Vaccination against COVID-19 in patients with allergic diseases

ABSTRACT

Background: In the context of the COVID-19 pandemic it is very important to achieve collective immunity. Allergic reactions to vaccines are rare -up to 30 per 100 000, but 4-8 may have anaphylaxis. The aim of this study was to develop safe COVID-19 vaccination algorithm for patients with allergic diseases (AD). Method(s) Patients with the history of AD were invited for vacination to the Regional Allergy Center in Dnipro (Ukraine). Before vaccination all patients underwent serum tryptase, whole blood count (WBC), D-dimer, blood biochemistry, electrocardiogram (ECG) and spirometry (for patients with asthma (A) only). 126 patients with AD 19-85 (53.2+/-1.5) years old (50, 39.68% men) were included into the study. 25.39% of them had seasonal allergic rhinitis (SAR);15.07% -A;10.32% -A+ SAR;35.71% -urticaria;11.11% -drug allergy;2.38% -history of anaphylaxis. Result(s) There were not any clinically significant changes found in WBC, blood biochemistry and ECG. At the same time in 4 patients (3.2%) high tryptase level was detected. Mastocytosis was diagnosed by sternal puncture in 3 of them. During 12 weeks they were treated by monoclonal antibodies and after that vaccinated with two doses of mRNA vaccine without adverse reactions. For 1 patient with high tryptase level and a history of 3 anaphylaxis with hospitalization vacination was postponed. 1 patient had elevated D-dimer (PTA was diagnosed by CT) -vaccination was temporarily delayed. In 10 patients uncontrolled A with FEV1 below 70% (36-65%) was found. After the correction of basic therapy, within 2 weeks vaccination was carried out. All patients were given a 4-fold dose of desloratadine 30 minutes before vaccination. Conclusion(s) 1. AD are not a contraindication for vacciantion against COVID-19. 2. Before vacciantion all patients with a history of AD should be examined by an allergist. 3. For patients with severe AD level of serum tryptase should be detected before vacciantion. 4. Patients with AD should be vaccinated in an allergy center with premedication of H1-blocker in a 4-fold dose.