ABSTRACT
Background: X-Linked Moesin-Associated Immune Deficiency (X-MAID) is a rare severe combined immunodeficiency (SCID) subtype that can present at any age due to its variability. Depending on severity, patients demonstrate failure to thrive, recurrent bacterial and viral infections, and increased susceptibility to varicella zoster. It has been characterized by marked lymphopenia with hypogammaglobulinemia and impaired T-cell migration and proliferation. Case Presentation: This is a report of a Cuban 7-year-old male with poor weight gain and facial dysmorphia. He had a history of recurrent bacterial gastrointestinal infections and pneumonia beginning at 4 months of age. He additionally had 4-6 upper respiratory tract and ear infections annually. While still living in Cuba, he was admitted for a profound EBV infection in the setting of significant leukopenia. A bone marrow biopsy confirmed no malignancy. After he moved to the United States, his laboratory work-up revealed marked leukopenia with low absolute neutrophil and lymphocyte count with low T and B cells, very low immunoglobulin levels IgG, IgA, and IgM, and poor vaccination responses to streptococcus pneumonia, varicella zoster, and SARS-CoV-2. Genetic testing revealed a missense pathogenic variant c.511C>T (p.Arg171Trp) in the moesin (MSN) gene associated with X-MAID. He was managed with Bactrim and acyclovir prophylaxis, and immunoglobulin replacement therapy, and considered for hematopoietic stem cell transplantation. Discussion(s): Diagnosis of X-MAID should be considered in patients with recurrent infections and profound lymphopenia. As with SCID, early diagnosis and intervention is of utmost importance to prevent morbidity and mortality. This case demonstrates the importance of genetic testing in identifying this disease as it may prompt an immunologist to consider HSCT if conservative management is suboptimal. In the current literature, HSCT appears promising, but the long-term outcomes have yet to be described.Copyright © 2023 Elsevier Inc.
ABSTRACT
Background: Hong Kong started its territory-wide COVID-19 vaccination program in February 2021. A territory-wide VAS (Vaccine Allergy Safety) Clinic was set up to assess individuals deemed at "higher risk" of COVID-19 vaccine-associated allergies. A novel "Hub-and- Spoke" model was piloted to tackle the overwhelming demand of VAS services by allowing non-allergists to conduct allergy assessment. This study aims to evaluate the outcomes and effectiveness of the VAS Hub-and- Spoke Model for pre-vaccination allergy assessment. Method(s): Medical records of patients attending the VAS Hub and Spoke Clinics between March and August 2021 were reviewed (n = 2725). We studied the overall and comparative results between the Hub (allergist-led) and Spoke (non-allergist- led) Clinics. The Hub and the HKWC Spoke Clinic were selected for subgroup analysis as they saw the largest number of patients (n = 1411). Result(s): A total of 2725 patients were assessed under the VAS Hub-and- Spoke Model. Overall, 2324 patients (85.3%) were recommended to proceed with vaccination (Figure 1). There were no significant demographic differences noted. Allergists recommended significantly more patients for vaccination than non-allergists (OR = 21.58 [95% CI = 10.16-45.82], p < 0.001). Subgroup analysis revealed that 881/1055 (83.5%) of patients received their first dose of COVID-19 vaccination safely following assessment. Among those recommended vaccination, more patients assessed by allergists received their first dose of COVID-19 vaccination (OR = 4.18 [95% CI = 2.81-6.21], p < 0.001) (Table 1). Conclusion(s): The Hub-and- Spoke model has proven to be successful for the vaccination campaign. This study has illustrated the crucial role of allergists in countering vaccine hesitancy. Results from the study showed considerable differences in outcomes between allergist-led and non-allergist clinics. Precise reasons for these differences warrant further examination. We are hopeful the Hub-and Spoke model can be similarly adapted for other allergist-integrative services in the future.
ABSTRACT
Background: Bibliometric analysis has gained increasing interest as an efficient method to visualize COVID-19 research trends and patterns. This analysis may help to describe the profile of scientific contribution of allergy and clinical immunology specialists in the current COVID-19 pandemic. One of the arguments to support the leading role of allergists and clinical immunologists in the COVID-19 pandemic control is their expertise on disease mechanisms. We hypothesized that this role could also have an impact in the COVID-19 literature. Therefore, our objective was to compare the proportion of COVID-19 related publications dealing with the "mechanism" research topic between allergy and non-allergy journals. Method(s): This study involves a large-scale bibliometric analysis of more than 205,000 COVID-19 publications. This evaluation is embedded into the Covid Content Curation Project (0011-3638- 2020- 000001, Health Department of Navarra Government, Spain), an ongoing research to design an artificial intelligence platform for grading the relevance for decision making of COVID-19 scientific publications. We used web scraping functionalities of the Covid Content Curation platform to obtain a complete and up-to- date list of COVID-19 publications. Exclusion criteria were duplicate publications, publications from the preprint servers, publications published before March 1, 2020 or after December 31, 2021, or with any missing date data. Result(s): After exclusion criteria, 205,982 COVID-19 publications were available for analysis. The cumulative total of COVID-19 publications in allergy journals was 923 (4.48;95% CI: 4.20 to 4.78). The number of COVID-19 publications dealing with "mechanism" as a research topic was 13.22 (95% CI: 10.03 to 16.41) percentage points greater among allergy journals than non-allergy journals (p < 0.001) (Figure 1). Conclusion(s): These results show that the "mechanism" research topic is of greater prevalence in COVID-19 publications of allergy journals than non-allergy journals, and support the hypothesis that the prominent role of allergists and clinical immunologists in the COVID-19 pandemic control, based on their expertise on disease mechanisms, may also have an impact in the COVID-19 literature.
ABSTRACT
Background: In March 2020, the state of alarm was declared in Spain due to the health crisis caused by SARS-COV-2. The rapid spread of the virus generated uncertainty and concern about the impact it could have on patients with severe asthma (SA) and boosted for the first time the use of teleconsultation for the management of these patients. For this reason, it was necessary to facilitate the transition to a hybrid model that combines face-to-face and digital consultations. Objective(s): Development of the first document designed for SA patients, aimed to support the preparation of the telematic follow-up consultations with their specialist. Method(s): Nine experts in SA from different specialties: 4 allergists, 3 pulmonologists and 2 asthma unit nurses contributed to the conceptualization and development of the document. In a first phase of conceptualization, the profile of patients to which the material is addressed was defined and the minimum content needed to be useful to both patients and healthcare professionals (HCPs) was established. A first draft was prepared and refined after evaluation by adult patients and parents of pediatric patients through cognitive interviews. Result(s): Onasm@ is the first document intended for SA patients to prepare the telematic follow-up consultation with their specialist. It consists of three blocks: A first one with general considerations to be applied on the telematic consultation, a second one to collect all the information that might be requested by the healthcare professional (HCP) during the off-site visit (asthma medications, dosage, adherence, asthma crisis events, emergency visits and oral corticosteroid use) and the third block with tips for achieving and maintaining asthma control. The asthma control test (ACTTM) for adults and the children's version (cACTTM) is also incorporated. Conclusion(s): The transition to a hybrid healthcare model due to the pandemic situation makes it essential to support SA patients to face the telematic follow-up consultation with their specialist. Onasm@ is the first document designed to help patients to appreciate the information needed to face this type of visit, with the aim to promote a fluid communication with their HCP and more efficient visits. This type of document could be applied to the management of other conditions and as such have broader impact on the future of healthcare, which is currently immersed in far-reaching change and transformation.
ABSTRACT
Background: Adverse reaction's reported after COVID 19 vaccination had a negative impact on public opinion. These adverse reactions may be or may be not be mediated by hypersensibility reactions. The proper assesment and the manegament of adverse reactions are crucial in order to offer a safer inmunitation and also to reduce the misinformation and the growing rejection to COVID 19 vaccination. Objective(s): To describe clinical characteristics and the allergological study done in different patients who had an adverse event right after COVID 19 vaccine administration Method: Descriptive study in patients who have experienced an adverse event after one single dose of the SARS CoV2's vaccine. Sex, age, atopy, drug allergies, anaphylaxis reaction (according to EEACI), syntoms, timing, vaccine and dose are described on this study. Skin test were done in every patient (Prick-Test and intradermo reaction) with ARN vaccine samples (Pfizer and Moderna), Adenovirus vaccine extract (Astrazeneca) and a battery of excipients (Polietilenglicol, Polisorbato80 and Trometamol). Result(s): The study included 44 patients with an average of 48,76 +/- 12,23 years, (93% women-29% atopic). 29% of the patients reported to be allergic to other drugs (AINES especially). The most frequent reaction according to EEACI anaphilaxy's classification was Grade 1 with a 61%. Grade 2: 18%, Grade 3: 21%. Urticaria and/or angioedema were the most frequent syntoms (60%) followed by disnea (20%) and being late syntoms (50%) the most usual ones. Pfizer was the most implicated vaccine (64%) with the first dose (84%). Skin tests with Polietilenglicol, Trometamol and Polisorbato80 at different concentrations were negative in all patients but two, one positive to Polisorbato80 0.004mg/ml with a previous sensitization to Prontosan (contains Polisorbato) and another one positive to Trometamol 0.1mg/ml. Conclusion(s): Allergists play a main role to offer the maximum befenits to their patients and to improve the vaccine's safety. Skin tests were the most efective tool to diagnose hypersensibility reactions. The 93,17% of the patients with a negative test result tolerated the second dose. The others did not get the second dose due to their own will. Avoiding the COVID 19 vaccine was recommended in those patients with a hypersensibility to the vaccine components diagnose.
ABSTRACT
Background: Telemedicine (TM) has grown substantially worldwide during COVID-19 pandemic, with numerous advantages in healthcare. Specific governmental recommendations and society guidelines are currently stablished to direct a safe and efficient use of TM. The aim of this study was to assess the characteristics of TM practices among Brazilian allergists/immunologists (A/I) doctors and to evaluate their knowledge on the regulatory recommendations. Method(s): An electronic, self-reported survey (27 questions regarding demographic data, TM practices and knowledge about regulatory recommendations) was e-mailed once a week between August and October/2021 to 2600 Brazilian A/I doctors. Result(s): 205 (7.9%) participants fulfill the forms. One form was excluded due to be duplicate. 143/204 (70.2%) are currently using TM in their daily practice, and 184 (89.9%) had never used it before COVID-19 pandemic. 192 A/I doctors (93.8%) used TM for follow-up appointments, 186 (91%) to check complementary tests, and 136 (66.7%) used it in first consultations. 143 A/I doctors (70.2%) felt safe on their diagnostic through TM, and 7 (3.5%) answered that they could not find a correct diagnostic using TM. The main benefits of TM reported were: greater accessibility, mainly in more distant areas 159 (77.6%), reduced traveling costs 158 (77.1%) and safety regarding COVID-19 transmission 145 (71.2%). On the other hand, some disadvantages of TM were listed by participants: absence of physical examination 183 (89.7%), weakened patient-physician relationship 59 (28.8%) and internet issues 45 (22%). Regarding legal/ ethic field, 105 (51.4%) of the specialists applied the consent terms and 34 (16.7%) recorded the teleconsultation, both required steps in a TM appointment, according to local regulatory recommendations. Additionally, inappropriate online platforms for TM, such as social media apps and non-specific online meeting programs, were reported to be used by 131 (64.1%) of participants. Eighty (40%) did not read the official statements and recommendations which regulate TM practice in Brazil. Conclusion(s): An increasing use of TM in Brazil was observed, mainly influenced by COVID-19 pandemic. Its benefits are clear;however, it is primordial to ensure all the correct and recommended practices are being followed when using this modality of healthcare service, in order to avoid ethical, legal and medical issues that may arise.
ABSTRACT
Background: Anaphylaxis reports after Covid-19 vaccination caused concerns regarding adverse effects. Many allergic patients demanded assurances by their allergists. Online Medical Consultations (OMC) are a communication tool between Primary Care and Allergy Department in Navarre. We assessed the impact of allergists' advice regarding Covid-19 vaccination in allergic patients, defined by vaccination status after OMC, and compared reported allergy severity between vaccinated and non-vaccinated. Method(s): Retrospective review of Allergy OMC and vaccination records of patients attended between 2020th September and 2021th August. We screened Covid-19 related OMC and selected those related with possible contraindications/specific recommendations before vaccination (BV).We analysed demographics, vaccination status, allergic diseases (green: non-anaphylactic allergy;yellow: anaphylaxis/ severe drug allergy;red: severe allergy to Covid-19 vaccine or related drug/excipients;blue: non-immunologic symptoms) and OMC replies (contraindication or other recommendations) Results: We received 1438 OMC, 422 due to Covid-19 vaccine and analysed 302 (71.6%), concerning BV. Demographics: Age (median, P25-P75) 61 (46.7-72.25) years. Sex: Female 221 (73.2%);Male 81 (26.8%). Vaccination: 275 (91.1%) completed vaccination (CV) (2 doses), 11 (3.6%) received 1 (IC) and 16 patients (5.3%) none (NC). Specific preparations were contraindicated in 28 (9.4%) (Pfizer-Biontech : 17, Astra-Zeneca 3 and Moderna: 8 cases). Recommendations: 30-minute observation 18.2%;45-minute observation 14.6%;antihistamines 2.6%;time interval with other injectables 1%;alternative vaccine 2.3%;other modifications 1%;premedication and observation period (2.3%). Ten patients (3.3%) required another OMC after adverse events during vaccination. Allergy severity was different according to sex (Male: green 59.2%, yellow 38.2%, red 0%;blue 2.46%;Female: green: 60.2%, yellow 31.8%, red 9.9%, blue: 4.5% (p = 0.025)). Comparison of allergies between groups: CV (Green: 60.7%, yellow: 33.4%, red: 2.9%, blue: 1%);IC (Green: 27%;yellow: 63.6% red: 0%, blue: 9%);NC (Green: 68.75%, yellow: 12.5%, red: 0%, blue: 18.75% (p = 0.03)) Conclusion(s): Adherence to OMC recommendations has been excellent in these patients. Differences in the number of OMC according to sex appear related to previous allergy diagnosis. Observed differences in past allergic diseases according to vaccination status are not related to real contraindications.
ABSTRACT
Background: The SARS-COV- 2 vaccination campaign has massively mobilized the allergists' community to screen patients deemed at risk for the SARS-COV- 2 vaccines. To describe data regarding the management of medical calls regarding the allergic risk for the SARS-COV- 2 vaccination, amongst French allergists. Method(s): A questionnaire-based survey was launched on the AdviceMedica platform (a platform of medical advice exchange between peers) between July and October 2021 (including two reminders). Result(s): Fifty-four allergists answered the survey. Three quarters of the responders were full-time allergists. Overall, 42% and 35% had an exclusive hospital or private practice, respectively. Allergists were mostly contacted by telephone (96.3%) and e-mail (79.6%), by general practitioners (92.6%) or physicians practicing in vaccination centers (88.8%) (median of vaccine related medical calls: 10 per week (Q25-Q75: 7-20, range (2-300). Allergists favored in-person visits rather than teleconsultations (85.2% vs. 61.1%). Allergy testing was prescribed for suspicions of allergy to polyethylene glycol (84.4%) or other vaccines and non-identified drugs (64.4%). Half of the responders (29, 53.7%) could perform vaccination and four (13.7%) declared reactions during vaccination. The responders used several tools in taking their clinical decision: exchanges with peers from the AdviceMedica platform (40.4%), advice from tertiary university hospital allergy units (25%), recommendations of the French Society of Allergy (17.3%). The three most frequent drawbacks that the allergists encountered were: having a hard time adding supplementary patient visits within optimal delays (three quarters of the responders), the reluctance expressed by the physicians requiring the advice and by the patients (two thirds) and the fact that the learnt society recommendations were deemed not to cover many on-field situations (one third). The major benefits from screening were estimated to be the lack of allergy contraindication to vaccination (88.7%) and the increased visibility of the allergist's role (69.8%). Conclusion(s): This survey put numbers on the management of screening patients deemed at risk for the SARS-COV- 2 vaccination amongst French allergists. Peer exchange was the most frequent tool in taking a clinical decision.
ABSTRACT
Background: Since the introduction of COVID-19 vaccines, many reports have focused on adverse reactions. However, there is no global agreement on how to manage those patients. We aim to assess the management of adverse reactions by an immunoallergology department and its outcomes. Method(s): Retrospective analysis of the patients sent to our centre from January to October 2021 for adverse reactions to a COVID-19 vaccine, and who were considered ineligible for a 2nd dose by general practitioners. We collected data on the reported reactions, allergological study and outcomes. Result(s): 123 patients with adverse reactions were included (77% women, n = 95), mean age 55 years-old (min 12;max 92). Pfizer/ BioNTech Vaccine was inoculated in 64 patients (52%);Moderna in 15 (12%);AstraZeneca in 44 (36%). 65 patients (53%) presented symptoms compatible with allergic reactions: 86% (n = 56) with mucocutaneous symptoms, mainly urticaria-like lesions and/or angioedema;17% (n = 11) with suspected anaphylaxis and 5% (n = 3) with Steven-Johnson Syndrome. 19 patients performed skin testing with: PEG2000 (n = 17);polysorbate 80 (n = 15);COVID-19 vaccines (n = 21). Four patients had at least one positive test. 58 patients (47%) presented with non-allergic reactions. They showed great variability of symptoms. Most mild: 47% reported non-specific symptoms (such as malaise, headache, myalgia, fever, or fatigue) and 26% reported local reactions on the inoculation site. Some severe: 6 with deep vein or pulmonary thrombosis, 4 with myocarditis, 2 with stroke or myocardial infarction, and 1 with VITT. Patients with positive skin tests or severe previous reactions (n = 36, 29%) were referred for an alternative vaccine. Those with suspected allergic reaction but negative skin tests were premedicated with antihistamines before the 2nd dose. Follow-up showed: of the 81 patients (66%) who received an additional dose, 25% (n = 20) reported an adverse reaction, which was mild, and no case of anaphylaxis was reported. 16 (13%) refused a 2nd dose, and for 26 (21%) the information could not be obtained. Conclusion(s): The intervention of an allergologist had a significant positive impact on vaccination rates, with 2/3 of patients being reclassified as eligible for a 2nd dose. Allergological study and intervention identified vaccine-allergic patients and guided the decision on vaccine change and premedication, which resulted in a considerably lower number of adverse reactions to the 2nd dose, or at least its severity.
ABSTRACT
Background: Following the use of COVID-19 vaccines worldwide, few cases of severe allergic reactions were reported. According to recent Portuguese guidelines, patients (pts) with suspected allergy to a COVID-19 vaccine component, history of anaphylaxis following vaccination, idiopathic anaphylaxis and mast cell disorders, should be referenced for Immunoallergology evaluation. Fear of a hypersensitivity reaction, especially among pts with allergic disease, is associated with lower vaccine adherence. This study aimed to evaluate BNT162b2 vaccination outcomes in pediatric pts with suspected severe allergic reactions prior to or after vaccination. Method(s): W e c onducted a p rospective s tudy i ncluding p ediatric pts with high risk of allergy to COVID-19 vaccine referred to Immunoallergology Department of a Tertiary Hospital. Demographic data, primary medical conditions and vaccination status were collected. After a detailed assessment by an allergologist, in selected cases, BNT162b2 vaccine administration in hospital facilities was performed, followed by a 1-hour observation period. Result(s): Twenty-two pts were included (18 males, 13.1+/-2.6years;min 7, max 17;13 atopic), referenced mainly from primary care (9) and other specialties (8). Most of the pts were referenced for the first dose of vaccine (18), due to mastocytosis/tryptasemia (5), previous allergic reaction to another vaccine (4), idiopathic anaphylaxis (3), complex comorbidities (2), drug anaphylaxis (1), parental reluctance (1), other (2). Four pts were evaluated for the second dose of COVID-19 vaccine, due to an acute urticaria after the first BNT162b2 vaccine dose. Three pts were eligible, after our evaluation, for primary care vaccination, that occurred without adverse reactions. Regarding the remaining 19 pts eligible for hospital vaccination, 13 were premedicated with oral antihistamines +/- montelukast. Eleven pts received BNT162b2 vaccine in hospital facilities [first dose (9);second dose (2)] with no reported adverse events. Vaccine administration was postponed in 3 pts due to SARS-CoV- 2 infection and 1 due to parental hesitancy. Conclusion(s): Our data support that allergic reactions to BNT162b2 vaccines are rare, even in the pediatric population with high risk of allergic reactions or with a history of previous severe allergic reactions. The favourable safety profile outcomes, along with the risk reduction of allergic reactions, increase vaccine confidence, broadening community protection.
ABSTRACT
Background: Allergic reactions to COVID-19 vaccines have raised concerns, particularly as repeated doses are required. Skin tests with vaccines excipient were found to be of low value whereas the utility of skin tests with the whole vaccine is yet to be determined. Objective(s): we set to evaluate a panel of skin tests and outcomes of subsequent doses of immunization among subjects that suffered an immediate allergic reaction to the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine. Method(s): In a prospective cohort study during December 27th-2020 to February 22nd-2021 Individuals with allergies who applied to the COVID 19 vaccine referral center at the Sheba Medical Center in israel, underwent risk assessment using an algorithm that included a detailed questionnaire department. Patients were considered to be at high risk for allergic reactions if thery either had: (1) prior anaphylactic reaction to any drug or vaccine, (2) multiple drug allergies, (3) multiplemallergies, or (4) mast cell disorders, as were patients who were deferred by their GP or local allergist or the immunization team from vaccination in the regular setting because of concerns about allergic. reactions. This high-risk group was referred to be immunized with 2 hours of observation by a dedicated allergy team. Result(s): Of the 429/8102 individuals who applied to the COVID-19 referral center and were defined as "highly allergic", 304 (70.8%) were female, mean age was 52 +/- 16 years. This "highly allergic" group was referred to immunization under medical supervision. Following the 1st dose of the BNT162b2, 420/429 (98%) had no immediate allergic event, 6/429 (1.4%) developed minor responses and 3/429 (0.7%) had anaphylactic reactions. During the study period, 218/429 "highly allergic" patients received the 2nd dose, of which 214/218 (98.1%) had no allergic reactions while 4 patients had minor allergic reactions. Other immediate and late reactions were comparable to the general population except for delayed itch and rash that were more common among allergic patients. Conclusion(s): The rate of allergic reactions to BNT162b2 vaccine, is higher among allergic patients, particularly in a sub-group with high-risk history. In this study we showed that the vast majority of patients with a history of allergic diseases and particularly "highly allergic" patients can be safely immunized. Utilizing an algorithm that can be implemented in different medical facilities and include a referral center, a risk assessment questionnaire and a setting for immunization under medical supervision of "highly allergic" patients. Further studies are required to define more specific risk factors for allergic reactions to BNT162b2 vaccine.
ABSTRACT
Background: Few studies demonstrating the involvement of the complement system in COVID-19 pathogenesis have been published, suggesting its role in pulmonary symptoms and endothelial permeability, which is known to be crucial in the origin of Hereditary Angioedema (HAE).1 Post-morten tissue of COVID-19 patients reported depots of complement, activated by the lectin pathway, in type I and II alveolar epithelial cells.2 After this evidence and the link that infectious processes have as triggers of angioedema episodes, in patients with HAE, we propose to study the implication of both the infection and de doses of the COVID vaccine, in the appearance of episodes of angioedema in our population with a diagnos is of HAE. Method(s): Telemedicine interventions (telephone consultations) were carried out by trained Allergists from Hospital Universitario de Canarias, reaching out patients with a confirmed diagnosis of HEA by Skin Allergy Unit (SAU) within the local health district. Result(s): A total of 17 (11 females) were finally screened, and 2 (11.76%) passed a confirmed COVID-19 disease in January 2022 associating no acute attacks or need for rescue medication. Both subjects were fully vaccinated (3 doses-schedule) prior to the infection and suffered from a COVID-19 mild disease only. Only an individual dose of COVID-19 vaccination (Vaxzevria, Astra-Zeneca) -out of 40 overall given doses in 15 subjects and 3 different brands-was associated to an acute episode of abdominal swelling demanding immediate self-administered rescue therapy (icatibant) thus, preventing the patient from rushing to the Emergency Department. The subsequent 2 doses of the COVID-19 vaccination were safely scheduled in the same patient. Conclusion(s): In accordance with former reports4, only mild COVID-19 symptoms were associated in subjects with a confirmed diagnosis of HAE.
ABSTRACT
Background: Public concern has risen regarding the risk of hypersensitivity reactions (HSR) due to vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2) in the general allergic population, especially in those with a history of anaphylaxis. Moreover, the associated alarm that patients diagnosed with allergies to polyethylene glycol (PEG) could suffer from an allergic reaction to vaccines against SARS-CoV- 2 has become a limitation during the mass immunization campaign. Method(s): Objective: 1. To describe the management implemented between allergology and primary care physicians (PCP) in our territory during the first mass immunization campaign in order to safely reach the largest number of people immunized. 2. To only asses patients at risk of having an HSR to the components of the SARS-CoV- 2 vaccine according to the algorithm implemented in primary care centers. Method(s): A retrospective study was performed including patients referred to the allergist by PCP due to the potential risk of presenting HSR to SARS-COV- 2 vaccines between March and September 2021. An algorithm was created, to assess the potential risk of presenting HSR to SARS-COV- 2 vaccine in allergic population. Patients were visited firstly by PCP, who applied the algorithm proceeding with virtual consultation with the allergist if needed. Risk assessment performed by the allergist determined if vaccination could continue at their assigned place or if an allergological diagnosis approach was needed. The rate of virtual and physical consultations with the allergist as well as the results of skin test and drug provocation tests were recorded. Result(s): A total of 181 patients were assessed virtually. A total of 147 (81%) patients were immunized at their assigned vaccination point after virtual consultation without incidences. On the other hand, 19% of the patients were assessed by the allergist physically and only 12 (6.6%) patients underwent skin tests and drug provocation test with negative results and good tolerance to the vaccine in all cases. Conclusion(s): A careful allergological risk assessment protocol significantly reduced the number of patients who would have avoided vaccination due to a history of allergies or apparent HSR to the first doses of SARS-CoV- 2, demonstrating the low incidence of true allergy to SARS-COV- 2 vaccines in our territory.
ABSTRACT
Background: During the initial rollout of COVID-19 vaccination in Singapore, the Ministry of Health (MOH) issued recommendations that patients with a history of any previous vaccine allergy be referred to an allergist for further review on suitability to proceed with mRNA-based COVID-19 vaccines. We review the evaluation of these patients with suspected vaccine allergies prior to receiving mRNA-based COVID-19 vaccines. Method(s): Between 8 April and 22 September 2021, 304 patients were evaluated prior to receiving the COVID-19 vaccinations. Of these, 63 (20.7%) patients with suspected immediate hypersensitivity reactions to non-COVID polysorbate-containing vaccines proceeded to have skin prick test (SPT) and Intradermal test (IDT) to polyethylene glycol (PEG)-3350, polysorbate 80 and polysorbate 20 containing products. Another 62 (20.4%) who reported delayed hypersensitivity reactions to polysorbate-containing vaccines proceeded to have direct inoculation (DI) of the Pfizer BNT162b2 vaccine under the supervision of an allergist. The remaining 242 (76.6%) finally assessed not allergic polysorbate-or tolerated previous non-polysorbate- containing vaccines were recommended to proceed with COVID-19 vaccinations at the community vaccination sites. 99 patients in the SPT/IDT and DI group completed a questionnaire-based survey to report any post vaccination reactions. (Figure 1) Results: Of 63 patients who underwent SPT/IDT, 2 (3.2%) with equivocal IDT tolerated both doses of the BNT162b2 vaccine without major allergic reactions. 61 (6.8%) patients with negative SPT/IDT and 62 (100%) in the DI group completed both doses of BNT162b2 vaccination without major reactions. Among those who completed the questionnaire survey, 13 (13%) reported reactions including non-specific rashes and mild urticaria/angioedema post first dose vaccine. All subsequently completed the second dose of the BNT162b2 vaccine following allergist review;with 8 (61.5%) reporting similar mild skin reactions. Conclusion(s): Majority of those with suspected reactions to polysorbate containing vaccines are able to tolerate the BNT162n2 vaccine which contains PEG-2000. Skin tests prior to mRNA COVID-19 vaccination is unnecessary. Those who report mild potentially allergic reactions after the first dose are able to tolerate the second dose of the BNT162b2 vaccine.
ABSTRACT
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.
ABSTRACT
Background: The real-world management and clinical characteristics of chronic spontaneous urticaria (CSU) in Hong Kong, and its implications for COVID-19 vaccination are unknown. We investigated the patient characteristics, effectiveness of an immunologist-led Urticaria Clinic, and the impact of CSU on COVID-19 vaccine uptake in Hong Kong. Method(s): Longitudinal clinical data of 257 CSU patients attending our immunologist-led Urticaria Clinic were analysed. Result(s): Most patients had experienced wheals (98.8%) and 65.4% had angioedema. 1.2% of CSU patients had angioedema without wheals. Two-thirds (66.5%) received inappropriate treatment prior to immunologist review. A significant proportion of patients had concomitant autoimmunity (14.8%) and history of suspected drug allergy (9.7%) respectively. Weekly Urticaria Activity Score (UAS7) was significantly lower after immunologist review (12.0 vs 0.00, p < 0.001). The change in UAS7 was significantly greater among patients with baseline UAS7 >=16 (-24.0 vs -2.00, p < 0.001);and, among those with uncontrolled disease despite second-line treatment, with access to omalizumab and/or ciclosporin (-26.0 vs -3.50, p < 0.001). Majority of patients received at least one (68.5%) and two doses (65.0%) of COVID-19 vaccine respectively. History of suspected drug allergy was associated with lower COVID-19 vaccine uptake (odds ratio: 0.47, p = 0.010). Conclusion(s): CSU patients in Hong Kong have unique clinical characteristics and a considerable proportion had received inappropriate treatment before immunologist review. An immunologist-led Urticaria Clinic was effective in CSU management. COVID-19 vaccination rates were lower than the general population in Hong Kong, and a history of suspected drug allergy was associated with lower COVID-19 vaccine uptake.
ABSTRACT
Background: The unprecedented prevalence of olfactory disfunction (OD) by SARS-CoV- 2 has revealed the lack of specialized units dealing with sense of smell. The main objective of the study is to know the number of newly created olfactory units (OU) since the COVID-19 pandemic, as well as to evaluate the diagnosis, management and treatment of patients with OD. Method(s): Prospective cross-sectional study. Carried out by means of a survey with 20 items: having or not having an OU, demographic data, smell test, evolution and management of OD, data on treatments. The variables of the survey were approved by the rhinology commission of the Spanish society of ENT. The digital survey was distributed to all members of Spanish ENT and Allergy Societies. Result(s): A total of 16 responses were missing data, and further 12 responses were duplicated. Finally, 136 surveys were included. From them 82.4% answers were from otolaryngologists and 17.7% from allergists. The cohort of allergists and otolaryngologists was compared to ensure comparability of both samples. There were significant differences in the instrumental assessment of the olfaction, VAS and smell test (p = 0.016) was more common in otolaryngologists. Also, the prescription of olfactory rehabilitation (OR) (p < 0.001) was more common in otolaryngologists. The 40.5% (+/- 7.6) of all the existent OU were created after COVID-19 pandemics. The 33.9% (+/- 4.5) of the respondent have an OU now, while 22.3% (+/- 3.9) already had it before COVID-19 pandemics. It means that 17% of hospitals who did not have an OU before COVID-19, now they have it, while 82.8% are still lacking it. OR was prescribed for 1-3 months by 38%;3-6 months by 48.1% and > 6 months by 13.9%. Those with an OU prescribe OR during more time (p = 0.002) being the most frequent answer 3-6 months (69.4%) when they have OU while 1-3 months (52.4%) for those who do not have it. Conclusion(s): This study revealed that COVID-19 pandemic has stimulated the creation of OU and has demonstrated the utility of OU to deal with patients with OD, as their daily practice is more adapted to up-to- date clinical evidence between allergist and otolaryngologists.
ABSTRACT
Background: The French vaccination campaign against COVID-19 was accompanied by an overwhelming increase in allergists work load highlighting our key role in the stratification of the allergy risk prior to vaccination. Method(s): In order to describe our triage and testing experience for the COVID-19 vaccination all requests were analysed in a standardized way prospectively. Our final goal was to filter the requests and avoid any delay in the vaccination process. We first set up and validated locally a questionnaire (completed by the requesting practitioner) allowing to evaluate the risk of allergy to the vaccine, based on the clinical history of the patient. Questionnaire-based allergy advices were delivered (regular vaccination or allergy testing prior to vaccination). Result(s): From January 2021 to January 2022, we addressed 1047 requests. Forty-one patients (4%) were tested. 96% had allergies to other compounds, not increasing the risk of reacting to the covid vaccines and were vaccinated safely. Half of the tested patients experienced an immediate reaction to the vaccine and the other half had a history of allergy to the vaccine's components. We identified 3 groups of patients: -Suspicions of polyethylene glycol (PEG) containing laxative allergy comprised 8 patients (26%), including 2 cases with proven IgE-mediated allergy to PEG. They were 63% (5) women, 63% (5) atopic (average age of 49 +/-10 yrs). Two thirds (63%, 5 patients) had an immediate reaction to PEG, including 3 and 2 patients with anaphylaxis with and without shock, respectively. The two allergic patients refused vaccination and received a certificate of contraindication to PEG-containing vaccines (as per French law). -Reactions to the covid vaccine comprised 21 patients: most were women (86%, 18 patients) and 29% (6) were atopic (average age was 51 +/-19 yrs). Three quarters (76%, 16 patients) presented a reaction within 1 hour after the vaccination, considered as potential anaphylaxis in 12 patients (8 patients with and 5 without shock). 100% (21 patients) were tested negative. Twenty patients (95%) were further vaccinated without reaction. One required H1 antihistamine. -Suspicions of allergy to PEG or polysorbate as excipients included 12 patients (29%). Most clinical histories were anaphylactic (42% without and 33% with shock). Following negative excipient skin testing, regular vaccination was authorized. Conclusion(s): Overall, only 4% of the initial requests were deemed eligible for allergy testing. We did not diagnose any allergy in patients who reacted to the vaccines and we delivered two certificates of contraindication to mRNA COVID-19 PEG-containing vaccines in two cases of confirmed IgE-mediated allergy to PEG.
ABSTRACT
Background: The COVID-19 pandemic has placed an unprecedented physical and mental burden on healthcare workers who are frequently at high risk of infection, particularly in low-income countries. Particularly, allergists who are frequently exposed to the airway and respiratory diseases. This study aimed to assess the prevalence and associated factors of anxiety, depression, and stress, as well as changes in daily and occupational activities among healthcare professionals due to the COVID-19 pandemic in Colombia. Method(s): An observational, cross-sectional study was conducted between February and June 2021. The survey incorporated validated mental health tools such as the Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, and the Perceived Stress Scale-10. Multivariable ordinal logistic regression analysis was performed to determine the factors associated with severe mental health outcomes. Result(s): Among 1345 healthcare workers the prevalence of anxiety, depression, and stress were 75.61%, 59.18%, and 53.09%, respectively. Anxiety (OR:1.44;95%CI:1.16-1.8), depression (OR:1.74;95%CI:1.27-2.37), and stress (OR:1.51;95%CI:1.18-1.94) were more frequent in women, and individuals who expressed fear of a negative outcome (death, sequelae) (OR:2.25;95%CI:1.60-3.25), (OR:1.49;95%CI:1.03-2.16) and (OR:2.36;95%CI:1.69-3.29) respectively. Allergists were morelikely to report symptoms of anxiety (76.47%), depression(43.14%), and stress (49.02%). Age was negatively associated with anxiety (OR:0.98;95%CI:0.98-0.99), stress (OR:0.98;95%CI:0.97-0.99), and depression (OR:0.97;95% CI:0.96-0.98). Reduction in consultations and surgeries (OR:1.01;95%CI:1.0-1.01) was positively associated with anxiety. Due to the pandemic, most specialists expected to incorporate drastic long-term (>1 year) changes in their clinical setting and daily activities. Conclusion(s): The prevalence of anxiety, depression, and stress is higher among Colombian healthcare workers compared to previous reports. Further research regarding these psychological outcomes is needed to achieve early mental health intervention strategies.
ABSTRACT
Background: Vaccines against coronavirus disease-19 (COVID-19) are important to control the current pandemic. Misinformation, lack of awareness, and beliefs about vaccines can cause hesitations about vaccines and affect the rate of vaccination. We aimed to reveal the vaccination rates against COVID-19 (vaccine type and dose), and the reasons for not being vaccinated in patients admitted to the immunology and allergy outpatient clinic. In addition, we aimed to find out whether allergic reactions were observed in vaccinated patients. Method(s): The history of COVID-19 and vaccination of patients admitted to the Immunology and Allergy Outpatient Clinic between December 2021 and February 2022 were evaluated retrospectively. Result(s): In our study, which included 451 patients, the median age of the patients was 35 (range 18-82), and 61.2% were women. 16.9% of the patients admitted to the immunology and allergy outpatient clinic were never vaccinated, while the rate of those who did not receive two doses of vaccine was 26.6%. The top three reasons for not being vaccinated were fear of allergies, fear of adverse effects, and distrust of the vaccine, respectively. Unvaccinated patients were younger, which is statistically significant. Vaccination rate was found to be lower in drug allergy and immunodeficiencies compared to other disease groups. The rate of vaccination of at least 2 doses in the allergic rhinitis group was significantly higher than those without allergic rhinitis. Conclusion(s): Fear of allergies, fear of advers effects, and distrust of the vaccine reduce the rate of vaccination. Understanding the causes of vaccine hesitations and increasing the vaccination rate by organizing public health campaigns is an important point in the control of the pandemic. Despite being rare, allergic reactions can be observed with COVID-19 vaccines. Therefore, immunologists and allergists play an important role in the COVID-19 vaccine program.