Vaccination of patients with allergic disease against novel coronavirus infection: Position paper of the russian association of allergology and clinical immunology

One of the key tasks of the previous year is to stop the spread of coronavirus disease (COVID-19), which became a pandemic that led to the deaths of more than 4 million people worldwide and more than 140 thousand deaths in Russia. COVID-19 is caused by the severe acute respiratory syndrome coronavirus 2 (2019-nCoV) virus of the coro-navirus family. Vaccination plays a leading role in ending the pandemic. Currently, five vaccines against COVID-19 have been registered in Russia, namely, Sputnik V, Sputnik light, EpiVacCorona, EpiVacCorona-H, and SoviVak. The short follow-up period and absence of randomized placebo-controlled trials of COVID-19 vaccines in certain patients with chronic diseases lead to several questions about the effectiveness/safety of vaccination in these patients. Given the wide spread of allergic diseases and the heterogeneity of patients with allergopathology, experts of the Russian Association of Allergology and Clinical Immunology have developed and approved a position paper on vaccination of patients with allergopathology.Copyright © 2020 Pharmarus Print Media.

Are allergic diseases a risk factor for systemic side effects after COVID-19 vaccines?

Background: Mass vaccination seems to be the most effective way to turn back to the pre-pandemic period and end the pandemic. Unfortunately, COVID-19 vaccines have some side effects. In phase studies of currently-approved COVID-19 vaccines, patients with a known allergy or a history of anaphylaxis were excluded from the studies. This situation creates doubts about the course of atopy and the presence of allergic disease related to the side effects of COVID-19 vaccines in patients with allergic diseases. Therefore, our aim with this study was to evaluate local side effects (LSE) and systemic side effects (SSE) after COVID-19 vaccines in patients with allergic diseases and to determine possible risk factors. Method(s): Six hundred forty-eight adult patients who received any COVID-19 vaccine between April 1, 2021 and September 30, 2021 and agreed to participate in the study were included in this case-control retrospective study. Result(s): Six hundred forty-eight adult patients [Female: 446 (68.8%), Male: 202 (32.2%)] participated in the study. After the 1st dose of COVID-19 vaccine, 24.1% of patients reported SSE. After the 2nd dose of COVID-19 vaccine, 67 patients (12.3%) developed SSE. Female gender (OR: 1.757, 95%Cl: 1.143-2.702, p: 0.010), history of previous COVID-19 infection (OR: 1.762, 95%Cl: 1.068-2.906, p: 0.026), and COVID-19 vaccine type administered (OR: 4.443, 95% CI: 2.640-7.476, p < 0.001) were found to be independent risk factors for SSE after COVID-19 vaccines. Premedication (OR: 0.454, 95% Cl: 0.281-0.733, p < 0.001), was found to be a protective factor for SSE developing after COVID-19 vaccines. Conclusion(s): CoronoVac and Pfizer-BioNTech COVID-19 vaccines are shown to be well tolerated. Patients with allergic disease do not have an increased risk for SSE that may develop after COVID-19 vaccines. Moreover, doubts or fears about possible side effects in the allergic patient group should not be an obstacle to COVID-19 vaccination.

COVID-19 severity in allergic patients with or without allergen immunotherapy

Background: SARS-CoV- 2 impacts on the immune response in a variable way. In pilot study we showed last year that in allergic patients allergen immunotherapy (AIT) seemed to reduce COVID-19 severity. Here we present final results. Method(s): in cooperation with allergists, dermatologists and ENTs we conducted a Latin-American registry of patients with allergic disorders, including urticaria, who got COVID-19. Apart from demographic data, COVID-19 severity, allergic diseases, comorbidities and compliance with underlying allergy/asthma treatment we collected data on AIT. Result(s): Of the 1095 registered patients, 54% female, 89.4% were confirmed and 10.6% highly suspected COVID-19 cases. IgE-mediated allergy was confirmed (81%) or clinically suspected (16%);while 3.2% had only urticaria. 630/1095 (57.5%) received AIT;in both groups (yes or no AIT) median age was 30-39y. For COVID-19 severity, see table. Compared to allergic patients without AIT, receiving AIT reduced the Risk Ratio (RR) for severe disease with lower respiratory symptoms or worse (COVID-4- 7) to 0.78 (.95 CI 0.6703-0.9024), p = 0.0017) and for critical COVID-19 in need of oxygen therapy or worse to 0.65 (.95 CI 0.42-0.9992, p = 0.048). There was only one fatality in the no-AIT group. There was no difference between groups in co-morbidities, public or private practice or allergic disease;AIT patients tended to be younger. Conclusion(s): These data seem to favor the outcome of COVID in allergic patients receiving AIT, but more in-depth analysis is needed.

Are allergic diseases a risk factor for more severe COVID-19?

Background: The vast majority of studies indicate that asthma and allergic diseases are not risk factors, neither for COVID-19 susceptibility nor to cause a more severe course of disease. The study aimed to compare medical history, clinical characteristics, and outcome of COVID-19 in patients with allergic comorbidities and in general hospitalized population. Method(s): The study was a single-center retrospective analysis based on data of 632 COVID-19 patients admitted to the City Hospital No 4 (Dnipro) from August to October 2021. The patients' demographics, medical history, particularly the presence of allergic diseases, symptoms and lab tests on admission were collected from medical cards and analyzed. The methods of descriptive and non-parametric statistics were used to process the results. Result(s): Among 632 COVID-19 patients, 27 (4.3%) had the allergic diseases and reactions in medical history (Figure 1). Their median age was 60 (52;69) (p > 0.1), 21 (78%) were women (p = 0.072). The information concerning patients' demographics and clinical characteristics on admission is presented in Table 1. Conclusion(s): The hospitalized patients with COVID-19 and allergic diseases did not differ by from the general population with COVID-19. The Severity Index and lethality weren't higher in patients with allergies. At that time the frequency of saturation < 90% as key indicators of respiratory failure were lower in patients with allergic diseases. While there wasn't difference in need for supplemental oxygen support, interestingly, that there were less patients admitted to ICU in comparison with the general population. Thus, allergic diseases, at least, are not a risk factor for more severe COVID-19.

Increasing capacity in acute day care settings: patients' experiences of a pop-up day care unit.

The COVID-19 pandemic had considerable impact on paediatric ambulatory care. A pop-up paediatric day care unit for children with allergic and inflammatory bowel diseases was delivered from Nightingale Hospital Bristol (NHB) which was set up to treat patients during the pandemic. METHODOLOGY: The unit operated fortnightly between December 2020 and March 2021. Family feedback on the service was collated via an online survey. RESULTS: 72 respondents found NHB acceptable; 70 (97%) would be happy to return; 63 (90.3%) preferred the NHB to attending Bristol Royal Hospital for Children or had no preference for their appointments. Positive comments focused on service organisation and clinical environment. Families valued the availability of the close, free parking. The minimal negative comments related to travel directions, lack of catering facilities and the small number of toilets. CONCLUSION: The pop-up service model was highly acceptable to families. This highlights the need for appropriate hospital services to explore similar initiatives beyond traditional healthcare settings in order to ensure that the provision of equitable health care is in line with the NHS Long Term Plan.

Longitudinal Alpha-gal IgE Levels in a University of Virginia Employee Cohort

Rationale: The alpha-gal syndrome (AGS) is caused by IgE to galactose-α-1,3-galactose (α-Gal) and is strongly linked to tick bites. To date there have been limited studies on the natural history of AGS and α-Gal sensitization. Here we monitored α-Gal IgE levels over time among sensitized individuals in an employee vaccine cohort unselected for allergic disease. Methods: University of Virginia employees were recruited for an IRB-approved COVID-19 vaccine study. Study subjects provided blood samples and answered a questionnaire capturing medical history including diet and allergy history. α-Gal IgE (cut-off 0.1 kU/L) and total IgE were assayed in banked serum by ImmunoCAP and slopes calculated by linear regression. Results: Of the 266 subjects in the study, 46 (17%) were sensitized to alpha-gal. 38 sensitized subjects had two or more samples separated by at least 100 days. Of these, 68% were female, median age was 55.6 and α-Gal IgE levels dropped over time in 25 (66%). Median rate of decay among subjects with decreasing titers was 53%/year (IQR 46-61). Of the 38 sensitized subjects, 12 (32%) reported interval tick bites over the course of the study. The correlation between α-Gal IgE slopes and total IgE slopes was moderately strong (Pearson's R = 0.60, P<0.001). Conclusions: α-Gal IgE levels decrease over time in many subjects, with a median decay rate of 53%/year. Although α-Gal specific IgE is often only a small fraction of total IgE, both track closely with each other over time, likely a reflection of changes in IgE relating to tick bites.

THE UNEXPLORED POSSIBILITIES, PERCEPTIONS AND ETHICAL IMPLICATIONS OF GENE-EDITING ALLERGIC DISEASE: ENGAGING STAKEHOLDERS IN SOUTH AFRICA

Clinically approved cell and gene therapies are opening up future possibilities to treat and prevent myriad diseases, which may include allergic diseases. In South Africa, this could help alleviate the high disease burden and economic cost of treating such diseases. However, even if viable gene-editing options to treat, cure and prevent allergic diseases become safe, effective and affordable for the South African market within the next few decades, the ethical implications and challenges of perceptions, regulation and oversight to ensure safety and equitable access remain. It would be important for all stakeholders involved, including the public and physicians, clinicians and ethicists on clinical and research ethics committees, to be informed about the possibilities, to engage in discussions with one another and to redress any gaps in knowledge. It would be especially important to determine whether cases for gene-editing aimed at allergy would be applied for therapeutic purposes or for enhancement. Much research and discussion remain to be embarked upon;however, it is imperative that research and engagement are expanded and prioritised.

Allergic Children's Parents' Hesitancy About COVID-19 Vaccination

Objective: With the approval of the use of COVID-19 vaccines for children, their administration has started in many countries. However, families have some hesitations about vaccinating their children with the COVID-19 vaccines. The aim of this study was to determine the COVID-19 vaccination rates in allergic children aged 12-19 years and to evaluate contributing factors to vaccine hesitation. Materials and Methods: This cross sectional study was carried out in a Pediatric Allergy Department of a university-affiliated hospital between 15th December 2021 and 15th February 2022. Parents of allergic children who agreed to participate in this study constituted the study population (n=261).Results: Of the 261 children with allergic diseases, 137 (52.4%) had two doses of the COVID-19 vaccine, and 89.3% of the mothers and 92.3% of the fathers had at least two doses of the COVID-19 vaccine. Among children who were not vaccinated (n=124), the leading reason was the novelty of the vaccine, and the second reason was the side effects. The perceived stress scale score of the parents in the vaccinated group was significantly (p <0.05) higher than in the unvaccinated group.Conclusion: Although there is an effective and safe vaccine for children during the pandemic, vaccination rates are not yet at the desired level.

Evidence-Based Guidelines for SARS-COV-2 Vaccination of Patients of Skin Allergic Diseases and Patients on Immuno-Therapeutics.

There is a dearth of data regarding the safety and timing of the severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) vaccination of patients on immunosuppressive or immunomodulatory therapies. However, data from other vaccine trials may be extrapolated to get an idea regarding the recommendation of SARS-COV-2 vaccines. All the novel SARS-COV-2 vaccines are non-live, thus ensuring the safety of the vaccines. However, the vaccines may not be able to generate an equipotent immunogenic response in patients receiving immunotherapeutics, in comparison to those who are not. We have attempted to put forward certain statements, with respect to SARS-COV-2 vaccination of patients who are on treatment for different dermatological conditions. However, the risk-benefit ratio must be discussed between the patient and the physician, and the final call should be individualized.

Management of patients with allergic diseases in the era of COVID-19.

In the early days of the coronavirus disease 2019 (COVID-19) pandemic, allergic diseases, especially asthma, were considered to be risk factors for severe COVID-19 infection, hospitalization, and death. These concerns stemmed from the idea that individuals with allergic diseases are generally more susceptible to respiratory virus infections, which are major causes of exacerbation of allergic diseases. However, epidemiologic data with mechanistic studies showed that the associations between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and clinical outcomes of allergic diseases are complex and affected by diverse factors such as allergic disease severity, phenotypes, and control status with current medications. In addition, children generally have less severe clinical outcomes of COVID-19 than those of adults, which complicates the association between allergic diseases and COVID-19-related outcomes among them. The present review summarizes the potential association between allergic diseases and COVID-19-related outcomes and discusses the factors requiring consideration. The findings viewed herein will aid the management of allergic diseases in patients with SARS-CoV-2 infection and the establishment of medical polices for managing patients with allergic diseases.

Increase in Psychiatric Care Needs of Rural Children Postcovid-19

Background: Due to the COVID-19 pandemic children were deprived of in-person attendance at school and experienced social isolation. The impact of these social-distancing measures on pediatric mental health is only now being unraveled. We conducted a descriptive review of psychiatric diagnoses at a pediatric outpatient practice in a Southern Illinois rural community. We compared the trends of pediatric psychiatric diagnosis before and following the COVID pandemic. Methods: Pediatric Group LLC has multiple office locations in Rural Southern Illinois catering to about 10,000 pediatric patients staffed by pediatric providers and a clinical psychologist. The pediatric population has remained stable during the period. The care providers and practices have remained unchanged over the past four years. We did a retrospective review of electronic health records from January 2019 through June 2021. Using ICD10 diagnostic codes, we analyzed the top 100 diagnoses made at the pediatric practice. Diagnoses were broadly classified into psychiatric and non-psychiatric categories. Psychiatric illnesses included anxiety, attention deficit hypersensitivity disorder (ADHD), conduct disorders, mood disorders, sleep disorders, and other psychiatric illnesses such as post-traumatic stress disorder (PTSD). Descriptive comparisons were made between pre-COVID (2019) and post-COVID (2021) periods. Results: Compared to a baseline of 5044 encounters in 2019 (pre-COVID), attendance was 9% lower (4680) in 2020. Attendance dropped by 14% (2206) in the first half of 2020, increasing by 11% (2474) to reach preCOVID levels in the second half of 2020. The attendances continued to increase in the first half of 2021, reaching 43% higher (3614) numbers compared to pre-COVID levels. Compared to 2019 and 2020, an increase in all psychiatric diagnoses was seen in our offices in the year 2021. Further analysis of the year 2021 showed significant increases in Anxiety and Depressive disorders, Oppositional Defiant Disorder (ODD), Disruptive Mood Dysregulation disorder (DMDD), and Major Depressive disorders (MDD) that almost doubled the statistics from the pre-COVID period. Sleep disorders and Post Traumatic Distress Disorder (PTSD) visits increased by far more than 150 percent. (Table 1) Conclusion: A steady increase in pediatric psychiatric illness has been noted in the second half of 2020 and first half of 2021 following COVID pandemic. We observed an increase by over two times with almost all the psychiatric disorders in 2021. The overall increase in the incidence of various pediatric psychiatric illnesses is concerning. We believe that the absence of in-school attendance may have played a significant role.

CHARACTERIZING SLEEP AND MOOD DURING COVID FOR YOUTH WITH ALLERGIC DISEASE

Introduction: The COVID-19 pandemic significantly disrupted the daily lives of children and adolescents. This study aimed to characterize sleep and mood during COVID in youth with asthma and/or eczema at two times: shortly after the lifting of stay at home orders (Summer 2020 [T1]) and after youth returned to school (Winter 2021 [T2]). Methods: Pediatric PROMIS measures (Sleep Disturbances, Sleep- Related Impairment, Anxiety, Depressive Symptoms) and the Pediatric Sleep Practices Questionnaire were administered through REDCap. Parents of younger children (YC, 5-7 years, n=16) completed proxy measures for their children, while older children (OC, 8-12 years, n=16) and adolescents (ADOL, 13-17 years, n=17) completed self-report measures. Results: For YC, mean Sleep Disturbances T-scores significantly decreased between T1 and T2 (62.0 vs. 56.4, p=.02), with no significant changes in the other variables. For OC, there were no significant changes in mean T-scores for any of the outcomes. For ADOL, there was a significant increase in Sleep-Related Impairment between T1 and T2 (52.0 vs. 57.7, p=.003), as well as a significant increase in Depressive Symptoms (48.2 vs. 52.5, p=.04). At T1, technology use prior to bedtime was more common in ADOL (YC=37.5%, OC=37.5%, ADOL=88.2%). At T2, technology use was also more common in ADOL (YC=50.0%, OC=37.5%, ADOL=64.7%), with an increase in YC technology use and a decrease in ADOL technology use observed. Parental presence while falling asleep was greatest in YC at both time points, with no noted changes in any group across time (T1: YC=56.3%, OC=18.8%, ADOL=17.6%;T2: YC=50.0%, OC=25.0%, ADOL=11.8%). Conclusion: This study was limited by a small sample size, but provides some insights into the sleep and mood of children and adolescents with allergic disease during the first year of the COVID-19 pandemic. Although YC had fewer sleep disturbances at T2, there was an increase in technology use prior to bedtime. For ADOL, some of the changes in sleep, technology use, and depressive symptoms were likely due to the return to school at T2. Finally, it was notable that multiple OC and ADOL required parental presence to fall asleep. Additional research is needed to understand how the ongoing pandemic is impacting children and adolescents.

Atopy and Allergic Diseases Have No Impact on the Severity of COVID-19

Objective: The clinical features of COVID-19 range from asymptomatic disease to severe pneumonia or even death. Therefore, many researchers have investigated the factors that could affect the severity of COVID-19. We aimed to assess the impact of aero-allergen sensitization and allergic diseases on the severity of COVID-19. Materials and Methods: We included 60 adult patients with symptomatic COVID-19 and allocated them into two groups equal in number as having severe and non-severe COVID-19. We evaluated the demographic features and allergic diseases in addition to clinical, laboratory and radiological findings of COVID-19. Skin prick tests (SPTs) with common aero-allergens, serum total IgE levels and blood eosinophil counts were evaluated 3 months after the patient's recovery from COVID-19. Results: The mean age of the patients was 52 ± 11 years and 73.3% of the patients were male. There was no significant difference between the two groups in terms of age, gender, smoking habits, obesity and comorbidities. Although the frequency of sensitization to aeroallergens and the allergic diseases were similar, the history of allergic diseases in the family was higher in the severe group (p<0.001). The polysensitization in SPTs was associated with the presence of a cytokine storm during the infection (p=0.02). Total IgE levels and blood eosinophil counts were not significantly different between the two groups. Conclusion: The presence of atopy or allergic diseases does not seem to be related to the severity of COVID-19. However, polysensitization and a family history of allergic diseases are more prominent in those having a cytokine storm and severe COVID-19, respectively.

Atopy and Allergic Diseases Have No Impact on the Severity of COVID-19

Objective: The clinical features of COVID-19 range from asymptomatic disease to severe pneumonia or even death. Therefore, many researchers have investigated the factors that could affect the severity of COVID-19. We aimed to assess the impact of aero-allergen sensitization and allergic diseases on the severity of COVID-19. Materials and Methods: We included 60 adult patients with symptomatic COVID-19 and allocated them into two groups equal in number as having severe and non-severe COVID-19. We evaluated the demographic features and allergic diseases in addition to clinical, laboratory and radiological findings of COVID-19. Skin prick tests (SPTs) with common aero-allergens, serum total IgE levels and blood eosinophil counts were evaluated 3 months after the patient's recovery from COVID-19. Results: The mean age of the patients was 52 ± 11 years and 73.3% of the patients were male. There was no significant difference between the two groups in terms of age, gender, smoking habits, obesity and comorbidities. Although the frequency of sensitization to aeroallergens and the allergic diseases were similar, the history of allergic diseases in the family was higher in the severe group (p<0.001). The polysensitization in SPTs was associated with the presence of a cytokine storm during the infection (p=0.02). Total IgE levels and blood eosinophil counts were not significantly different between the two groups. Conclusion: The presence of atopy or allergic diseases does not seem to be related to the severity of COVID-19. However, polysensitization and a family history of allergic diseases are more prominent in those having a cytokine storm and severe COVID-19, respectively. [ FROM AUTHOR] Copyright of Asthma Allergy Immunology / Astim Allerji Immunoloji is the property of Turkish National Society of Allergy & Clinical Immunology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

COVID-19 vaccine uncertainty amongst people with allergic disease in Australia. Learning from a patient advocacy organisation

Purpose: The Australia n national vaccination program for COVID-19 began on 21 February 2021, with specific advice regarding the use and administration of the vaccines in people with a history of allergic disease. Allergy &Anaphylaxis Australia (A&AA) is a patient advocacy organisation for people with allergic disease and those who care for them. A&AA receives direct health support requests from the public relating to various aspects of managing allergic disease. Following an increase in COVID-19 vaccine related enquiries, an online webinar presented by clinical immunology/allergy specialists with expertise in drug allergy and vaccinology was scheduled to disseminate factual information on COVID-19 vaccination for people with allergic disease. Metrics on the webinar and surrounding promotion were obtained in order to: 1) understand the reach of A&AA's assistance;and 2) understand the utilisation of evidence-based resources. Method: An audit of requests for support related to COVID-19 vaccination was undertaken. A&AA conducted a COVID-19 vaccination webinar and promoted it through three social media posts. Metrics were obtained for the webinar and related social media posts. Results: A&AA received 45 direct enquiries for health support related to the COVID-19 vaccines. In response to these direct enquires a COVID-19 vaccine webinar was held on 15 March 2021. This webinar was attended by 97 individuals and subsequently viewed 8,107 times as an on-demand digital resource. Across A&AA's social media channels, 738 people engaged with the three social media posts relating to the webinar, with a total reach of 13,003 people. Conclusion: The findings of this audit demonstrate the ability for allergy focused patient advocacy organisations to assist in the dissemination of evidence-based information on the appropriateness of COVID-19 vaccination for people with allergic disease during times of uncertainty.

Impact of allergen immunotherapy in COVID-19: An italian survey

Background: COVID-19 may present with many different clinical manifestations and a wide severity range. Common signs are respiratory disorders, that could be similar in some cases to those observed in allergic rhinitis or asthma. Respiratory allergies may be treated with allergen immunotherapy (AIT). It is assumed that AIT reduces the tendency to produce IgE, modulates the Th2-polarized immune system, increases IFN-γ production and reduces allergic inflammation. On the other hand, it is described that severe forms of COVID-19 are related to the secretion of type-I cytokines. The main purpose of the following survey was to evaluate, from the physician's perspective, if COVID-19 could have an impact in allergic diseases, and specially in patients treated with AIT. Method: A web-based survey (SurveyMonkey®) of 18 questions was defined to evaluate, from the clinician's perspective, the impact of COVID-19 in allergic diseases and patients under AIT based in their clinical practice. It was shared with a pool of 855 Italian physicians. Results: A total of 62 respondents answered the survey. 93% asked to their patients regularly about COVID-19. They estimated that 1/100 have had COVID-19, being mild in the 88% of cases, with no severe or fatal cases to their knowledge. 16% observed higher incidence of COVID-19 in patients with rhinitis, but most of them considered that disease was equal to other patients (71%) or less severe (24%). Similar was observed for asthma. None of the responders considered that COVID-19 was more severe in patients with AIT, however, 48% prescribed AIT less frequently. Most doctors (75%) maintained their prescription habits, while 22% increased SLIT vs SCIT. Conclusion: Among the 62 Italian doctors answering the survey, doctors reduced AIT prescription during COVID-19 pandemic, switching to SLIT in some cases. They did not consider that AIT could affect COVID-19 severity. In addition, some doctors believed that COVID-19 is less severe in allergic rhinitis or asthma patients.

Successful allergological risk-assessment protocol and SARS-CoV-2 vaccination: The experience of a large Italian University Hospital

Background: Novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccines have been recently approved, and public concern regarding the risk of anaphylactic reactions arised after few cases during the first days of mass-vaccination. Polyethylene glycol (PEG) has been suggested as the most probable culprit agent for allergic reactions. We describe the allergy work-up protocol implemented for the vaccination campaign in our Center, aiming to allow the greatest number of people to be vaccinated safely. Method: The protocol included the self-report of a history of suspected drug or vaccine allergies, and subsequent teleconsultation and allergometric tests for PEG and Polysorbate 80 (PS80). A desensitizing protocol of vaccine administration was applied to patients sensitized only to PS80, and to those with a suspect allergic reaction after the first vaccine dose. Results: 10.2% (414 out of 4042) of the entire vaccine population have been screened: only one patient resulted allergic to PEG and therefore excluded from the vaccination. Another patient was sensitized to PS80 only and safely vaccinated applying the desensitizing protocol. Seven subjects without a previous history of allergic disease experienced suspect hypersensitivity reactions to the first administered dose: one of them resulted allergic to PEG and was excluded from the second dose, while the others safely completed the vaccination with the desensitizing protocol. Conclusion: A careful allergological risk-assessment protocol significantly reduces the number of patients who would have avoided SARS-CoV-2 vaccination for their allergies and to effectively identify and manage those rare patients with sensitization to PEGs and/or PS80.

Changes in asthma control after administration of COVID-19 mRNA vaccines

Background: Rapid development of vaccines to prevent coronavirus disease 2019 (COVID-19) has become a global imperative. Two mRNA vaccines have been recently approved by European Medicines Agency: BNT162b2 and mRNA-1273 COVID-19 vaccine. They have demonstrated safety in 1-3 phase clinical trials but data in asthmatics vaccinated in real-life is scarce. We sought to assess the change in asthma control before and 4 weeks after the administration of mRNA vaccine against COVID-19 in adults diagnosed with mild to severe asthma. Method: We performed an observational descriptive study of asthmatic healthcare workers who were vaccinated in our Allergy Department. Asthma severity were measured following Spanish Guideline on the Management of Asthma (GEMA) criteria. Asthma control was evaluated prior to vaccination and 4 weeks after vaccination using Asthma Control Test (ACT) questionnaire. The mRNA vaccines were administered under medical supervision and 30 minutes observation. Results: We recorded a total of 52 asthmatic healthcare workers who receive COVID-19 vaccination in our Allergy Department. The mean age was 52.3 years (range 21-66) and 46 (88.5%) were female. Ten (19.2%) and 42 (80.8%) subjects received BNT162b2 and mRNA-1273 COVID-19 vaccine, respectively. Twenty patients (38.5%) had intermittent asthma, 8 (15.4%) mild, 18 (34.6%) moderate, and 6 (11.5%) severe asthma. One patient was receiving oral corticosteroids and one biologic treatment. Coexisting allergic diseases were common: 26 (50%) had allergic rhinitis, 5 (9.6%) atopic dermatitis, 18 (34.6%) food allergy, 19 (36.5%) drug allergy. Other comorbidities were cardiovascular disease (23.1%), obesity (21.2%), autoimmunity (19.2%) and nasal polyposis (5.8%). The ACT before vaccination was 24.2 (range 21-25, SD 1.4). We detected 2 (3.8%) patients with ACT<20 who were vaccinated once ACT was ≥20. Four weeks after the first and second dose of mRNA vaccine, ACT was 23.4 (range 10-25, SD 2.6) and 23.8 (range 12-25, SD 2.5), respectively. We found no statistical significant differences in ACT changes among intermittent, mild, moderate, and severe asthma. Conclusion: In our experience, asthma exacerbation after mRNA vaccination is infrequent and not related to asthma severity. Asthmatic population can safely receive mRNA vaccines against COVID-19.

Reality of allergists during the COVID-19 pandemic in Argentina 2020

Background: The COVID-19 pandemic modified the way of practicing medicine, causing a changes in medical actions in the health professional and in their habits in relation to daily practices. Accelerated changes have taken place, which have led to the development and implementation of telemedicine as a very useful tool that allows professional contact with their patients, and on the other hand, access to up-to-date scientific training. Objetive: Evaluate the impact of the COVID-19 pandemic on the activity of the allergist in Argentina during phase 1 of preventive and mandatory social isolation (april and may 2020). Determine the impact of the pandemic on allergic diseases. Analyze the use of telemedicine in daily practice. Method: It is a prospective, observational and cross-sectional study. A questionnaire was made to specialist doctors in Allergy and Immunology during april and may 2020 of preventive and compulsory social isolation, for subsequent statistical study. Results: 113 surveys were carried out, 72.9% showed a decrease in work practice by 50%, 20.7% between 25-50% and 6.3% less than 25%. The most frequent consultations were request for prescriptions in 67%, medical history certificates in 48%, rhinitis and urticaria in 46%, atopic dermatitis and asthma attack in 23%, and contact dermatitis in 5.3%. 94% implemented telemedicine, the most used tools were whatsapp/webcam (61%) followed by telephone assistance (38%). Conclusion: The COVID-19 pandemic affected the practice of the specialty in terms of the decrease in medical consultation, the way of working, interacting with patients, the need for protective equipment, with an emotional and economic cost. On the other hand, it gave the possibility of having other care alternatives such as telemedicine.

COVID-19 vaccines: An allergological study

Background: In order to prevent infection with severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) an active approach is necessary. On December 2020 the commercialization of the COVID-19 vaccines was made. In Spain the first one to arrive was Pfizer-BioNtech vaccine. Initially, several reports of anaphylactic reactions due to the vaccine in the USA and in the UK were reported, which lead to an early recommendation to avoid the administration in patients with allergic history. The objective of this study is to describe and characterize the allergenic profiles of patients attended in our clinic for allergy testing to prevent reactions with the COVID-19 vaccine. Method: The allergological profile of 85 patients diagnosed with previous history of allergic disorders was analysed between January 18th and March 16th 2021. The allergological study included skin-prick test with polyethylene glycol (PEG), Tween 20, Tween 80, and COVID-19 vaccine (Pfizerâ), together with latex and other allergens when necessary. After the double dose of vaccine was completed, a follow up was done by telephone. Results: Risk stratification and approach is exposed in figure 1. Clinical and allergological characteristics of 85 patients are shown in table 1. Out of them, 88.2% had an allergic comorbidity and 48.2% had drug allergy. The reason for consultation was in 92.9% due to their allergic history, 76.5% were referred from the Occupational Health Service, and 80.6% of the patients have had previous vaccination with other anti-infective vaccines without reactions. Also, table 1 shows the prick-test results with COVID vaccine an its excipients, without any positive result. 70.7% of our population has completed the vaccination. Only 9 patients had a possible allergic reaction to the first dose, 8 of them had cutaneous and the remaining had respiratory symptoms. Out of these 9 patients, 6 had their second dose without any symptoms. Conclusion: None of the patients studied showed a positive test for neither the components of the vaccine nor the vaccine itself. More studies are required with a larger sample size to reach final conclusions. (Table Presented).