Allergies and COVID-19 vaccines: An ENDA/EAACI Position paper

Annick Barbaud 1, Lene Heise Garvey 2 3, Alessandra Arcolaci 4, Knut Brockow 5, Francesca Mori 6, Cristobalina Mayorga 7, Patrizia Bonadonna 8, Marina Atanaskovic-Markovic 9, Luis Moral 10, Giovanna Zanoni 11, Mauro Pagani 12, Angèle Soria 13, Maja Jošt 14, Jean-Christoph Caubet 15, Abreu Carmo 16, Al-Ahmad Mona 17, Alberto Alvarez-Perea 18, Sevim Bavbek 19, Biagioni Benedetta 20, M Beatrice Bilo 21 22, Natalia Blanca-López 23, Herrera Gádor Bogas 24, Alessandro Buonomo 25, Gianfranco Calogiuri 26, Giulia Carli 27, Josefina Cernadas 28, Gabriele Cortellini 29, Gülfem Celik 30, Semra Demir 31, Inmaculada Doña 32, Adile Berna Dursun 33, Bernadette Eberlein 34, Emilia Faria 35, Bryan Fernandes 36, Tomaz Garcez 37, Ignacio Garcia-Nunez 38, Radoslaw Gawlik 39, Asli Gelincik 31, Eva Gomes 40, Jimmy H C Gooi 41, Martine Grosber 42, Theo Gülen 43, Florence Hacard 44, Cyrille Hoarau 45, Christer Janson 46, Sebastian L Johnston 47, Lukas Joerg 48, Seçil Kepil Özdemir 49, Ludger Klimek 50, Mitja Košnik 51, Marek L Kowalski 52, Semanur Kuyucu 53, Violeta Kvedariene 54, Jose Julio Laguna 55, Carla Lombardo 56, Susana Marinho 57, Hans Merk 58, Elisa Meucci 59, Martine Morisset 60, Rosa Munoz-Cano 61, Francesco Murzilli 62, Alla Nakonechna 63, Florin-Dan Popescu 64, Grzegorz Porebski 65, Anna Radice 59, Frederico S Regateiro 35 66 67, Heike Röckmann 68, Antonino Romano 69, Ravishankar Sargur 70, Joaquin Sastre 71, Kathrin Scherer Hofmeier 72, Lenka Sedláčková 73, Marta Sobotkova 74, Ingrid Terreehorst 75, Regina Treudler 76, Jolanta Walusiak-Skorupa 77, Bettina Wedi 78, Stefan Wöhrl 79, Mihael Zidarn 80, Torsten Zuberbier 81, Ioana Agache 82, Maria J Torres 83


 

Affiliations

01 August 2022

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doi: 10.1111/all.15241

Abstract

Background: Anaphylaxis, which is rare, has been reported after COVID-19 vaccination, but its management is not standardized.

Method: Members of the European Network for Drug Allergy and the European Academy of Allergy and Clinical Immunology interested in drug allergy participated in an online questionnaire on pre-vaccination screening and management of allergic reactions to COVID-19 vaccines, and literature was analysed.

Results: No death due to anaphylaxis to COVID-19 vaccines has been confirmed in scientific literature. Potential allergens, polyethylene glycol (PEG), polysorbate and tromethamine are excipients. The authors propose allergy evaluation of persons with the following histories: 1-anaphylaxis to injectable drug or vaccine containing PEG or derivatives; 2-anaphylaxis to oral/topical PEG containing products; 3-recurrent anaphylaxis of unknown cause; 4-suspected or confirmed allergy to any mRNA vaccine; and 5-confirmed allergy to PEG or derivatives. We recommend a prick-to-prick skin test with the left-over solution in the suspected vaccine vial to avoid waste. Prick test panel should include PEG 4000 or 3500, PEG 2000 and polysorbate 80. The value of in vitro test is arguable.

Conclusions: These recommendations will lead to a better knowledge of the management and mechanisms involved in anaphylaxis to COVID-19 vaccines and enable more people with history of allergy to be vaccinated.

Keywords: COVID-19 vaccine; allergy test; anaphylaxis; mRNA vaccines; risk assessment.


 

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