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COVID-19 vaccine-associated anaphylaxis: A statement of the World Allergy Organization Anaphylaxis Committee.

ABSTRACT: Vaccines against COVID-19 (and its emerging variants) are an essential global intervention to control the current pandemic situation. Vaccines often cause adverse events; however, the vast majority of adverse events following immunization (AEFI) are a consequence of the vaccine stimulating a protective immune response, and not allergic in etiology. Anaphylaxis as an AEFI is uncommon, occurring at a rate of less than 1 per million doses for most vaccines. However, within the first days of initiating mass vaccination with the Pfizer-BioNTech COVID-19 vaccine BNT162b2, there were reports of anaphylaxis from the United Kingdom and United States. More recent data imply an incidence of anaphylaxis closer to 1:200,000 doses with respect to the Pfizer-BioNTech vaccine. In this position paper, we discuss the background to reactions to the current COVID-19 vaccines and relevant steps to mitigate against the risk of anaphylaxis as an AEFI. We propose a global surveillance strategy led by allergists in order to understand the potential risk and generate data to inform evidence-based guidance, and thus provide reassurance to public health bodies and members of the public.

SUBMITTER: Turner PJ

PROVIDER: S-EPMC7857113 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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COVID-19 vaccine-associated anaphylaxis: A statement of the World Allergy Organization Anaphylaxis Committee.

Turner Paul J PJ Ansotegui Ignacio J IJ Campbell Dianne E DE Cardona Victoria V Ebisawa Motohiro M El-Gamal Yehia Y Fineman Stanley S Geller Mario M Gonzalez-Estrada Alexei A Greenberger Paul A PA Leung Agnes S Y ASY Levin Michael E ME Muraro Antonella A Sánchez Borges Mario M Senna Gianenrico G Tanno Luciana K LK Yu-Hor Thong Bernard B Worm Margitta M

The World Allergy Organization journal 20210203 2

Vaccines against COVID-19 (and its emerging variants) are an essential global intervention to control the current pandemic situation. Vaccines often cause adverse events; however, the vast majority of adverse events following immunization (AEFI) are a consequence of the vaccine stimulating a protective immune response, and not allergic in etiology. Anaphylaxis as an AEFI is uncommon, occurring at a rate of less than 1 per million doses for most vaccines. However, within the first days of initiat ...[more]

PMID: 33558825

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Project description:BackgroundVaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) was one crucial element to overcome the coronavirus disease 2019 (COVID-19) pandemic. Even though anaphylaxis to vaccines is rare, 47 patients came to the Allergy Unit at the University Hospital Graz, Austria, reporting immediate anaphylactoid symptoms after administration of COVID-19 vaccines. In addition, 29 patients with known drug-induced anaphylaxis wanted to be tested for a possible sensitization against COVID-19 vaccines or excipients, such as polyethylene glycol (PEG) or polysorbate 80 (PS80) before the first COVID-19 vaccination. Skin prick tests and intradermal tests were performed in all 76 patients, mostly using PEG 2000, and/or PS80. Skin prick tests with COVID-19 vaccines were performed depending on availability.ObjectiveOur aim was to characterize this patient cohort in terms of patients' anaphylactoid responses, their willingness to future vaccinations against SARS-Cov‑2, and reasons for their decision.MethodsWe developed a questionnaire and analyzed 34 completed copies.ResultsOf the 47 patients with anaphylactoid reactions to COVID-19 vaccination, most were female (40 female/7 male). The skin tests, even when performed with the respective COVID-19 vaccine, were negative in all but one patient. Most patients who experienced anaphylactoid reactions after a COVID-19 vaccination, did not want another COVID-19 vaccination at the time of answering the questionnaire because of anxiety for another anaphylactoid response at the next shot. Premedication with antihistamines significantly lowered (n = 74 vaccinations) the severity of anaphylactoid responses after COVID-19 vaccinations.ConclusionAnxiety about another anaphylactoid episode hinders patients to be vaccinated against SARS-CoV‑2 again. Premedication with antihistamines and collaboration of allergologists with psychologists might lower the risk of an anaphylactic/anaphylactoid response as well anxiety in drug-induced anaphylactic patients.

Project description:In the last two years, the coronavirus disease 19 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a scientific and social challenge worldwide. Vaccines have been the most effective intervention for reducing virus transmission and disease severity. However, virus genetic variants are still circulating among vaccinated individuals with different symptomatology disease cases. Understanding the protective or disease associated mechanisms in vaccinated individuals is relevant to advance in vaccine development and implementation. To address this objective, serum protein profiles were characterized by quantitative proteomics and data analysis algorithms in four cohorts of vaccinated individuals uninfected and SARS-CoV-2 infected with asymptomatic, nonsevere and severe disease symptomatology. The results showed that immunoglobulins were the most overrepresented proteins in infected cohorts when compared to PCR-negative individuals. The immunoglobulin profile varied between different infected cohorts and correlated with protective or disease associated capacity. Overrepresented immunoglobulins in PCR-positive individuals correlated with protective response against SARS-CoV-2, other viruses, and thrombosis in asymptomatic cases. In nonsevere cases, correlates of protection against SARS-CoV-2 and HBV together with risk of myasthenia gravis and allergy and autoantibodies were observed. Patients with severe symptoms presented risk for allergy, chronic idiopathic thrombocytopenic purpura, and autoantibodies. The analysis of underrepresented immunoglobulins in PCR-positive compared to PCR-negative individuals identified vaccine-induced protective epitopes in various coronavirus proteins including the Spike receptor-binding domain RBD. Non-immunoglobulin proteins were associated with COVID-19 symptoms and biological processes. These results evidence host-associated differences in response to vaccination and the possibility of improving vaccine efficacy against SARS-CoV-2.

Dataset Information

COVID-19 vaccine-associated anaphylaxis: A statement of the World Allergy Organization Anaphylaxis Committee.

Publications

COVID-19 vaccine-associated anaphylaxis: A statement of the World Allergy Organization Anaphylaxis Committee.

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