Allergies and COVID‐19 vaccines: An ENDA/EAACI Position paper
A. Barbaud, Lene H. Garvey, Alessandra Arcolacı, Knut Brockow, Francesca Mori, Cristobalina Mayorga, Patrizia Bonadonna, Marina Atanasković‐Marković, Luis Moral, Giovanna Zanoni, Mauro Pagani, A. Soria, Maja Jošt, Jean‐Christoph Caubet, Abreu Carmo, Mona Al‐Ahmad, Alberto Álvarez‐Perea, Sevim Bavbek, Benedetta Biagioni, Maria Beatrice Bilò, Natalia Blanca‐López, Herrera Gádor Bogas, Alessandro Buonomo, Gianfranco Calogiuri, G Carli, Josefina Cernadas, Gabriele Cortellini, Gülfem Çelík, Semra Demir, Inmaculada Doña, Adile Berna Dursun, Bernadette Eberlein, Emília Faria, Bryan Fernandes, Tomaz Garcez, I García-Núñez, Radosław Gawlik, Aslı Gelincik, Eva Gómes, J. Gooi, Martine Grosber, Theo Gülen, F. Hacard, Cyrille Hoarau, Christer Janson, Sebastian L. Johnston, Lukas Joerg, Seçil Kepil Özdemir, Ludger Klimek, Mitja Košnik, Marek L. Kowalski, Semanur Kuyucu, Violeta Kvedarienė, José Julio Laguna, Carla Lombardo, Susana Marinho, Hans F. Merk, Elisa Meucci, M. Morisset, Rosa Muñoz‐Cano, F Murzilli, Alla Nakonechna, Florin‐Dan Popescu, Grzegorz Porębski, Anna Radice, Frederico S. Regateiro, Heike Röckmann, Antonino Romano, Ravishankar Sargur, J. Sastre, Kathrin Scherer Hofmeier, Lenka Sedláčková, Marta Sobotková, Ingrid Terreehorst, Regina Treudler, Jolanta Walusiak‐Skorupa, Bettina Wedi, Stefan Wöhrl, Mihael Zidarn, Torsten Zuberbier, Ioana Agache, Marı́a José Torres
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.