Protocol of safe vaccination against COVID‐19 in patients with high risk of allergic reactions
Abstract Background Sars‐CoV‐2 infections are hazardous, especially to the elderly and patients with comorbidities. With no efficient treatment available, newly developed vaccines are the only way to change the course of the pandemic. However, reports of allergic reactions resulted in some patients...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2022-05-01
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| Series: | Clinical and Translational Allergy |
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| Online Access: | https://doi.org/10.1002/clt2.12152 |
| _version_ | 1811253455995535360 |
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| author | Jan Romantowski Jerzy Kruszewski Oskar Solarski Andrzej Bant Andrzej Chciałowski Ilona Pietrzyk Patrycja Sańpruch Aleksandra Górska Marta Chełmińska Agata Knurowska Marika Gawinowska Ewa Jassem Marek Niedoszytko |
| author_facet | Jan Romantowski Jerzy Kruszewski Oskar Solarski Andrzej Bant Andrzej Chciałowski Ilona Pietrzyk Patrycja Sańpruch Aleksandra Górska Marta Chełmińska Agata Knurowska Marika Gawinowska Ewa Jassem Marek Niedoszytko |
| author_sort | Jan Romantowski |
| collection | DOAJ |
| description | Abstract Background Sars‐CoV‐2 infections are hazardous, especially to the elderly and patients with comorbidities. With no efficient treatment available, newly developed vaccines are the only way to change the course of the pandemic. However, reports of allergic reactions resulted in some patients and practicing physicians being concerned about the safety of vaccine administration, particularly in people with severe anaphylactic reactions to multiple or unknown factors in their medical history. This study aimed to develop an allergic work‐up protocol based on skin prick tests (SPT), intradermal testing (IDT) and intramuscular provocations, and desensitisation which may contribute to diagnosis and management of anti‐COVID‐19 vaccine allergy. Methods Two hundred and eighty‐five patients were enrolled. Two hundred and five of them entered the study based on severe anaphylactic reaction to unknown or multiple factors in their medical history which disqualified them for standard treatment. Another 80 patients were enrolled after developing an allergic reaction to the first dose of one such vaccine. In all subjects, SPT and IDT were performed. Serum tryptase was assessed in 79 patients randomly chosen from the study group. Results Two hundred and seventy‐seven patients with negative tests were given a vaccine without complications. Seven patients had positive skin tests. In two cases, tests confirmed Comirnaty allergy, while the other five confirmed solely skin sensitisation with no exposure prior to the study. Six patients with positive tests received titrated challenge using desensitisation protocol with a reasonable tolerance. One patient did not consent to desensitisation and one patient resigned despite negative tests. Overall, 283 (99%) patients were vaccinated using this newly developed protocol. Patients with adverse reactions to the first dose of the vaccine before the study had a significantly lower basal serum tryptase concentration (p = 0.001). Conclusion Skin tests with anti‐COVID‐19 vaccines are a useful tool in the vaccination protocol. This protocol enables safe immunisation of high‐allergy‐risk patients even in cases of positive skin tests. |
| first_indexed | 2024-04-12T16:51:13Z |
| format | Article |
| id | doaj.art-e0aa8ee9fe2345c5b4c92fcb0dda85f5 |
| institution | Directory Open Access Journal |
| issn | 2045-7022 |
| language | English |
| last_indexed | 2024-04-12T16:51:13Z |
| publishDate | 2022-05-01 |
| publisher | Wiley |
| record_format | Article |
| series | Clinical and Translational Allergy |
| spelling | doaj.art-e0aa8ee9fe2345c5b4c92fcb0dda85f52022-12-22T03:24:23ZengWileyClinical and Translational Allergy2045-70222022-05-01125n/an/a10.1002/clt2.12152Protocol of safe vaccination against COVID‐19 in patients with high risk of allergic reactionsJan Romantowski0Jerzy Kruszewski1Oskar Solarski2Andrzej Bant3Andrzej Chciałowski4Ilona Pietrzyk5Patrycja Sańpruch6Aleksandra Górska7Marta Chełmińska8Agata Knurowska9Marika Gawinowska10Ewa Jassem11Marek Niedoszytko12Department of Allergology Medical University of Gdansk Gdańsk PolandDepartment of Infectious Diseases and Allergology Military Institute of Medicine Warsaw PolandDepartment of Allergology Chmielnik Hospital Chmielnik PolandDepartment of Infectious Diseases and Allergology Military Institute of Medicine Warsaw PolandDepartment of Infectious Diseases and Allergology Military Institute of Medicine Warsaw PolandDepartment of Allergology Chmielnik Hospital Chmielnik PolandDepartment of Allergology Chmielnik Hospital Chmielnik PolandDepartment of Allergology Medical University of Gdansk Gdańsk PolandDepartment of Allergology Medical University of Gdansk Gdańsk PolandII Department of Radiology Medical University of Gdansk Gdańsk PolandDepartment of Allergology Medical University of Gdansk Gdańsk PolandDepartment of Pneumonology Medical University of Gdańsk Gdańsk PolandDepartment of Allergology Medical University of Gdansk Gdańsk PolandAbstract Background Sars‐CoV‐2 infections are hazardous, especially to the elderly and patients with comorbidities. With no efficient treatment available, newly developed vaccines are the only way to change the course of the pandemic. However, reports of allergic reactions resulted in some patients and practicing physicians being concerned about the safety of vaccine administration, particularly in people with severe anaphylactic reactions to multiple or unknown factors in their medical history. This study aimed to develop an allergic work‐up protocol based on skin prick tests (SPT), intradermal testing (IDT) and intramuscular provocations, and desensitisation which may contribute to diagnosis and management of anti‐COVID‐19 vaccine allergy. Methods Two hundred and eighty‐five patients were enrolled. Two hundred and five of them entered the study based on severe anaphylactic reaction to unknown or multiple factors in their medical history which disqualified them for standard treatment. Another 80 patients were enrolled after developing an allergic reaction to the first dose of one such vaccine. In all subjects, SPT and IDT were performed. Serum tryptase was assessed in 79 patients randomly chosen from the study group. Results Two hundred and seventy‐seven patients with negative tests were given a vaccine without complications. Seven patients had positive skin tests. In two cases, tests confirmed Comirnaty allergy, while the other five confirmed solely skin sensitisation with no exposure prior to the study. Six patients with positive tests received titrated challenge using desensitisation protocol with a reasonable tolerance. One patient did not consent to desensitisation and one patient resigned despite negative tests. Overall, 283 (99%) patients were vaccinated using this newly developed protocol. Patients with adverse reactions to the first dose of the vaccine before the study had a significantly lower basal serum tryptase concentration (p = 0.001). Conclusion Skin tests with anti‐COVID‐19 vaccines are a useful tool in the vaccination protocol. This protocol enables safe immunisation of high‐allergy‐risk patients even in cases of positive skin tests.https://doi.org/10.1002/clt2.12152allergencoronavirusimmunitysars‐cov‐2vaccination |
| spellingShingle | Jan Romantowski Jerzy Kruszewski Oskar Solarski Andrzej Bant Andrzej Chciałowski Ilona Pietrzyk Patrycja Sańpruch Aleksandra Górska Marta Chełmińska Agata Knurowska Marika Gawinowska Ewa Jassem Marek Niedoszytko Protocol of safe vaccination against COVID‐19 in patients with high risk of allergic reactions Clinical and Translational Allergy allergen coronavirus immunity sars‐cov‐2 vaccination |
| title | Protocol of safe vaccination against COVID‐19 in patients with high risk of allergic reactions |
| title_full | Protocol of safe vaccination against COVID‐19 in patients with high risk of allergic reactions |
| title_fullStr | Protocol of safe vaccination against COVID‐19 in patients with high risk of allergic reactions |
| title_full_unstemmed | Protocol of safe vaccination against COVID‐19 in patients with high risk of allergic reactions |
| title_short | Protocol of safe vaccination against COVID‐19 in patients with high risk of allergic reactions |
| title_sort | protocol of safe vaccination against covid 19 in patients with high risk of allergic reactions |
| topic | allergen coronavirus immunity sars‐cov‐2 vaccination |
| url | https://doi.org/10.1002/clt2.12152 |
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