Updated consensus statements on COVID-19 Vaccine Allergy Safety in Hong Kong.

Due to global concerns over coronavirus disease 2019 (COVID-19) vaccine-associated allergic reactions; the Hong Kong Institute of Allergy (HKIA) formulated an initial set of consensus statements (CS) on COVID-19 Vaccine Allergy Safety (VAS) in early 2021. Following accumulation of both local and international experience on and COVID-19 VAS, the HKIA task force reformed to update the Hong Kong consensus on COVID-19 VAS. A nominated task force of experts managing patients with drug and vaccine allergies in Hong Kong formulated the updated CS by unanimous decision. A total of 9 new statements were established. Individuals with history of food allergies and anaphylaxis unrelated to the components of COVID-19 vaccines do not require allergist review prior to vaccination. Individuals with history suspicious of an excipient allergy may now be vaccinated with a non-PEG containing vaccine without prior allergist assessment. Individuals with suspected mild allergic reactions following prior COVID-19 vaccination can proceed with the next dose. Only individuals who present with immediate-type allergic reaction with systemic symptoms or more severe nonimmediate type reactions should defer their next dose until allergist review. The remaining statements regarding adequate safety during vaccination and advocation for legislative changes regarding excipient disclosure in Hong Kong remained unchanged from the prior CS. The updated CS are updated in accordance with local and international experience thus far and serve as guidance for local frontline healthcare providers to further promote safe COVID-19 vaccine uptake in Hong Kong.

Hong Kong Anaphylaxis Consortium Consensus Statements on prescription of adrenaline autoinjectors in the acute care setting.

BACKGROUND: Adrenaline autoinjectors (AAInj) facilitates early administration of adrenaline and remains the first-line treatment for anaphylaxis. However, only a minority of anaphylaxis survivors in Hong Kong are prescribed AAInj and formal guidance do not exist. International anaphylaxis guidelines have been largely based on Western studies, which may not be as relevant for non-Western populations. OBJECTIVE: To formulate a set of consensus statements on the prescription of AAInj in Hong Kong. METHODS: Consensus statements were formulated by the Hong Kong Anaphylaxis Consortium by the Delphi method. Agreement was defined as greater than or equal to 80% consensus. Subgroup analysis was performed to investigate differences between allergy and emergency medicine physicians. RESULTS: A total of 7 statements met criteria for consensus with good overall agreement between allergy and emergency medicine physicians. AAInj should be used as first-line treatment and prescribed for all patients at risk of anaphylaxis. This should be prescribed prior to discharge from the Accident and Emergency Department together with an immediate referral to an allergy center. The decision for prescribing AAInj should be based on the severity of previous reactions; including objective signs of respiratory involvement, objective signs of cardiovascular involvement and multiorgan involvement (regardless of severity). Patient demographics and comorbidities, specifically history of asthma or chronic obstructive pulmonary disease, should also be considered. Patients deemed eligible for AAInj should be offered avoidance advice and prescribed one AAInj while awaiting review by allergists. AAInj technique should be demonstrated by a healthcare professional or instruction video, and a return demonstration by the patient is required. The patient should also be counseled that the decision on the continued need of AAInj prescription in the long-term should be reviewed by an allergist. CONCLUSION: Consensus statements support the prescription of AAInj by front-line physicians with subsequent allergist review when treating patients at risk of anaphylaxis in Hong Kong.

Consensus Statements on the Approach to COVID-19 Vaccine Allergy Safety in Hong Kong.

Background: Mass coronavirus disease 2019 (COVID-19) vaccination to achieve herd immunity is an effective means to mitigate the current COVID-19 pandemic. Reports of COVID-19 vaccine-associated allergic reactions and lack of clear local guidance are contributing factors leading to a low vaccine acceptance rate in the community. A task force of experts from the Hong Kong Institute of Allergy (HKIA) has been formed to address current needs. Objective: To formulate a set of consensus statements (CS) on COVID-19 vaccine allergy safety (VAS) in Hong Kong. Methods: A nominated task force of experts managing patients with drug and vaccine allergies in Hong Kong formulated the CS by the Delphi method. An agreement was a priori defined as ≥80% consensus. Results: A total of 11 statements met the criteria for consensus with good overall agreement among task force members, including seven statements on pre-vaccination recommendations and four statements on vaccination and post-vaccination guidance. Individuals with a history of suspected allergic reaction to prior COVID-19 vaccination should not receive further COVID-19 vaccination, and other groups at risk of COVID-19 vaccine-associated allergic reactions have been identified. The importance of pre-vaccination and post-vaccination assessment by frontline healthcare workers and evaluation by allergists are highlighted. Conclusion: The CS provides pragmatic and timely guidance for local frontline healthcare providers on decisions regarding COVID-19 VAS.

Clinical characteristics and pattern of skin test reactivities in shellfish allergy patients in Hong Kong.

Allergens from crustaceans and mollusks exhibit extensive cross-reactivity in vitro. However, the degree and pattern of cross-reactivity between different shellfish species in vivo is still unclear. The objective of this study was to determine the clinical characteristics of shellfish allergic patients in Hong Kong and the pattern of skin test reactivities to the different species. This cohort study involves patients attending the allergy clinic of a large teaching hospital for suspected shellfish allergy. Each subject underwent skin-prick tests to eight species of shellfish and house-dust mites. Eighty-four consecutive patients were tested. Twenty-eight patients reported a history of severe anaphylaxis. Fourteen patients had no positive shellfish skin test and were excluded. There were 183 positive shellfish skin tests, with an average of 2.61 positive tests per subject. Ninety percent of subjects also had positive skin tests to house-dust mites. Overall, 65. 7% of subjects had more than one positive skin test to shellfish. There were strong statistical associations between species belonging to the same order but also between some mollusks and crustaceans. We found a high degree of skin test cross-reactivity between different species of shellfish and between shellfish and house-dust mites. Therefore, patients with a history of shellfish allergy should be cautious with all types of shellfish.

DNA immunization using a secreted cell wall antigen Mp1p is protective against Penicillium marneffei infection.

None of the vaccines used in dimorphic fungal infections utilized the mucosal route for immunization, whereas only one utilized a secreted protein as antigen, despite knowing that infections caused by dimorphic fungi are usually acquired through inhalation. In this study, we investigated the usefulness of Mp1p (a secreted cell wall antigen encoded by MP1)-based vaccines for generation of protective immune responses against Penicillium marneffei infection using a mouse model, and compared the relative effectiveness of intramuscular MP1 DNA vaccine, oral mucosal MP1 DNA vaccine delivered by live-attenuated Salmonella typhimurium, and intraperitoneal recombinant Mp1p protein vaccine. The serum IgM level of the Mp1p protein vaccine group at day 7 and the serum IgG levels of the Mp1p protein vaccine group at days 7 and 21 were significantly higher than those of the other groups (P<0.0001). The serum IgG level of the MP1 DNA vaccine group was significantly higher than that of the corresponding control group and oral mucosal MP1 DNA vaccine group (one dose) at day 21 (P<0.0001 and <0.05, respectively). The groups of mice immunized with intramuscular MP1 DNA vaccine, oral mucosal MP1 DNA vaccine, and intraperitoneal Mp1p protein vaccine showed significantly higher Mp1p-specific lymphocyte proliferation index (LPI) than the control groups. The interferon-gamma (IF-gamma) levels of supernatant of splenic cell cultures obtained from mice after intramuscular MP1 DNA vaccine, mucosal MP1 DNA vaccine (three doses), or intraperitoneal Mp1p protein vaccine administration were higher than that which occurred after mucosal MP1 DNA vaccine (one dose) administration or those of controls. Interleukin-4 (IL-4) was not detectable in the supernatant of splenic cell cultures obtained from all groups of mice. The percentage survival of the mice immunized with intramuscular MP1 DNA vaccine, oral mucosal MP1 DNA vaccine (three doses), oral mucosal MP1 DNA vaccine (one dose), intraperitoneal recombinant Mp1p protein, oral live-attenuated S. typhimurium control, and intramuscular pJW4303 DNA control at day 60 after wild type P. marneffei challenge were 100, 60, 40, 40, 40, and 0%, respectively. The survival of mice in the MP1 DNA vaccine group was significantly better than those of the oral mucosal MP1 DNA vaccine (three doses) group (P<0.05), oral mucosal MP1 DNA vaccine (one dose) group (P<0.005), recombinant Mp1p protein group (P<0.005), S. typhimurium aroA strain group (P<0.05), and pJW4303 group (P<0.00001). Although, the mechanism by which intramuscular MP1 DNA vaccine offered the best protection against P. marneffei infection remains to be elucidated, the present observation prompted further clinical trials on the use of MP1 DNA immunization on asymptomatic human immunodeficiency virus carriers in P. marneffei endemic areas.