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
Affiliations
Affiliations
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP.Sorbonne Université, Hôpital Tenon, Département de dermatologie et allergologie, Paris, France.
- Allergy Clinic, Copenhagen University Hospital at Gentofte, Copenhagen, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Denmark.
- Immunology Unit, University Hospital of Verona, Policlinico G.B. Rossi, Verona, Italy.
- Department of Dermatology and Allergy Biederstein, Faculty of Medicine, Technical University of Munich, Munich, Germany.
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital.
- Allergy Clinical Unit, Hospital Regional Universitario de Málaga-Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Málaga, Spain.
- Allergy Unit, Verona University Hospital, Verona, Italy.
- Faculty of Medicine, University of Belgrade, University Children's Hospital, Belgrade, Serbia.
- Moral Luis. Pediatric Allergy and Respiratory Unit, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
- Giovanna Zanoni, Immunology Unit, Policlinico G.B. Rossi, Azienda Ospedaliera Universitaria Integrata Verona, Italy.
- Medicine Department, Medicine Ward Mantova Hospital, ASST di Mantova, Italy.
- Sorbonne Université, INSERM 1135 Cimi-Paris, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Departement de dermatologie et d'allergologie, Paris, France.
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia.
- Department of Women-Children-Teenagers, University Hospital of Geneva, Geneva, Switzerland.
- Allergy and Clinical Immunology Unit, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real and Allergy and Clinical Immunology Unit, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal.
- Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait.
- Allergy Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
- School of Medicine, Department of Pulmonary Diseases, Division of Allergy, FAAAI, Ankara University, Ankara, Turkey.
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Disease, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy.
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.
- Allergy Unit - Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Italy.
- Infanta Leonor University Hospital, Madrid, Spain.
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, and Allergy Unit, Hospital Regional Universitario de Málaga-HRUM, Málaga, Spain.
- Allergy Unit - Fondazione Policlinico Gemelli IRCCS - Largo Gemelli, Rome, Italy.
- Hospital Vito Fazzi, Lecce, Italy.
- SOS Allergologia e Immunologia, Azienda USL Toscana Centro, Ospedale S. Stefano, Prato, Italy.
- Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, Porto and Allergy Unit, Hospital Lusíadas, Porto, Portugal.
- Allergy Unit, Departments of Internal Medicine, Azienda Sanitaria della Romagna, Rimini, Hospital, Rimini, Italy.
- Department of Chest Diseases, Division of Immunology and allergy, Ankara University School of Medicine cebeci Hospital, Ankara, Turkey.
- Istanbul University, Istanbul Faculty of Medicine, Internal Medicine, Immunology and Allergic Diseases, Istanbul, Turkey.
- Allergy Research Group, Allergy Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga-IBIMA, Plaza del Hospital Civil s/n, Málaga, Spain.
- Department of Adult Allergy, Memorial Ankara Hospital, Ankara, Turkey.
- Faculty of Medicine, Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany.
- Allergy and Clinical Immunology Unit, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal.
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK.
- Immunology Department, Manchester University NHS Foundation Trust, Manchester, UK.
- Hospital Quironsalud Cordoba, Cordoba, Spain.
- Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland.
- Allergy Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.
- Department of Clinical Immunology, King's College Hospital, London, UK.
- Department of Dermatology, Universitair Ziekenhuis, Vrije Universiteit Brussel, Brussel, Belgium.
- Department of Respiratory Medicine and Allergy, Department of Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden.
- Allergology and Clinical Immunology Department, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.
- Service transversal d'allergologie et immunologie clinique, CHR de Tours, Tours, France.
- Department of Medical Sciences, Uppsala university, Sweden.
- National Heart and Lung Institute, Imperial College London, London, UK.
- Division of Allergology and Clinical Immunology, Department of Pneumology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Department of Chest Diseases, Division of Allergy and Immunology, Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey.
- Center for Rhinology and Allergology, Wiesbaden, Germany.
- University Clinic Golnik, Slovenia.
- Department of Immunology and Allergy, Medical University of Lodz, Poland.
- Faculty of Medicine, Dpt of Pediatric Allergy and Immunology, Mersin University, Mersin, Turkey.
- Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Institute of Clinical Medicine, Clinic of Chest diseases, Immunology and Allergology, Faculty of Medicine, Vilnius, Lithuania.
- Allergy Unit, Allergo-Anaesthesia Unit, Faculty of Medicine, Hospital Central de la Cruz Roja, Alfonso X El Sabio University, Madrid, Spain.
- Allergy Unit, Trento, Italy.
- Allergy Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust and University of Manchester, Manchester, UK.
- Dohlenfeld, Muelheim, Germany.
- SOS Allergologia ed Immunologia clinica, Azienda USL Toscana Centro, Ospedale San Giovanni di Dio, Firenze, Italy.
- Allergy Unit, Angers University Hospital, Angers, France.
- C/Villarroel, Barcelona, Spain.
- Allergy Unit, S,S, Filippo and Nicola, Avezzano, Italy.
- Allergy and Clinical Immunology Department, University of Liverpool, Royal Preston Hospital, Lancashire Teaching Hospitals, NHS Foundation Trust, UK.
- Department of Allergology, Carol Davila University of Medicine and Pharmacy, Nicolae Malaxa Clinical Hospital, Bucharest, Romania.
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland.
- Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
- ICBR - Coimbra Institute for Clinical and Biomedical Research, CIBB, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
- Department of Dermatology, University Medical Centre Utrecht-Heidelberglaan 100, Utrecht, The Netherlands.
- Oasi Research Institute-IRCCS, Troina, Italy.
- Clinical Immunology and Allergy Unit, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
- Allergy Department, Fundación Jiménez Diaz, Universidad Autonoma de Madrid, CIBERES, Instituto de Salud Carlos III, Spain.
- Department of Dermatology and Allergy, Cantonal Hospital Aarau, Aarau, Switzerland.
- Gennet s.r.o., Allergy and Clinical Immunology, Czech Republic.
- Department of Immunology, Motol University Hospital and 2nd Faculty of Medicine Charles University, Prague, Czech Republic.
- Department of ENT, AUMC, Amsterdam, The Netherlands.
- Department of Dermatology, Venerology and Allergology, Universitätsmedizin Leipzig, Leipzig, Germany.
- Department of Occupational Diseases and Environmental Health, Walusiak-Skorupa Jolanta, Nofer Institute of Occupational Medicine, Lodz, Poland.
- Department of Dermatology & Allergy, OE6600, Comprehensive Allergy Center, Hannover Medical School, Hannover, Germany.
- Floridsdorf Allergy Center (FAZ), Vienna, Austria.
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, and Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
- Charité - Universitätsmedizin Berlin, Klinik für Dermatologie, Berlin, Germany.
- Faculty of Medicine, Transylvania University, Brasov, Romania.
- Allergy Unit, Regional University Hospital of Malaga, IBIMA-UMA-ARADyAL, Malaga, Spain.
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.
References
https://pubmed.ncbi.nlm.nih.gov/