Practical handling of allergic reactions to COVID-19 vaccines: A position paper from German and Austrian Allergy Societies AeDA, DGAKI, GPA and ÖGAI

Ludger Klimek; Karl-Christian Bergmann; Randolf Brehler; Wolfgang Pfützner; Torsten Zuberbier; Karin Hartmann; Thilo Jakob; Natalija Novak; Johannes Ring; Hans Merk; Eckard Hamelmann; Tobias Ankermann; Sebastian Schmidt; Eva Untersmayr; Wolfram Hötzenecker; Erika Jensen-Jarolim; Knut Brockow; Vera Mahler; Margitta Worm

doi:10.1007/s40629-021-00165-7

Practical handling of allergic reactions to COVID-19 vaccines: A position paper from German and Austrian Allergy Societies AeDA, DGAKI, GPA and ÖGAI

Allergo J Int. 2021;30(3):79-95. doi: 10.1007/s40629-021-00165-7. Epub 2021 Apr 19.

Authors

Ludger Klimek¹, Karl-Christian Bergmann^{2

3}, Randolf Brehler⁴, Wolfgang Pfützner⁵, Torsten Zuberbier^{2

3}, Karin Hartmann⁶, Thilo Jakob⁷, Natalija Novak⁸, Johannes Ring⁹, Hans Merk¹⁰, Eckard Hamelmann¹¹, Tobias Ankermann¹², Sebastian Schmidt¹³, Eva Untersmayr¹⁴, Wolfram Hötzenecker¹⁵, Erika Jensen-Jarolim^{14

16}, Knut Brockow⁹, Vera Mahler¹⁷, Margitta Worm¹⁸

Affiliations

¹ Center for Rhinology and Allergology, Wiesbaden, Germany.
² Clinic for Dermatology, Venereology and Allergy, Charité-University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany.
³ Berlin Institute of Health, Charité-Medical University Berlin, Berlin, Germany.
⁴ Outpatient Clinic for Allergology, Occupational Dermatology and Environmental Medicine, General Dermatology and Venereology, Department of Skin Diseases, Münster University Hospital, Münster, Germany.
⁵ Department of Dermatology and Allergology, University Hospital Marburg, UKGM, Philipps University Marburg, Marburg, Germany.
⁶ Department of Dermatology and Allergology, University Hospital Basel, University of Basel, Basel, Switzerland.
⁷ Department of Dermatology and Allergology, Giessen University Hospital, UKGM, Justus Liebig University Giessen, Giessen, Germany.
⁸ Clinic and Polyclinic for Dermatology and Allergology, University Hospital Bonn, Bonn, Germany.
⁹ Clinic and Polyclinic for Dermatology and Allergology at Biederstein, Technical University of Munich, Munich, Germany.
¹⁰ Department of Dermatology and Allergology, RWTH Aachen University Hospital, Aachen, Germany.
¹¹ Pediatric and Adolescent Medicine, Bethel Children's Center, OWL University Hospital, Bielefeld University, Bielefeld, Germany.
¹² Clinic for Pediatric and Adolescent Medicine, Municipal Hospital Kiel GmbH, Kiel, Germany.
¹³ Center for Pediatric and Adolescent Medicine, Clinic and Polyclinic for Pediatric and Adolescent Medicine, University Medicine Greifswald, Greifswald, Germany.
¹⁴ Institute for Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
¹⁵ Clinic for Dermatology and Venereology, Allergy Center, Kepler University Hospital GmbH, Linz, Austria.
¹⁶ Inter-university Messerli Research Institute Vienna, Vienna, Austria.
¹⁷ Paul-Ehrlich-Institute, Langen, Germany.
¹⁸ Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-University Medicine Berlin, Berlin, Germany.

Abstract

Background: For the preventive treatment of the 2019 coronavirus disease (COVID-19) an unprecedented global research effort studied the safety and efficacy of new vaccine platforms that have not been previously used in humans. Less than one year after the discovery of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral sequence, these vaccines were approved for use in the European Union (EU) as well as in numerous other countries and mass vaccination efforts began. The so far in the EU approved mRNA vaccines BNT162b2 and mRNA-1273 are based on similar lipid-based nanoparticle carrier technologies; however, the lipid components differ. Severe allergic reactions and anaphylaxis after COVID-19 vaccination are very rare adverse events but have drawn attention due to potentially lethal outcomes and have triggered a high degree of uncertainty.

Methods: Current knowledge on anaphylactic reactions to vaccines and specifically the new mRNA COVID-19 vaccines was compiled using a literature search in Medline, PubMed, as well as the national and international study and guideline registries, the Cochrane Library, and the Internet, with special reference to official websites of the World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC), Robert Koch Institute (RKI), and Paul Ehrlich Institute (PEI).

Results: Based on the international literature and previous experience, recommendations for prophylaxis, diagnosis and therapy of these allergic reactions are given by a panel of experts.

Conclusion: Allergy testing is not necessary for the vast majority of allergic patients prior to COVID-19 vaccination with currently licensed vaccines. In case of allergic/anaphylactic reactions after vaccination, allergy workup is recommended, as it is for a small potential risk population prior to the first vaccination. Evaluation and approval of diagnostic tests should be done for this purpose.

Keywords: Allergic reaction; Anaphylactic reaction; Corona virus; Safety; Vaccination.