Management of anaphylaxis due to COVID-19 vaccines in the elderly

Jean Bousquet 1 2 3, Ioana Agache 4, Hubert Blain 5, Marek Jutel 6 7, Maria Teresa Ventura 8, Margitta Worm 1, Stefano Del Giacco 9, Athanasios Benetos 10, Beatrice Maria Bilo 11 12, Wienczyslawa Czarlewski 13, Amir Hamzah Abdul Latiff 14, Mona Al-Ahmad 15 16, Elizabeth Angier 17, Isabella Annesi-Maesano 18, Marina Atanaskovic-Markovic 19, Claus Bachert 20 21 22 23, Annick Barbaud 24 25, Anna Bedbrook 14, Kazi S Bennoor 26, Elena Camelia Berghea 27 28, Carsten Bindslev-Jensen 29, Sergio Bonini 30, Sinthia Bosnic-Anticevich 31 32, Knut Brockow 33, Luisa Brussino 34, Paulo Camargos 35, G Walter Canonica 36 37, Victoria Cardona 38 39, Pedro Carreiro-Martins 40 41, Ana Carriazo 42, Thomas Casale 43, Jean-Christoph Caubet 44, Lorenzo Cecchi 45, Antonio Cherubini 46, George Christoff 47, Derek K Chu 48, Alvaro A Cruz 49, Dejan Dokic 50, Yehia El-Gamal 51, Motohiro Ebisawa 52, Bernadette Eberlein 33, John Farrell 53, Montserrat Fernandez-Rivas 54, Wytske J Fokkens 55 56, Joao A Fonseca 57 58, Yadong Gao 59, Gaëtan Gavazzi 60, Radoslaw Gawlik 61, Asli Gelincik 62, Bilun Gemicioğlu 63, Maia Gotua 64, Olivier Guérin 65, Tari Haahtela 66, Karin Hoffmann-Sommergruber 67, Hans Jürgen Hoffmann 68 69, Maja Hofmann 1, Martin Hrubisko 70, Maddalena Illario 71, Carla Irani 72, Zhanat Ispayeva 73, Juan Carlos Ivancevich 74, Kaja Julge 75, Igor Kaidashev 76, Musa Khaitov 77, Edward Knol 78, Helga Kraxner 79, Piotr Kuna 80, Violeta Kvedariene 81 82, Antti Lauerma 83, Lan T T Le 84, Vincent Le Moing 85, Michael Levin 86, Renaud Louis 87, Olga Lourenco 88, Vera Mahler 89, Finbarr C Martin 90, Andrea Matucci 91, Branislava Milenkovic 92, Stéphanie Miot 5, Emma Montella 71, Mario Morais-Almeida 93, Charlotte G Mortz 29, Joaquim Mullol 94 95, Leyla Namazova-Baranova 96, Hugo Neffen 97, Kristof Nekam 98, Marek Niedoszytko 99, Mikaëla Odemyr 100, Robyn E O'Hehir 101, Yoshitaka Okamoto 102, Markus Ollert 103 104, Oscar Palomares 105, Nikolaos G Papadopoulos 106, Petr Panzner 107, Giovanni Passalacqua 108, Vincenzo Patella 109, Mirko Petrovic 110, Oliver Pfaar 111, Nhân Pham-Thi 112, Davor Plavec 113 114, Todor A Popov 115, Marysia T Recto 116, Frederico S Regateiro 117 118 119, Jacques Reynes 85, Regina E Roller-Winsberger 120, Yves Rolland 121, Antonino Romano 122 123, Carmen Rondon 124 125, Menachem Rottem 126 127, Philip W Rouadi 128, Nathalie Salles 129, Boleslaw Samolinski 130, Alexandra F Santos 131 132 133 134, Faradiba S Sarquis 135, Joaquin Sastre 136, Jos M G A Schols 137, Nicola Scichilone 138, Anna Sediva 139, Mohamed H Shamji 140 141, Aziz Sheikh 142, Isabel Skypala 143, Sylwia Smolinska 144 145, Milena Sokolowska 146, Bernardo Sousa-Pinto 57 58 147, Milan Sova 148, Rafael Stelmach 149, Gunter Sturm 150 151, Charlotte Suppli Ulrik 152, Ana Maria Todo-Bom 153, Sanna Toppila-Salmi 66, Ioanna Tsiligianni 154 155, Maria Torres 156, Eva Untersmayr 67, Marilyn Urrutia Pereira 157, Arunas Valiulis 158 159, Joana Vitte 160 161, Alessandra Vultaggio 91, Dana Wallace 162, Jolanta Walusiak-Skorupa 163, De-Yun Wang 164, Susan Waserman 48, Arzu Yorgancioglu 165, Osman M Yusuf 166, Mario Zernotti 167, Mihaela Zidarn 168, Tomas Chivato 169, Cezmi A Akdis 170, Torsten Zuberbier 1, Ludger Klimek 171 172

Affiliations

01 October 2021

-

doi: 10.1111/all.14838

Abstract

Older adults, especially men and/or those with diabetes, hypertension, and/or obesity, are prone to severe COVID-19. In some countries, older adults, particularly those residing in nursing homes, have been prioritized to receive COVID-19 vaccines due to high risk of death. In very rare instances, the COVID-19 vaccines can induce anaphylaxis, and the management of anaphylaxis in older people should be considered carefully. An ARIA-EAACI-EuGMS (Allergic Rhinitis and its Impact on Asthma, European Academy of Allergy and Clinical Immunology, and European Geriatric Medicine Society) Working Group has proposed some recommendations for older adults receiving the COVID-19 vaccines. Anaphylaxis to COVID-19 vaccines is extremely rare (from 1 per 100,000 to 5 per million injections). Symptoms are similar in younger and older adults but they tend to be more severe in the older patients. Adrenaline is the mainstay treatment and should be readily available. A flowchart is proposed to manage anaphylaxis in the older patients.

Keywords: COVID-19 vaccines; adrenaline; anaphylaxis; older (adults/people).

 

 

Conflict of interest statement

IA reports is Associate Editor Allergy and CTA. JB reports personal fees from Chiesi, Cipla, Hikma, Menarini, Mundipharma, Mylan, Novartis, Sanofi‐Aventis, Takeda, Teva, Uriach, other from KYomed‐Innov, personal fees from Purina. VC reports personal fees from ALK, Allergy Therapeutics, LETI, Thermo Fisher, Merck, Astrazeneca, GSK. AC reports personal fees from BMS, MSD. ME reports personal fees from DBV Technologies, Mylan. MFR reports grants from ISCII (Spanish Government), Aimmune, Diater, personal fees from Aimmune, DBV, Novartis, SPRIM, ALK, Allergy Therapeutics, Diater, GSK, Thermo Fisher. BG reports grants from Astrazeneca, Novartis, MSD, Deva, Abdi Ibrahim, GSK. TH reports personal fees from GSK, Mundipharma, OrionPharma, Sanofi. LK reports grants and personal fees from Allergopharma, LETI Pharma, MEDA/Mylan, Sanofi, personal fees from HAL Allergie, Allergy Therapeut., Cassella med, grants from ALK Abelló, Stallergenes, Quintiles ASIT biotech, Lofarma, AstraZeneca, GSK, Inmunotk, and Membership: AeDA, DGHNO, Deutsche Akademie fürAllergologie und klinischeImmunologie, HNO‐BV, GPA, EAACI. PK reports personal fees from Adamed, AstraZeneca, Berlin Chemie, Boehringer Ingelheim, Hal Allergy, Lekam, Mylan, GSK, Novartis, Polpharma, Sanofi, from Teva. VK reports non‐financial support from AstraZeneca, DIMUNA, BerlinCHemieMenarini Baltic. RL reports grants from Astra Zeneca, Chiesi, GSK, other from Astra Zeneca, Novartis, GSK, Sanofi. JM reports personal fees and other from SANOFI GENZYME & REGENERON, NOVARTIS, ALLAKOS, grants and personal fees from MYLAN Pharma, URIACH Group, personal fees from Mitsubishi‐Tanabe, Menarini, UCB, AstraZeneca, GSK, MSD. MO reports grants from Astra Zeneca, Chiesi, GSK, DBV Technologies, Aimmune, Novartis, Pfizer, Regeneron, Sanofi, Boehringer Ingelheim; and volunteer President of the European Federation of Allergy and Airways Diseases Patients’ Associations EFA who receives unrestricted grants from pharmaceutical companies. Second Vice President of the Swedish Asthma and Allergy Association, who receives no income from companies. Takes part in Novartis Asthma Patient Advisory Committee, GSK Global Respiratory Patient Advisory Group and have participated/presented in AstraZeneca events. Whenever there was a honorarium, this went to EFA. OP reports research grants from Inmunotek S.L., Novartis, and MINECO. fees for giving scientific lectures or participation in Advisory Boards from Allergy Therapeutics, Amgen, AstraZeneca, Diater, GlaxoSmithKline, S.A, Inmunotek S.L, Novartis, Sanofi Genzyme and Stallergenes. NP reports personal fees from Novartis, Nutricia, HAL, MENARINI/FAES FARMA, SANOFI, MYLAN/MEDA, BIOMAY, AstraZeneca, GSK, MSD, ASIT BIOTECH, Boehringer Ingelheim, grants from Gerolymatos International SA, Capricare. OP reports grants and personal fees from ALK‐Abelló, Allergopharma, Stallergenes Greer, HAL Allergy Holding B.V./HAL Allergie GmbH, BencardAllergie GmbH/Allergy Therapeutics, Lofarma, ASIT Biotech Tools S.A., rom Laboratorios LETI/LETI Pharma, Anergis S.A., Glaxo Smith Kline, personal fees from Astellas Pharma Global, MEDA Pharma/MYLAN, EUFOREA, ROXALL Medizin, Novartis, Sanofi‐Aventis, and Sanofi Genzyme, Med Update Europe GmbH, streamedup! GmbH, John Wiley and Sons, AS, Paul‐Martini‐Stiftung (PMS), Mobile Chamber Experts (a GA2LEN Partner), Indoor Biotechnologies grants from Pohl‐Boskamp, Inmunotek S.L., Biomay, Circassia. DP reports grants and personal fees from GlaxoSmithKline, personal fees and non‐financial support from Boehringer Ingelheim, personal fees from Belupo, AbbVie, MSD, Chiesi, Menarini, Pliva, Revenio, non‐financial support from Philips. YR reports grants from BIOPHYTIS, NOVARTIS. BS reports personal fees from Allergopharma, Viatris, TEVA, ADAMED, patient ombudsman, Polish Allergology Society grants from AstraZeneca, National Health Programm, grant and personal fees from Polpharma, AstraZeneca. AS reports grants and personal fees from Medical Research Council, Thermo Fisher, Buhlmann, Infomed, Nutricia and Nestle, Allergy Therapeutics, Novartis and Stallergenes, grants from Food Allergy Research and Education, Asthma UK, NIAID / Immune Tolerance Network, non‐financial support from National Institute for Health Research, Thermo Fisher and Buhlmann. Dr. Serpa reports personal fees from Takeda, personal fees and other from Novartis, personal fees from Sanofi, personal fees from GSK, other from Astra Zeneca. JS reports grants and personal fees from SANOFI, personal fees from GSK, NOVARTIS, ASTRA ZENECA, MUNDIPHARMA, FAES FARMA. AS reports grants from HDRUK. MS reports grants from Swiss National Science Foundation (SNF), GlaxoSmithKline (GSK). RS reports grants from São Paulo Research Foundation, MSD, grants and personal fees from Novartis, grants, personal fees and non‐financial support from AstraZeneca, grants, personal fees and non‐financial support from Chiesi, personal fees and non‐financial support from Boehringer Ingelheim. GS reports grants and personal fees from ALK‐Abello, personal fees from Novartis, Bencard, Stallergens, HAL, Allergopharma, Mylan. AMTB reports grants and personal fees from Teva, AstraZeneca, GSK (GlaxoSmithKline), Sanofi, Mundipharma, personal fees from Bial, grants from Leti, Novartis. STS reports personal fees from AstraZeneca, ERT, Novartis, Sanofi Pharma, Roche Products, grants from GSK. MT reports grants from European Commission, SEAIC, ISCIII, personal fees from Diater laboratory, Leti laboratory, Aimmune Therapeutics. IT reports personal fees from Honoraria for educational activities, speaking engagements, advisory boards from Boehringer Ingelheim, Astra Zeneca, GSK, Novartis and grants from GSK Hellas and Elpen. CSU reports personal fees from Astra Zeneca, personal fees from Chiesi, grants and personal fees from Novartis, Boehringer Ingelheim, personal fees from ALK‐Abello, TEVA, Orion Pharma, grants Sanofi Genzyme, personal fees and non‐financial support from GSK. IV reports personal fees from Novartis, Sanofi, personal fees and non‐financial support from Thermo Fisher, non‐financial support from Beckman Coulter. DW reports other from Kaleo, Mylan, and on the AAAAI/ACAAI Joint Task Force on Practice Parameters updating the Anaphylaxis practice parameter. SW reports other from Pfizer, Kaleo, Bausch Lomb. MW reports other from Regeneron Pharmaceuticals, DBV Technologies S.A, Stallergenes GmbH, HAL Allergie GmbH, BencardAllergie GmbH, Allergopharma GmbH & Co. KG, ALK‐AbellóArzneimittel GmbH, Mylan Germany GmbH, Leo Pharma GmbH, Sanofi‐Aventis Deutschland GmbH, Aimmune Therapeutics UK Limited, Actelion Pharmaceuticals Deutschland GmbH, Novartis AG, Biotest AG, AbbVie Deutschland GmbH & Co. KG, Lilly Deutschland GmbH. TZ reports and Organizational affiliations: Committee member: WHO‐Initiative "Allergic Rhinitis and Its Impact on Asthma" (ARIA), Member of the Board: German Society for Allergy and Clinical Immunology (DGAKI), Board Chairman: European Centre for Allergy Research Foundation (ECARF). President: Global Allergy and Asthma European Network (GA2LEN), Member: Committee on Allergy Diagnosis and Molecular Allergology, World Allergy Organization (WAO).

Figures

FIGURE 1 Hospitalizations and intensive care units in older people (from 30 ). Grades of anaphylaxis according to Ring and Messner. Old age people: N = 1123, adults: N = 5768. ***: p < 0.001. In this study, hospitalization and ICU were differentiated between adults and old age people

FIGURE 1 Hospitalizations and intensive care units in older people (from 30 ). Grades of anaphylaxis according to Ring and Messner. Old age people: N = 1123, adults: N = 5768. ***: p < 0.001. In this study, hospitalization and ICU were differentiated between adults and old age people

FIGURE 2 The ABCDE approach in emergencies (from 42 )

FIGURE 2 The ABCDE approach in emergencies (from 42 )

FIGURE 3 Diagnosis and management of severe allergic reactions after COVID‐19 vaccination in the vaccination center (from 29 )

FIGURE 3 Diagnosis and management of severe allergic reactions after COVID‐19 vaccination in the vaccination center (from 29 )

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