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2.
Pediatr Allergy Immunol ; 33 Suppl 27: 58-60, 2022 01.
Article in English | MEDLINE | ID: covidwho-1840508

ABSTRACT

Allergic individuals at risk for hypersensitivity reactions to measles vaccine marketed for a long time are well established. On the other hand, risk factors for hypersensitivity reactions to the new mRNA COVID-19 vaccines currently include a history of allergy, allergy to excipient of the vaccine, or hypersensitivity reactions to the first dose of COVID-19 vaccine. In the last two cases, the recipient should be assessed by an allergist before vaccination to share a decision on the choice of vaccination. Studies on skin testing accuracy and desensitization protocols to the COVID-19 vaccines and the efficacy of potential alternatives in patients with confirmed hypersensitivity reactions to the first COVID-19 vaccine are necessary to improve the safety of COVID-19 vaccines.


Subject(s)
COVID-19 , Hypersensitivity , Measles , Vaccines , COVID-19 Vaccines , Child , Humans , Hypersensitivity/etiology , Measles/prevention & control , SARS-CoV-2 , Vaccination/adverse effects
3.
Clin Exp Allergy ; 52(3): 364-366, 2022 03.
Article in English | MEDLINE | ID: covidwho-1735895
5.
Ann Allergy Asthma Immunol ; 128(2): 153-160, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1597012

ABSTRACT

BACKGROUND: The mechanism of coronavirus disease 2019 (COVID-19) vaccine hypersensitivity reactions is unknown. COVID-19 vaccine excipient skin testing has been used in evaluation of these reactions, but its utility in predicting subsequent COVID-19 vaccine tolerance is also unknown. OBJECTIVE: To evaluate the utility of COVID-19 vaccine and vaccine excipient skin testing in both patients with an allergic reaction to their first messenger RNA COVID-19 vaccine dose and patients with a history of polyethylene glycol allergy who have not yet received a COVID-19 vaccine dose. METHODS: In this multicenter, retrospective review, COVID-19 vaccine and vaccine excipient skin testing was performed in patients referred to 1 of 3 large tertiary academic institutions. Patient medical records were reviewed after skin testing to determine subsequent COVID-19 vaccine tolerance. RESULTS: A total of 129 patients underwent skin testing, in whom 12 patients (9.3%) had positive results. There were 101 patients who received a COVID-19 vaccine after the skin testing, which was tolerated in 90 patients (89.1%) with no allergic symptoms, including 5 of 6 patients with positive skin testing results who received a COVID-19 vaccine after the skin testing. The remaining 11 patients experienced minor allergic symptoms after COVID-19 vaccination, none of whom required treatment beyond antihistamines. CONCLUSION: The low positivity rate of COVID-19 vaccine excipient skin testing and high rate of subsequent COVID-19 vaccine tolerance suggest a low utility of this method in evaluation of COVID-19 vaccine hypersensitivity reactions. Focus should shift to the use of existing vaccine allergy practice parameters, with consideration of graded dosing when necessary. On the basis of these results, strict avoidance of subsequent COVID-19 vaccination should be discouraged.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19 , Hypersensitivity , Skin Tests , COVID-19/prevention & control , Humans , Hypersensitivity/etiology , Medical Futility , Retrospective Studies , Vaccine Excipients/adverse effects , Vaccines, Synthetic/adverse effects , /adverse effects
6.
Mucosal Immunol ; 14(5): 1144-1159, 2021 09.
Article in English | MEDLINE | ID: covidwho-1550272

ABSTRACT

Increased IgE is a typical feature of allergic rhinitis. Local class-switch recombination has been intimated but B cell precursors and mechanisms remain elusive. Here we describe the dynamics underlying the generation of IgE-antibody secreting cells (ASC) in human nasal polyps (NP), mucosal tissues rich in ASC without germinal centers (GC). Using VH next generation sequencing, we identified an extrafollicular (EF) mucosal IgD+ naïve-like intermediate B cell population with high connectivity to the mucosal IgE ASC. Mucosal IgD+ B cells, express germline epsilon transcripts and predominantly co-express IgM. However, a small but significant fraction co-express IgG or IgA instead which also show connectivity to ASC IgE. Phenotypically, NP IgD+ B cells display an activated profile and molecular evidence of BCR engagement. Transcriptionally, mucosal IgD+ B cells reveal an intermediate profile between naïve B cells and ASC. Single cell IgE ASC analysis demonstrates lower mutational frequencies relative to IgG, IgA, and IgD ASC consistent with IgE ASC derivation from mucosal IgD+ B cell with low mutational load. In conclusion, we describe a novel mechanism of GC-independent, extrafollicular IgE ASC formation at the nasal mucosa whereby activated IgD+ naïve B cells locally undergo direct and indirect (through IgG and IgA), IgE class switch.


Subject(s)
Antibody Formation/immunology , B-Lymphocyte Subsets/immunology , B-Lymphocyte Subsets/metabolism , Immunoglobulin D/immunology , Immunoglobulin E/immunology , Nasal Mucosa/immunology , Nasal Mucosa/metabolism , Adult , Antibody Formation/genetics , Antibody-Producing Cells/immunology , Antibody-Producing Cells/metabolism , Computational Biology , Gene Expression Profiling , Germinal Center/immunology , High-Throughput Nucleotide Sequencing , Humans , Hypersensitivity/etiology , Hypersensitivity/metabolism , Immunoglobulin Class Switching/genetics , Immunoglobulin Class Switching/immunology , Immunoglobulin Isotypes/genetics , Immunoglobulin Isotypes/immunology , Immunophenotyping , Nasal Polyps/etiology , Nasal Polyps/metabolism , Nasal Polyps/pathology , Pollen/immunology , Seasons , Somatic Hypermutation, Immunoglobulin
7.
J Cosmet Dermatol ; 21(1): 4-12, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1522766

ABSTRACT

INTRODUCTION: The pandemic caused by the novel coronavirus disease 2019 (COVID-19) has had an unprecedented impact on the overall health and the global economy. Vaccination is currently the most dependable strategy to end the pandemic, despite the slower-than-hoped-for rollout, particularly for low-to-middle-income countries, and the uncertain duration of protection afforded by vaccination. The spike protein of the virus (immunodominant antigen of the virus) is the main target of the approved and candidate SARS-CoV-2 vaccines. This protein binds to the ACE2 receptor of the host cell, initiating the entry of the virus into the cell and the chain of subsequent events ending to Acute Respiratory Distress Syndrome. The safety profile of these vaccines needs is closely assessed. METHODS: This comprehensive review includes searching the PubMed, EMBASE, and Web of Science databases using the keywords "coronavirus", "COVID-19", "vaccine", "cutaneous reactions", "allergic reactions", and "SARS-CoV-2". Manual searching of reference lists of included articles augmented the research. The research was updated in June 2021. RESULTS: In this narrative review, we tried to investigate and discuss the cutaneous and allergic reactions related to SARS-CoV-2 vaccines currently available in the literature. As a result, although COVID-19 vaccines can be reported to develop allergic and anaphylactic reactions, especially after m-RNA vaccines, they remain at a low rate, and it is observed that these reactions may develop more frequently, especially in patients with previous allergies and mast cell disorders. Fortunately, these reactions are generally transient, benign, self-limited. CONCLUSION: Although there is still no definitive evidence, as dermatologists, we must be aware of the possibility of cutaneous reactions, newly diagnosed dermatoses, or exacerbation of existing dermatoses that may develop after the COVID-19 vaccinations.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19 , Hypersensitivity , COVID-19/prevention & control , Humans , Hypersensitivity/etiology , Vaccination/adverse effects , /adverse effects
8.
JAMA Netw Open ; 4(10): e2131034, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1482079

ABSTRACT

Importance: Allergic history in individuals with confirmed anaphylaxis to a messenger RNA (mRNA) COVID-19 vaccine is common. However, the risk factors for allergy symptoms after receiving the vaccine are unknown. Objective: To assess the association between self-reported history of high-risk allergy and self-reported allergic reactions after mRNA COVID-19 vaccination of health care employees. Design, Setting, and Participants: This cohort study obtained demographic, medical, and vaccine administration data of employees of Mass General Brigham from the institutional electronic health record. Employees who received at least 1 dose of an mRNA COVID-19 vaccine between December 14, 2020, and February 1, 2021, and who completed at least 1 postvaccination symptom survey in the 3 days after vaccination were included. Exposures: Self-reported history of high-risk allergy, defined as a previous severe allergic reaction to a vaccine, an injectable medication, or other allergen. Main Outcomes and Measures: The primary outcome was 1 or more self-reported allergic reactions in the first 3 days after dose 1 or dose 2 of an mRNA COVID-19 vaccine. Multivariable log binomial regression was used to assess the association between allergic reactions and high-risk allergy status. Results: A total of 52 998 health care employees (mean [SD] age, 42 [14] years; 38 167 women [72.0%]) were included in the cohort, of whom 51 706 (97.6%) received 2 doses of an mRNA COVID-19 vaccine and 474 (0.9%) reported a history of high-risk allergy. Individuals with vs without a history of high-risk allergy reported more allergic reactions after receiving dose 1 or 2 of the vaccine (11.6% [n = 55] vs 4.7% [n = 2461]). In the adjusted model, a history of high-risk allergy was associated with an increased risk of allergic reactions (adjusted relative risk [aRR], 2.46; 95% CI, 1.92-3.16), with risk being highest for hives (aRR, 3.81; 95% CI, 2.33-6.22) and angioedema (aRR, 4.36; 95% CI, 2.52-7.54). Conclusions and Relevance: This cohort study found that self-reported history of high-risk allergy was associated with an increased risk of self-reported allergic reactions within 3 days of mRNA COVID-19 vaccination. However, reported allergy symptoms did not impede the completion of the 2-dose vaccine protocol among a cohort of eligible health care employees, supporting the overall safety of mRNA COVID-19 vaccine.


Subject(s)
COVID-19 Vaccines/adverse effects , Hypersensitivity/epidemiology , Vaccination/statistics & numerical data , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Case-Control Studies , Female , Humans , Hypersensitivity/etiology , Male , Middle Aged , Pandemics , Prospective Studies , Risk Factors , SARS-CoV-2 , Self Report
11.
JAMA Netw Open ; 4(8): e2122255, 2021 08 02.
Article in English | MEDLINE | ID: covidwho-1378909

ABSTRACT

Importance: Allergic reactions among some individuals who received the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine discourage patients with allergic conditions from receiving this vaccine and physicians from recommending the vaccine. Objective: To describe the assessment and immunization of highly allergic individuals with the BNT162b2 vaccine. Design, Setting, and Participants: In a prospective cohort study from December 27, 2020, to February 22, 2021, 8102 patients with allergies who applied to the COVID 19 vaccine referral center at the Sheba Medical Center underwent risk assessment using an algorithm that included a detailed questionnaire. High-risk patients (n = 429) were considered "highly allergic" and were immunized under medical supervision. Exposures: Pfizer-BioNTech (BNT162b2) COVID-19 vaccine. Main Outcomes and Measures: Allergic and anaphylactic reactions after the first and second doses of BNT162b2 vaccine among highly allergic patients. Results: Of the 429 individuals who applied to the COVID-19 referral center and were defined as highly allergic, 304 (70.9%) were women and the mean (SD) age was 52 (16) years. This highly allergic group was referred to receive immunization under medical supervision. After the first dose of the BNT162b2 vaccine, 420 patients (97.9%) had no immediate allergic event, 6 (1.4%) developed minor allergic responses, and 3 (0.7%) had anaphylactic reactions. During the study period, 218 highly allergic patients (50.8%) received the second BNT162b2 vaccine dose, of which 214 (98.2%) had no allergic reactions and 4 patients (1.8%) had minor allergic reactions. Other immediate and late reactions were comparable with those seen in the general population, except for delayed itch and skin eruption, which were more common among allergic patients. Conclusions and Relevance: The rate of allergic reactions to BNT162b2 vaccine, is higher among patients with allergies, particularly among a subgroup with a history of high-risk allergies. This study suggests that most patients with a history of allergic diseases and, particularly, highly allergic patients can be safely immunized by using an algorithm that can be implemented in different medical facilities and includes 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 the BNT162b2 vaccine.


Subject(s)
Anaphylaxis/etiology , COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Vaccination/adverse effects , Adolescent , Adult , Aged , Aged, 80 and over , Anaphylaxis/epidemiology , Female , Humans , Hypersensitivity/epidemiology , Hypersensitivity/etiology , Male , Middle Aged , Prevalence , Prospective Studies , Risk Assessment , SARS-CoV-2 , Young Adult
12.
Nutrients ; 13(8)2021 Aug 23.
Article in English | MEDLINE | ID: covidwho-1367878

ABSTRACT

BACKGROUND: Restrictions due to the COVID-19 pandemic limited patients' access to hospital care. The aims of this study were to assess dietary nutritional status, quality of life (QoL), and adherence to dietary therapy before and after 30-day personalized diet therapy through telenutrition tools in patients with systemic nickel allergic syndrome (SNAS). METHODS: Each SNAS patient underwent the following allergological procedures: (a) face-to-face visit (nutritional visit and QoL evaluation) with prescription of one out of five personalized and balanced dietary plans different for calorie intake, (b) video call visit for dietary evaluation and assessment of adherence to diet after 15 days, and (c) video call visit for dietary and QoL evaluation and assessment of adherence to diet therapy after 30 days (end of study). RESULTS: We enrolled 20 SNAS patients. After 15 and 30 days, we found a statistically significant improvement in anthropometric findings after diet therapy, a significant adherence rate to low-nickel diet (60% and 80%, respectively), and an improvement in QoL with an increase in almost all psychometric indices. CONCLUSIONS: Our study demonstrates that telenutrition can be a valid tool to monitor nutritional status and adherence to balanced low-Ni diet positively affecting QoL in SNAS patients during the COVID-19 pandemic.


Subject(s)
COVID-19/epidemiology , Diet , Hypersensitivity/diet therapy , Nickel/immunology , Telemedicine/methods , Adult , Female , Food Hypersensitivity , Humans , Hypersensitivity/etiology , Hypersensitivity/immunology , Male , Middle Aged , Pandemics , Quality of Life , SARS-CoV-2/isolation & purification , Young Adult
15.
Ann Allergy Asthma Immunol ; 127(3): 312-317, 2021 09.
Article in English | MEDLINE | ID: covidwho-1220652

ABSTRACT

OBJECTIVE: To present an update of birth cohort study designs and their contributions to allergic risk. DATA SOURCES: The PubMed database was used to search for relevant articles. STUDY SELECTIONS: Peer-reviewed prospective and retrospective studies involving the assessment of allergy using human birth cohorts between 2014 and 2021 were evaluated. RESULTS: Parental history of allergic diseases, especially in cases involving both parents, is associated with increased risk of allergy. Exposure to prenatal and postnatal smoking and limited diet diversity were associated with increased allergic burden. The impact of early-life infections and antibiotics on disease development may be associated with the onset of asthma, though this remains debated. Cohort studies also revealed that the mode of delivery and breastfeeding duration affect the odds ratio of asthma and eczema development. Household exposures, including pets, house dust mites, and scented aeroallergens may confer protective effects, whereas high air pollution exposure and low socioeconomic status may be risk enhancing. Exposure to antibiotics during early life may be associated with increased asthma risk, whereas viral infections may lead to disease protection, though the impact of the coronavirus disease 2019 pandemic on allergic risk is yet to be understood. CONCLUSION: Although evaluating the risk of allergic disease development is complex, clinicians can apply these insights on the multifactorial nature of atopy to better understand and potentially mitigate disease development.


Subject(s)
Asthma/immunology , Breast Feeding/methods , Diet/methods , Eczema/immunology , Hypersensitivity/immunology , Inheritance Patterns/immunology , Allergens/administration & dosage , Animals , Anti-Bacterial Agents/adverse effects , Asthma/etiology , Asthma/genetics , Asthma/prevention & control , Cohort Studies , Eczema/etiology , Eczema/genetics , Eczema/prevention & control , Environmental Exposure/adverse effects , Environmental Pollutants/adverse effects , Female , Humans , Hypersensitivity/etiology , Hypersensitivity/genetics , Hypersensitivity/prevention & control , Pets/immunology , Pregnancy , Pyroglyphidae/chemistry , Pyroglyphidae/immunology , Risk Factors , Virus Diseases/immunology , Virus Diseases/virology
16.
Allergy ; 76(6): 1640-1660, 2021 06.
Article in English | MEDLINE | ID: covidwho-1165739

ABSTRACT

Vaccines are essential public health tools with a favorable safety profile and prophylactic effectiveness that have historically played significant roles in reducing infectious disease burden in populations, when the majority of individuals are vaccinated. The COVID-19 vaccines are expected to have similar positive impacts on health across the globe. While serious allergic reactions to vaccines are rare, their underlying mechanisms and implications for clinical management should be considered to provide individuals with the safest care possible. In this review, we provide an overview of different types of allergic adverse reactions that can potentially occur after vaccination and individual vaccine components capable of causing the allergic adverse reactions. We present the incidence of allergic adverse reactions during clinical studies and through post-authorization and post-marketing surveillance and provide plausible causes of these reactions based on potential allergenic components present in several common vaccines. Additionally, we review implications for individual diagnosis and management and vaccine manufacturing overall. Finally, we suggest areas for future research.


Subject(s)
COVID-19 , Hypersensitivity , Vaccines , COVID-19 Vaccines , Humans , Hypersensitivity/diagnosis , Hypersensitivity/epidemiology , Hypersensitivity/etiology , Pandemics , SARS-CoV-2 , Vaccines/adverse effects
17.
J Med Virol ; 93(7): 4054-4057, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1148833

ABSTRACT

On March 11, 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19) a pandemic; from that date, the vaccine race has begun, and many technology platforms to develop a specific and effective COVID-19 vaccine have been launched in several clinical trials (protein subunit, RNA-based, DNA-based, replicating viral vector, nonreplicating viral vector, inactivated virus, live attenuated virus, and virus-like particle). Among the next-generation strategies, nucleoside-modified messenger RNA vaccines appear the most attractive, not only to counteract emerging pathogens but also for the possible applications in regenerative medicine and cancer therapy. However, exactly as all innovative drugs, they deserve careful pharmacovigilance in the short and long term.


Subject(s)
COVID-19 Vaccines , COVID-19/prevention & control , Vaccines, Synthetic , COVID-19 Vaccines/administration & dosage , COVID-19 Vaccines/adverse effects , COVID-19 Vaccines/immunology , Humans , Hypersensitivity/etiology , Liposomes/adverse effects , Nanoparticles/adverse effects , Nucleosides , Pandemics/prevention & control , Pharmacovigilance , Polyethylene Glycols/adverse effects , RNA, Messenger/chemistry , Vaccines, Synthetic/administration & dosage , Vaccines, Synthetic/adverse effects , Vaccines, Synthetic/immunology
18.
J Cosmet Dermatol ; 20(5): 1557-1562, 2021 May.
Article in English | MEDLINE | ID: covidwho-1140266

ABSTRACT

The incidence of hypersensitivity reactions to hyaluronic acid dermal fillers is between 0.3 and 4.25%, mediated by T-lymphocytes. Flu-like illness can trigger immunogenic reactions at the site of filler placement. Cases of SARS-CoV-2 are significant and pose a possible risk of inducing hypersensitivity. This case report is of a delayed-type hypersensitivity after hyaluronic acid dermal filler treatment of the nose and subsequent infection with SARS-CoV-2. Risk factors for the development of such symptoms were identified as the presence of hyaluronic acid combined with flu-like illness and repeated treatment of one area. The case resolved without intervention. Clinicians should be mindful of the risk posed by the interaction of hyaluronic acid dermal filler with SARS-CoV-2 in light of the pandemic.


Subject(s)
COVID-19/complications , Dermal Fillers , Hyaluronic Acid , Hypersensitivity/etiology , Cosmetic Techniques , Dermal Fillers/adverse effects , Humans , Hyaluronic Acid/adverse effects
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