying a novel antigen delivery system: messenger RNA vaccines packaged in lipid nanoparticles. Unexpectedly, public vaccine administration led to a small number of severe allergic reactions, with resultant substantial public concern, especially within atopic individuals. We reviewed the constituents of the messenger RNA lipid nanoparticle vaccine and considered several contributors to these reactions: (1) contact system activation by nucleic acid, (2) complement recognition of the vaccine-activating allergic effector cells, (3) preexisting antibody recognition of polyethylene glycol, a lipid nanoparticle surface hydrophilic polymer, and (4) direct mast cell activation, coupled with potential genetic or environmental predispositions to hypersensitivity. Unfortunately, measurement of anti-polyethylene glycol antibodies in vitro is not clinically available, and the predictive value of skin testing to polyethylene glycol components as a coronavirus disease 2019 messenger RNA vaccine-specific anaphylaxis marker is unknown. Even less is known regarding the applicability of vaccine use for testing (in vitro/vivo) to ascertain pathogenesis or predict reactivity risk. Expedient and thorough research-based evaluation of patients who have suffered anaphylactic vaccine reactions and prospective clinical trials in putative at-risk individuals are needed to address these concerns during a public health crisis.
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Affiliation(s)
- Kimberly A Risma
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Kathryn M Edwards
- Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Donna S Hummell
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tenn
| | - Frederic F Little
- Division of Pulmonary, Allergy, Sleep and Critical Care Medicine, Department of Pediatrics, Boston University School of Medicine, Boston, Mass
| | - Allison E Norton
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tenn
| | - Amy Stallings
- Division of Pediatric Allergy and Immunology, Duke University Medical Center, Durham, NC
| | - Robert A Wood
- Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Joshua D Milner
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
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23
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Safety of COVID-19 vaccination in patients with mastocytosis and monoclonal mast cell activation syndrome. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3198-3199. [PMID: 34033981 PMCID: PMC8141687 DOI: 10.1016/j.jaip.2021.05.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/25/2021] [Accepted: 05/05/2021] [Indexed: 11/23/2022]
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Klimek L, Bergmann KC, Brehler R, Pfützner W, Worm M, Hartmann K, Jakob T, Novak N, Ring J, Hamelmann E, Ankermann T, Schmidt SM, Untersmayr E, Hötzenecker W, Jensen-Jarolim E, Zuberbier T. Praktischer Umgang mit allergischen Reaktionen auf COVID-19-Impfstoffe. ALLERGO JOURNAL 2021; 30:22-43. [PMID: 33967401 PMCID: PMC8091634 DOI: 10.1007/s15007-021-4773-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hintergrund: Zur vorbeugenden Behandlung von COVID-19 (Coronaviruserkrankung 2019) wurden in einer beispiellosen weltweiten Forschungsanstrengung Sicherheit und Wirksamkeit neuer Impfstoffplattformen studiert, die noch nie zuvor am Menschen eingesetzt wurden. Weniger als ein Jahr nach der Entdeckung der SARS-CoV-2-Virussequenz (SARS-CoV-2, "severe acute respiratory syndrome coronavirus type 2") wurden diese in zahlreichen Ländern für den Einsatz zugelassen und es wurde mit Massenimpfungen begonnen. Die bislang in der Europäischen Union (EU) zugelassenen mRNA-Impfstoffe (mRNA, "messenger"-RNA) gegen SARS-CoV-2 BNT162b2 und mRNA-1273 basieren auf einer ähnlichen lipidbasierten Nanopartikelträgertechnologie; die Lipidkomponenten unterscheiden sich jedoch. Schwere allergische Reaktionen und Anaphylaxien nach COVID-19-Impfungen sind sehr seltene unerwünschte Nebenwirkungen, die aber aufgrund potenziell letaler Ausgänge viel Aufmerksamkeit erhalten und ein hohes Maß an Verunsicherung ausgelöst haben. Methoden: Das aktuelle Wissen zu anaphylaktischen Reaktionen auf Impfstoffe und speziell zu den derzeit neuen mRNA-COVID-19-Impfstoffen wurde zusammengestellt mittels einer Literaturanalyse durch Recherchen in Medline, Pubmed sowie den nationalen und internationalen Studien- und Leitlinienregistern, der Cochrane Library und dem Internet unter besonderer Berücksichtigung offizieller Webseiten der World Health Oranization (WHO), der Centers for Disease Control and Prevention (CDC), der European Medicines Agency (EMA), des Robert-Koch-Instituts (RKI) und des Paul-Ehrlich-Instituts (PEI). Ergebnisse: Basierend auf der internationalen Literatur und bisheriger Erfahrungen zu schweren allergischen Reaktionen im Kontext der COVID-19-Impfungen werden von einem Expertengremium Empfehlungen für Prophylaxe, Diagnostik und Therapie dieser allergischen Reaktionen gegeben. Schlussfolgerung: Vor einer COVID-19-Impfung mit den derzeit zugelassenen Impfstoffen sind Allergietests für die allermeisten Allergiker nicht notwendig. Bei allergischer/anaphylaktischer Reaktion auf den verabreichten COVID-19-Impfstoff wird eine allergologische Abklärung empfohlen, wie auch für eine kleine potenzielle Risikopopulation vor der ersten Impfung. Die Evaluierung und Zulassung von Testverfahren sollten hierfür erfolgen. Zitierweise: Klimek L, Bergmann K-C, Brehler R, Pfützner W, Zuberbier T, Hartmann K, Jakob T, Novak N, Ring J, Merk H; Hamelmann E, Ankermann T, Schmidt S, Untersmayr E, Hötzenecker W, Jensen-Jarolim E, Brockow K, Mahler V, Worm M. Practical Handling of Allergic Reactions to COVID-19 vaccines. A Position Paper from German and Austrian Allergy Societies AeDA, DGAKI, GPA and ÖGAI. Allergo J Int 2021;30:79-95 https: //doi.org/10.1007/s40629-021-00165-7
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Affiliation(s)
- Ludger Klimek
- Zentrum f. Rhinologie und Allergologie, An den Quellen 10, 65183 Wiesbaden, Germany
| | | | - Randolf Brehler
- Wilhelm-Univ. Münster, Abtlg. Dermatologie, Von-Esmarch-Str. 58, 48149 Münster, Germany
| | - Wolfgang Pfützner
- Klinik für Dermatologie und Allergologie, Baldingerstraße, 35043 Marburg, Germany
| | - Margitta Worm
- Allergie-Centrum-Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | | | - Thilo Jakob
- Universitäts-Hautklinik Gießen, Gießen, Germany
| | - Natalija Novak
- Klinik u. Poliklinik f. Dermatologie u. Allergologie, Sigmund-Freud-Str. 25, 53105 Bonn, Germany
| | - Johannes Ring
- Haut- und Laserzentrum an der Oper, Perusastraße 5, 80333 München, Germany
| | - Eckard Hamelmann
- Evangelisches Krankenhaus Bielefeld gGmbH, Grenzweg 10, 33617 Bielefeld, Germany
| | - Tobias Ankermann
- Klinik f. Allg. Pädiatrie, Univ. Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, 24105 Kiel, Germany
| | | | - Eva Untersmayr
- Department of Pathophysiology and Allergy Research, Waehringer Gürtel 18-20, 1090 Wien, Österreich
| | - Wolfram Hötzenecker
- Kepler Universitätsklinikum \/ Med Campus III., Krankenhausstr. 9, 4021 Linz, Österreich
| | - Erika Jensen-Jarolim
- Institut für Pathophysiologie AKH Wien, Ebene 3 Q, Währinger Gürtel 18-20, 1090 Wien, Österreich
| | - Torsten Zuberbier
- Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
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New Insights into the Pathogenesis of Systemic Mastocytosis. Int J Mol Sci 2021; 22:ijms22094900. [PMID: 34063170 PMCID: PMC8125314 DOI: 10.3390/ijms22094900] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 12/16/2022] Open
Abstract
Mastocytosis is a type of myeloid neoplasm characterized by the clonal, neoplastic proliferation of morphologically and immunophenotypically abnormal mast cells that infiltrate one or more organ systems. Systemic mastocytosis (SM) is a more aggressive variant of mastocytosis with extracutaneous involvement, which might be associated with multi-organ dysfunction or failure and shortened survival. Over 80% of patients with SM carry the KIT D816V mutation. However, the KIT D816V mutation serves as a weak oncogene and appears to be a late event in the pathogenesis of mastocytosis. The management of SM is highly individualized and was largely palliative for patients without a targeted form of therapy in past decades. Targeted therapy with midostaurin, a multiple kinase inhibitor that inhibits KIT, has demonstrated efficacy in patients with advanced SM. This led to the recent approval of midostaurin by the United States Food and Drug Administration and European Medicines Agency. However, the overall survival of patients treated with midostaurin remains unsatisfactory. The identification of genetic and epigenetic alterations and understanding their interactions and the molecular mechanisms involved in mastocytosis is necessary to develop rationally targeted therapeutic strategies. This review briefly summarizes recent developments in the understanding of SM pathogenesis and potential treatment strategies for patients with SM.
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Paoletti G, Racca F, Piona A, Melone G, Merigo M, Puggioni F, Ferri S, Azzolini E, Lagioia M, Lamacchia D, Cataldo G, Cecconi M, Canonica GW, Heffler E. Successful SARS-CoV-2 vaccine allergy risk-management: The experience of a large Italian University Hospital. World Allergy Organ J 2021; 14:100541. [PMID: 33850601 PMCID: PMC8030995 DOI: 10.1016/j.waojou.2021.100541] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/29/2021] [Accepted: 04/01/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccines have been approved recently, and public concern regarding the risk of anaphylactic reactions arose after a few cases during the first days of mass vaccination. Polyethylene glycol (PEG) has been suggested as the most probable culprit agent for allergic reactions. OBJECTIVE We describe the allergy work-up protocol implemented for the vaccination campaign in our Center, aiming to allow the greatest number of people to be vaccinated safely. METHODS The protocol included the self-report of a history of suspected drug or vaccine allergies, and subsequent teleconsultation and allergometric tests for PEG and Polysorbate 80 (PS80). A desensitizing protocol of vaccine administration was applied to patients sensitized only to PS80, and to those with a suspect allergic reaction after the first vaccine dose. RESULTS 10.2% (414 out of 4042) of the entire vaccine population have been screened: only one patient resulted allergic to PEG and therefore excluded from the vaccination. Another patient was sensitized to PS80 only and safely vaccinated applying the desensitizing protocol. Seven subjects without a previous history of allergic disease experienced suspect hypersensitivity reactions to the first administered dose: one of them resulted allergic to PEG and was excluded from the second dose, while the others safely completed the vaccination with the desensitizing protocol. CONCLUSION A careful allergological risk-assessment protocol significantly reduces the number of patients who would have avoided SARS-CoV-2 vaccination for their allergies and to effectively identify and manage those rare patients with sensitization to PEGs and/or PS80.
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Affiliation(s)
- Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy – IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
- Department of Biomedical Sciences – Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - Francesca Racca
- Personalized Medicine, Asthma and Allergy – IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Alessandra Piona
- Allergy Service – Humanitas San Pio X Hospital, Via Francesco Nava 31, 20159, Milano, Italy
| | - Giulio Melone
- Personalized Medicine, Asthma and Allergy – IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Morena Merigo
- Personalized Medicine, Asthma and Allergy – IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy – IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
- Department of Biomedical Sciences – Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - Sebastian Ferri
- Personalized Medicine, Asthma and Allergy – IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
- Department of Biomedical Sciences – Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - Elena Azzolini
- Clinical Quality Department - IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Michele Lagioia
- Clinical Quality Department - IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Donatella Lamacchia
- Personalized Medicine, Asthma and Allergy – IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Giuseppe Cataldo
- Personalized Medicine, Asthma and Allergy – IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences – Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Department of Anesthesiology and Intensive Care - IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy – IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
- Department of Biomedical Sciences – Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy – IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy
- Department of Biomedical Sciences – Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
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Klimek L, Bergmann KC, Brehler R, Pfützner W, Zuberbier T, Hartmann K, Jakob T, Novak N, Ring J, Merk H, Hamelmann E, Ankermann T, Schmidt S, Untersmayr E, Hötzenecker W, Jensen-Jarolim E, Brockow K, Mahler V, Worm M. Practical handling of allergic reactions to COVID-19 vaccines: A position paper from German and Austrian Allergy Societies AeDA, DGAKI, GPA and ÖGAI. ALLERGO JOURNAL INTERNATIONAL 2021; 30:79-95. [PMID: 33898162 PMCID: PMC8054127 DOI: 10.1007/s40629-021-00165-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND For the preventive treatment of the 2019 coronavirus disease (COVID-19) an unprecedented global research effort studied the safety and efficacy of new vaccine platforms that have not been previously used in humans. Less than one year after the discovery of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral sequence, these vaccines were approved for use in the European Union (EU) as well as in numerous other countries and mass vaccination efforts began. The so far in the EU approved mRNA vaccines BNT162b2 and mRNA-1273 are based on similar lipid-based nanoparticle carrier technologies; however, the lipid components differ. Severe allergic reactions and anaphylaxis after COVID-19 vaccination are very rare adverse events but have drawn attention due to potentially lethal outcomes and have triggered a high degree of uncertainty. METHODS Current knowledge on anaphylactic reactions to vaccines and specifically the new mRNA COVID-19 vaccines was compiled using a literature search in Medline, PubMed, as well as the national and international study and guideline registries, the Cochrane Library, and the Internet, with special reference to official websites of the World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC), Robert Koch Institute (RKI), and Paul Ehrlich Institute (PEI). RESULTS Based on the international literature and previous experience, recommendations for prophylaxis, diagnosis and therapy of these allergic reactions are given by a panel of experts. CONCLUSION Allergy testing is not necessary for the vast majority of allergic patients prior to COVID-19 vaccination with currently licensed vaccines. In case of allergic/anaphylactic reactions after vaccination, allergy workup is recommended, as it is for a small potential risk population prior to the first vaccination. Evaluation and approval of diagnostic tests should be done for this purpose.
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Affiliation(s)
- Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Karl-Christian Bergmann
- Clinic for Dermatology, Venereology and Allergy, Charité—University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Berlin Institute of Health, Charité—Medical University Berlin, Berlin, Germany
| | - Randolf Brehler
- Outpatient Clinic for Allergology, Occupational Dermatology and Environmental Medicine, General Dermatology and Venereology, Department of Skin Diseases, Münster University Hospital, Münster, Germany
| | - Wolfgang Pfützner
- Department of Dermatology and Allergology, University Hospital Marburg, UKGM, Philipps University Marburg, Marburg, Germany
| | - Torsten Zuberbier
- Clinic for Dermatology, Venereology and Allergy, Charité—University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Berlin Institute of Health, Charité—Medical University Berlin, Berlin, Germany
| | - Karin Hartmann
- Department of Dermatology and Allergology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Thilo Jakob
- Department of Dermatology and Allergology, Giessen University Hospital, UKGM, Justus Liebig University Giessen, Giessen, Germany
| | - Natalija Novak
- Clinic and Polyclinic for Dermatology and Allergology, University Hospital Bonn, Bonn, Germany
| | - Johannes Ring
- Clinic and Polyclinic for Dermatology and Allergology at Biederstein, Technical University of Munich, Munich, Germany
| | - Hans Merk
- Department of Dermatology and Allergology, RWTH Aachen University Hospital, Aachen, Germany
| | - Eckard Hamelmann
- Pediatric and Adolescent Medicine, Bethel Children’s Center, OWL University Hospital, Bielefeld University, Bielefeld, Germany
| | - Tobias Ankermann
- Clinic for Pediatric and Adolescent Medicine, Municipal Hospital Kiel GmbH, Kiel, Germany
| | - Sebastian Schmidt
- Center for Pediatric and Adolescent Medicine, Clinic and Polyclinic for Pediatric and Adolescent Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Eva Untersmayr
- Institute for Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Wolfram Hötzenecker
- Clinic for Dermatology and Venereology, Allergy Center, Kepler University Hospital GmbH, Linz, Austria
| | - Erika Jensen-Jarolim
- Institute for Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
- Inter-university Messerli Research Institute Vienna, Vienna, Austria
| | - Knut Brockow
- Clinic and Polyclinic for Dermatology and Allergology at Biederstein, Technical University of Munich, Munich, Germany
| | | | - Margitta Worm
- Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité—University Medicine Berlin, Berlin, Germany
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COVID-19 Vaccination in Mastocytosis: Recommendations of the European Competence Network on Mastocytosis (ECNM) and American Initiative in Mast Cell Diseases (AIM). THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2139-2144. [PMID: 33831618 PMCID: PMC8019658 DOI: 10.1016/j.jaip.2021.03.041] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 02/06/2023]
Abstract
Mastocytosis is a neoplasm characterized by an accumulation of mast cells in various organs and increased risk for severe anaphylaxis in patients with concomitant allergies. Coronavirus disease 2019 (COVID-19) is a pandemic that is associated with a relatively high rate of severe lung disease and mortality. The mortality is particularly high in those with certain comorbidities and increases with age. Recently, several companies have developed an effective vaccination against COVID-19. Although the reported frequency of severe side effects is low, there is an emerging discussion about the safety of COVID-19 vaccination in patients with severe allergies and mastocytosis. However, even in these patients, severe adverse reactions are rare. We therefore recommend the broad use of COVID-19 vaccination in patients with mastocytosis on a global basis. The only well-established exception is a known or suspected allergy against a constituent of the vaccine. Safety measures, including premedication and postvaccination observation, should be considered in all patients with mastocytosis, depending on the individual personal risk and overall situation in each case. The current article provides a summary of published data, observations, and expert opinion that form the basis of these recommendations.
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29
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Kim MA, Lee YW, Kim SR, Kim JH, Min TK, Park HS, Shin M, Ye YM, Lee S, Lee J, Choi JH, Jang GC, Chang YS. COVID-19 Vaccine-associated Anaphylaxis and Allergic Reactions: Consensus Statements of the KAAACI Urticaria/Angioedema/Anaphylaxis Working Group. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2021; 13:526-544. [PMID: 34212542 PMCID: PMC8255352 DOI: 10.4168/aair.2021.13.4.526] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/02/2021] [Indexed: 12/23/2022]
Abstract
In the era of novel coronavirus epidemics, vaccines against coronavirus disease 2019 (COVID-19) have been recognized as the most effective public health interventions to control the pandemic. An adverse event following immunization (AEFI) is defined as any untoward occurrence following immunization, and the majority of AEFIs are caused by protective immune responses stimulated by vaccines. Most of the reported AEFIs are not serious, and many are not immunologically mediated or even reproducible on re-exposure. However, uncommon severe allergic adverse reactions, such as anaphylaxis or other allergic reactions, can occur after vaccinations. Confirmed allergic reactions to vaccines may be caused by residual non-human protein, preservatives, or stabilizers in the vaccine formulation (also known as excipients). There are 2 main potential allergenic/immunogenic excipients in COVID-19 vaccines, polyethylene glycol (PEG) and polysorbate 80. PEG, also known as macrogol, is an ingredient in various laxatives and injectable formulations, such as depot steroids. Polysorbate 80 is present in various medical products, creams, ointments, lotions, and medication tablets. Contraindications to the administration of COVID-19 vaccines include a previous history of severe allergic reactions to the first dose of COVID-19 vaccine or proven hypersensitivity to a vaccine component, such as PEG or polysorbate 80. Anaphylaxis or other allergic reactions following immunization can cause fear and loss of confidence in the safety of vaccines among the public. A better understanding of these events is thought to help alleviate concerns about the current COVID-19 vaccines and provide reassurance to the general population by analyzing the exact incidence of anaphylaxis and potential risk factors. COVID-19 vaccine-associated anaphylaxis could be prevented and managed by risk stratification based on our local and global experience.
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Affiliation(s)
- Mi Ae Kim
- Department of Pulmonology, Allergy and Critical Care Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Yong Won Lee
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - So Ri Kim
- Division of Respiratory Medicine and Allergy, Department of Internal Medicine, Research Center for Pulmonary Disorders, Jeonbuk National University Medical School, Jeonju, Korea
| | - Joo Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Taek Ki Min
- Department of Pediatrics, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Hae Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Meeyong Shin
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Young Min Ye
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Sooyoung Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, Korea
| | - Jeongmin Lee
- Department of Pediatrics, Yonsei Wonju College of Medicine, Wonju, Korea
| | - Jeong Hee Choi
- Department of Pulmonology and Allergy, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea.,Allergy and Clinical Immunology Research Center, Hallym University College of Medicine, Chuncheon, Korea
| | - Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
| | - Yoon Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital,Seoul National University College of Medicine, Seongnam, Korea.
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