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Batac ALR, Merrill KA, Askin N, Golding MA, Abrams EM, Bégin P, Ben-Shoshan M, Ladouceur E, Roos LE, Protudjer V, Protudjer JLP. Vaccine confidence among those living with allergy during the COVID pandemic (ACCORD): A scoping review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:100079. [PMID: 36785543 PMCID: PMC9907785 DOI: 10.1016/j.jacig.2023.100079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 02/11/2023]
Abstract
Background Reports of allergic reactions to coronavirus disease 2019 (COVID-19) vaccines, coupled with an "infodemic" of misinformation, carry the potential to undermine confidence in the COVID-19 vaccines. However, no attempts have been made to comprehensively synthesize the literature on how allergic disease and fear of allergic reactions to the vaccines contribute to hesitancy. Objectives Our aim was to review the academic and gray literature on COVID-19 vaccine hesitancy and allergic reactions. Methods We searched 4 databases (CINAHL, PsycINFO, MEDLINE, and Embase) using a search strategy developed by content and methodologic experts. No restrictions were applied regarding COVID-19 vaccine type, country of study, or patient age. Eligible articles were restricted to 10 languages. Results Of the 1385 unique records retrieved from our search, 60 articles (4.3%) were included. Allergic reactions to the COVID-19 vaccine were rare but slightly more common in individuals with a history of allergic disease. A fifth of the studies (13 of 60 [22%]) discussed vaccine hesitancy due to possibility of an allergic reaction. Additionally, the present review identified research on details of vaccine-related anaphylaxis (eg, a mean and median [excluding clinical trial data] of 12.4 and 5 cases per million doses, respectively) and allergic reactions (eg, a mean and median [excluding clinical trial data] of 489 and 528 cases per million doses, respectively). Conclusion COVID-19 vaccine acceptance among individuals living with allergy and among those with no history of allergic disease may be affected by fear of an allergic reaction. Despite the low incidence of allergic reactions to the COVID-19 vaccine, fear of such reactions is one of the most commonly cited concerns reported in the literature.
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Affiliation(s)
- Ayel Luis R Batac
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Kaitlyn A Merrill
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Askin
- WRHA Virtual Library, Winnipeg, Manitoba, Canada
| | - Michael A Golding
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philippe Bégin
- Division of Allergy, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada.,Division of Allergy, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Moshe Ben-Shoshan
- Division of Pediatric Allergy, Clinical Immunology, and Dermatology, Department of Pediatrics, Montréal Children's Hospital, Montréal, Quebec, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, Quebec, Canada.,Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, Montréal, Quebec, Canada.,Division of Experimental Medicine, Department of Medicine, School of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montréal, Quebec, Canada
| | | | - Leslie E Roos
- Department of Psychology, Faculty of Arts, Winnipeg, Manitoba, Canada
| | - Vladan Protudjer
- College of Nursing, Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
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Suzuki H, Ro A, Takada A, Saito K, Hayashi K. Autopsy findings of post-COVID-19 vaccination deaths in Tokyo Metropolis, Japan, 2021. Leg Med (Tokyo) 2022; 59:102134. [PMID: 36037554 PMCID: PMC9392553 DOI: 10.1016/j.legalmed.2022.102134] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND COVID-19 vaccines have been used across Japan since 17 February 2021, and as of 17 April 2022, 1690 deaths potentially caused by vaccine-related adverse effects have been reported to the Ministry of Health, Labour and Welfare. However, the causal relationship between vaccination and death could not be fully evaluated because of a lack of sufficient information. METHODS Autopsy cases in which deaths occurred within seven days after COVID-19 vaccination in Tokyo Metropolis and were handled by medical examiners were selected (n = 54). Age, sex, vaccine-related information, cause of death, and possible causal relationship between vaccination and death were examined. RESULTS The mean age of the deceased individuals was 68.1 years, and the study sample consisted of 34 males (63.9%) and 20 females (37.0%). Thirty-seven and six individuals received Comirnaty and Spikevax, respectively (68.5% and 11.1% respectively). The manner of death included natural (n = 43), non-natural (n = 8), and undetermined (n = 3). The most frequent cause of death was ischemic heart disease (n = 16). Regarding causal relationships, 46 cases (85.2%) did not show a causal relationship to vaccination, except for myocarditis (n = 3), thrombosis-related death (n = 4), and others (n = 1). CONCLUSION Although many cases of deaths after COVID-19 vaccination in this study showed no definite causal relationship between the vaccination and deaths, some cases showed possible adverse events such as myocarditis. Autopsies are essential for detecting vaccine-related deaths, and the Japanese death investigation system needs to be reinforced from this viewpoint.
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Affiliation(s)
- Hideto Suzuki
- Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, Tokyo, Japan. hideto-@qk9.so-net.ne.jp
| | - Ayako Ro
- Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, Tokyo, Japan; Department of Legal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Aya Takada
- Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, Tokyo, Japan; Department of Forensic Medicine, Saitama Medical University, Saitama, Japan; Department of Forensic Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kazuyuki Saito
- Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, Tokyo, Japan; Department of Forensic Medicine, Saitama Medical University, Saitama, Japan; Department of Forensic Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kino Hayashi
- Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, Tokyo, Japan
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Hörnle T. [Prioritizing the vaccinated?]. Ethik Med 2022; 34:481-495. [PMID: 35967089 PMCID: PMC9361248 DOI: 10.1007/s00481-022-00716-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/30/2022] [Indexed: 11/06/2022]
Abstract
Definition of the problem The article asks whether vaccination status could become relevant if it is unavoidable to prioritize between patients in intensive care units during a pandemic. The aim is to analyze different approaches and arguments in favor of and against the inclusion of vaccination status. Arguments The following arguments are assessed: First, it has been argued that it is unnecessary to open this discussion. Second, one could make the point that public debates about touchy subjects should be avoided. A third, frequently expressed opinion claims that physicians must never discriminate between vaccinated and unvaccinated patients, either because this is in conflict with human rights or because this is incompatible with the general principle that patients' prior conduct does not matter. Fourth, behavioral economists argue that intensive care medicine should take vaccination status into account with the goal to improve the overall numbers of vaccinations. A fifth line of thinking argues that it is more just to take vaccination into account. Conclusion The author concludes that the omission to get a necessary and recommended vaccination may be taken into account if patients' prospects to survive are similar. She points out that lotteries would be worse.
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Affiliation(s)
- Tatjana Hörnle
- Humboldt-Universität zu Berlin und Max-Planck-Institut zur Erforschung von Kriminalität, Sicherheit und Recht, Günterstalstr. 73, 79100 Freiburg, Deutschland
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Imai K, Tanaka F, Kawano S, Esaki K, Arakawa J, Nishiyama T, Seno S, Hatanaka K, Sugiura T, Kodama Y, Yamada S, Iwamoto S, Takeshima S, Abe N, Kamae C, Aono S, Ito T, Yamamoto T, Mizuguchi Y. Incidence and Risk Factors of Immediate Hypersensitivity Reactions and Immunization Stress-related Responses With COVID-19 mRNA Vaccine. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:2667-2676.e10. [PMID: 35953016 PMCID: PMC9359595 DOI: 10.1016/j.jaip.2022.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 07/01/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022]
Abstract
Background With the implementation of mass vaccination campaigns against COVID-19, the safety of vaccine needs to be evaluated. Objective We aimed to assess the incidence and risk factors for immediate hypersensitivity reactions (IHSR) and immunization stress–related responses (ISRR) with the Moderna COVID-19 vaccine. Methods This nested case-control study included recipients who received the Moderna vaccine at a mass vaccination center, Japan. Recipients with IHSR and ISRR were designated as cases 1 and 2, respectively. Controls 1 and 2 were selected from recipients without IHSR or ISRR and matched (1 case: 4 controls) with cases 1 and cases 2, respectively. Conditional logistic regression analysis was used to identify risk factors associated with IHSR and ISRR. Results Of the 614,151 vaccine recipients who received 1,201,688 vaccine doses, 306 recipients (cases 1) and 2478 recipients (cases 2) showed 318 events of IHSR and 2558 events of ISRR, respectively. The incidence rates per million doses were estimated as IHSR: 266 cases, ISRR: 2129 cases, anaphylaxis: 2 cases, and vasovagal syncope: 72 cases. Risk factors associated with IHSR included female, asthma, atopic dermatitis, thyroid diseases, and a history of allergy; for ISRR, the risk factors were younger age, female, asthma, thyroid diseases, mental disorders, and a history of allergy and vasovagal reflex. Conclusion In the mass vaccination settings, the Moderna vaccine can be used safely owing to the low incidence rates of IHSR and anaphylaxis. However, providers should be aware of the occurrence of ISRR. Although recipients with risk factors are associated with slightly increased risks of IHSR and ISRR, this is not of sufficient magnitude to warrant special measures regarding their vaccination.
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Affiliation(s)
- Kazuo Imai
- Self-Defence Forces Tokyo Large-scale Vaccination Centre, Tokyo, Japan; Department of Internal Medicine, Self-Defence Forces Central Hospital, Tokyo, Japan; NBC Countermeasure Medical Unit, Japan Ground Self-Defence Force, Tokyo, Japan.
| | - Fumika Tanaka
- Self-Defence Forces Tokyo Large-scale Vaccination Centre, Tokyo, Japan; Department of Emergency Medicine, Self-Defence Forces Central Hospital, Tokyo, Japan
| | - Shuichi Kawano
- Self-Defence Forces Tokyo Large-scale Vaccination Centre, Tokyo, Japan; Department of Internal Medicine, Self-Defence Forces Central Hospital, Tokyo, Japan
| | - Kotoba Esaki
- Self-Defence Forces Tokyo Large-scale Vaccination Centre, Tokyo, Japan; Department of Internal Medicine, Self-Defence Forces Central Hospital, Tokyo, Japan; NBC Countermeasure Medical Unit, Japan Ground Self-Defence Force, Tokyo, Japan
| | - Junko Arakawa
- Self-Defence Forces Tokyo Large-scale Vaccination Centre, Tokyo, Japan; Department of Internal Medicine, Self-Defence Forces Central Hospital, Tokyo, Japan; NBC Countermeasure Medical Unit, Japan Ground Self-Defence Force, Tokyo, Japan
| | - Takashi Nishiyama
- Self-Defence Forces Tokyo Large-scale Vaccination Centre, Tokyo, Japan; Department of Emergency Medicine, Self-Defence Forces Central Hospital, Tokyo, Japan
| | - Soichiro Seno
- Self-Defence Forces Tokyo Large-scale Vaccination Centre, Tokyo, Japan; Department of Emergency Medicine, Self-Defence Forces Central Hospital, Tokyo, Japan
| | - Kosuke Hatanaka
- Self-Defence Forces Tokyo Large-scale Vaccination Centre, Tokyo, Japan; Department of Emergency Medicine, Self-Defence Forces Central Hospital, Tokyo, Japan
| | - Takao Sugiura
- Self-Defence Forces Tokyo Large-scale Vaccination Centre, Tokyo, Japan; Department of Emergency Medicine, Self-Defence Forces Central Hospital, Tokyo, Japan
| | - Yu Kodama
- Self-Defence Forces Tokyo Large-scale Vaccination Centre, Tokyo, Japan; Department of Emergency Medicine, Self-Defence Forces Central Hospital, Tokyo, Japan
| | - Seigo Yamada
- Self-Defence Forces Tokyo Large-scale Vaccination Centre, Tokyo, Japan; Department of Emergency Medicine, Self-Defence Forces Central Hospital, Tokyo, Japan
| | - Shinichiro Iwamoto
- Self-Defence Forces Tokyo Large-scale Vaccination Centre, Tokyo, Japan; Department of Emergency Medicine, Self-Defence Forces Central Hospital, Tokyo, Japan
| | - Shigeto Takeshima
- Self-Defence Forces Tokyo Large-scale Vaccination Centre, Tokyo, Japan; Department of Emergency Medicine, Self-Defence Forces Central Hospital, Tokyo, Japan
| | - Nobujiro Abe
- Self-Defence Forces Tokyo Large-scale Vaccination Centre, Tokyo, Japan; Department of Internal Medicine, Self-Defence Forces Central Hospital, Tokyo, Japan; NBC Countermeasure Medical Unit, Japan Ground Self-Defence Force, Tokyo, Japan
| | - Chikako Kamae
- Self-Defence Forces Tokyo Large-scale Vaccination Centre, Tokyo, Japan; Eastern Army Medical Unit, Japan Ground Self-Defence Force, Tokyo, Japan
| | - Shigeaki Aono
- Self-Defence Forces Tokyo Large-scale Vaccination Centre, Tokyo, Japan; Department of Internal Medicine, Self-Defence Forces Central Hospital, Tokyo, Japan
| | - Toshimitsu Ito
- Self-Defence Forces Tokyo Large-scale Vaccination Centre, Tokyo, Japan; Department of Internal Medicine, Self-Defence Forces Central Hospital, Tokyo, Japan
| | - Tetsuo Yamamoto
- Self-Defence Forces Tokyo Large-scale Vaccination Centre, Tokyo, Japan; NBC Countermeasure Medical Unit, Japan Ground Self-Defence Force, Tokyo, Japan
| | - Yasunori Mizuguchi
- Self-Defence Forces Tokyo Large-scale Vaccination Centre, Tokyo, Japan; Department of Urology, Self-Defence Forces Central Hospital, Tokyo, Japan
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Yeo A, Kuek B, Lau M, Tan SR, Chan S. Post COVID-19 vaccine deaths - Singapore's early experience. Forensic Sci Int 2022; 332:111199. [PMID: 35078041 PMCID: PMC8767909 DOI: 10.1016/j.forsciint.2022.111199] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/20/2021] [Accepted: 01/17/2022] [Indexed: 02/06/2023]
Abstract
Singapore has been using mRNA vaccines developed by Pfizer-BioNTech and Moderna as part of the nation's COVID vaccination program since 30 December 2020. From 1 February 2021-30 June 2021, a total of 34 deaths that occurred within 72 h of the deceased receiving their COVID-19 vaccination were referred to the Forensic Medicine Division of the Health Sciences Authority of Singapore. Autopsies, histological sampling and ancillary investigations consisting of total tryptase level, Immunoglobulin E (IgE), and C-reactive Protein (CRP), were performed on 29 of these cases. Our study has shown no definite causative relationship between the mRNA vaccination and deaths of individuals who died within 72 h after receiving the vaccination, in particular with regards to anaphylactic reactions, myocarditis and pericarditis, and thrombotic complications. Further studies may consider increasing the incident time frame from 72 h to seven days post-vaccination or longer to include any potential delayed presentation of adverse effects.
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Affiliation(s)
- Audrey Yeo
- Forensic Medicine Division, Applied Sciences Group, Health Sciences Authority, Singapore.
| | - Benjamin Kuek
- Forensic Medicine Division, Applied Sciences Group, Health Sciences Authority, Singapore
| | - Mandy Lau
- Forensic Medicine Division, Applied Sciences Group, Health Sciences Authority, Singapore
| | - Shi Rui Tan
- Forensic Medicine Division, Applied Sciences Group, Health Sciences Authority, Singapore
| | - Shijia Chan
- Forensic Medicine Division, Applied Sciences Group, Health Sciences Authority, Singapore
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Bruce Yu Y, Taraban MB, Briggs KT. All vials are not the same: Potential role of vaccine quality in vaccine adverse reactions. Vaccine 2021; 39:6565-6569. [PMID: 34625289 PMCID: PMC8492451 DOI: 10.1016/j.vaccine.2021.09.065] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Yihua Bruce Yu
- Bio- and Nano-Technology Center, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA; Institute for Bioscience and Biotechnology Research, 9600 Gudelsky Drive, Rockville, MD 20850, USA.
| | - Marc B Taraban
- Bio- and Nano-Technology Center, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA; Institute for Bioscience and Biotechnology Research, 9600 Gudelsky Drive, Rockville, MD 20850, USA
| | - Katharine T Briggs
- Bio- and Nano-Technology Center, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA; Institute for Bioscience and Biotechnology Research, 9600 Gudelsky Drive, Rockville, MD 20850, USA
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7
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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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