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Introduction (contexte de la recherche) Polyethylene glycol (PEG) allergies through IgE activation and a complement activation-related pseudoallergy mechanism have been suggested during reactions to COVID-19-mRNA vaccines. Objectif Reported allergy work-up and outcomes of subsequent COVID-19 vaccinations in patients with a suspicion of hypersensitivity to COVID-19-mRNA vaccines to determine risk factors for anaphylaxis at the next dose. Méthodes In total, 190 patients were referred to two European allergy centers for suspicion of hypersensitivity to COVID-19-mRNA. These patients have been an allergy work-up [skin tests (ST) with COVID-19-mRNA vaccine and PEGs with different molecular weight, and basophil activation tests (BAT) to PEG-2000]. Immediate, delayed reactions compatible with hypersensitivity and reactions not suggestive of hypersensitivity, after a detailed analysis of the medical history, were reported in 69, 84 and 37 patients, respectively. Thirty-one cases with index anaphylaxis (16%);with only 3 severe anaphylaxis, all occurred within one hour after vaccine administration. One hundred and sixty patients (84%) were revaccinated with good tolerance in 139 cases (87%). In 145 patients, revaccination was performed with the culprit vaccine, which was well tolerated in 126 of the patients;with an alternative COVID-19 vaccine (other mRNA vaccine for 12) in 15, well tolerated in 13. Among the 31 patients reporting index anaphylaxis, 23 were revaccinated with the culprit vaccine under hospital supervision, with good tolerance in 15 (65%). The eight immediate reactions after revaccination were less severe than the index one. The work-up was positive in 9 patients (4.7%);among them, four tolerated the culprit vaccine (n=1) or another COVID-19 vaccine (n=3), and five refused further vaccination. Résultats Our results are in accordance with the literature and with ENDA/EAACI recommendations for allergies to COVID-19 vaccines. Although more studies are needed to determine the ST and BAT predictive value. Conclusions This series strongly argues for re-vaccinating in suspected vaccine allergies. And we suggest to refer for allergy work-up only patients with reactions occurring within the first hour after COVID-19-mRNA vaccine administration.
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PURPOSE OF THE STUDY: Several studies have confirmed the impact of confinement on the population, resulting in disruption of care, somatic and psychological effects. Our study looks at adverse effects and problems of adherence to oral immunotherapy therapy (OIT) during this period. PATIENTS AND METHODS: A total of 132 patients, mostly children (95%), with an atopic history (60%) followed for an OIT were included in 3 allergology centers in Île-de-France, during the period of confinement from 03/16 to 05/11/20. The main food allergens used for OIT were peanut (38%), cow's milk (24%), hazelnut (14%), egg (9%), cashew nut and pistachio nut (8%). RESULTS: Adverse effects were found in 13 patients or 10% of the cases. These reactions were mainly grade 1 and 2 according to the Ring and Messmer classification. Three patients had grade 3 reactions and six patients used epinephrine at home. Adherence was correct in 81% of cases with no omissions. Three patients increased their daily dose without medical advice. No significant difference was found in the subgroup analysis comparing age-matched children followed up in OIT in 2019 and 2020 over the same period in the same hospital. CONCLUSION: There was no increase in adverse events in OIT during the confinement period. Therapeutic education during OIT is paramount and helps to reduce the occurrence of adverse events.