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J Allergy Clin Immunol Pract ; 2022.
Article in English | PubMed | ID: covidwho-2028163


BACKGROUND: Although immediate potentially allergic reactions have been reported after dose one of mRNA COVID-19 vaccines, comprehensively defined subtypes have not been clearly distinguished. OBJECTIVE: To define distinct clinical phenotypes of immediate reactions after dose one of mRNA COVID-19 vaccination, and to assess the relation of clinical phenotype to mRNA COVID-19 vaccine second dose tolerance. METHODS: This retrospective study included patients with ≥1 potentially allergic symptom or sign within 4 hours of receiving dose one of a mRNA COVID-19 vaccine and assessed by Allergy/Immunology specialists from 5 US academic medical centers (January-June 2021). We used latent class analysis - an unbiased, machine-learning modeling method - to define novel clinical phenotypes. We assessed demographic, clinical, and reaction characteristics associated with phenotype membership. Using log-binomial regression, we assessed the relation between phenotype membership and second dose tolerance, defined as either no symptoms or mild, self-limited symptoms resolving with antihistamines alone. A sensitivity analysis considered second dose tolerance as 'objective signs only.' RESULTS: We identified 265 patients with dose one immediate reactions with 3 phenotype clusters: 1) Limited/Predominantly Cutaneous, 2) Sensory and 3) Systemic. A total of 223 patients (84%) received a second dose and 200 (90%) tolerated their second dose. Sensory cluster (all patients had the symptom of numbness or tingling) was associated with a higher likelihood of second dose intolerance, but this finding did not persist when accounting for objective signs. CONCLUSIONS: Three novel clinical phenotypes of immediate-onset reactions after dose one of mRNA COVID-19 vaccines were identified using latent class analysis: 1) Limited/Predominantly Cutaneous, 2) Sensory and 3) Systemic. While these clinical phenotypes may indicate differential mechanistic etiologies or associations with subsequent dose tolerance, most individuals proceeding to their second dose tolerated it.

Journal of Agriculture Food Systems and Community Development ; 10(2):291-295, 2021.
Article in English | Web of Science | ID: covidwho-1244303


Since the onset of the COVID-19 pandemic, the North Carolina Local Food Council has strengthened its role as a cohesive and effective organization during a public-health crisis to share challenges, devise solutions, and build resilience across local food systems in North Carolina. The Council includes representatives from 21 organizations working across the state, as well as three representatives from regional local food councils. The Council's response to the pandemic addressed three key areas of action: (1) Coordinate responses across multiple sectors;(2) Enhance collaboration across the food supply chain;and (3) Facilitate data collection and public messaging. This paper describes the positive impacts the Council has had across North Carolina on consumers and producers of local food as a result of this collaborative network and long-established relationships across the state. Now, more than ever, the relationships and collaborative efforts of statewide organizations and partners are needed. The Council's crisis response has been strong because of the long-standing relationships of its members and its ability to share resources quickly, allowing it to work toward coordinated responses. The work of the North Carolina Local Food Council can serve as a model for other states that have state-level local food councils or want to develop them. In addition, the Council's work demonstrates how collaborations among statewide partners can foster resilience within local food systems, particularly during a public health crisis.