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. 2021 Aug 24;5:251–259. doi: 10.5414/ALX02245E

COVID-19 vaccination and allergen immunotherapy (AIT) – A position paper of the German Society for Applied Allergology (AeDA) and the German Society for Allergology and Clinical Immunology (DGAKI)

Ludger Klimek 1, Oliver Pfaar 2, Eckard Hamelmann 3, Jörg Kleine-Tebbe 4, Christian  Taube 5, Martin Wagenmann 6, Thomas Werfel 7, Randolf Brehler 8, Natalija  Novak 9, Norbert Mülleneisen 10, Sven Becker 11, Margitta Worm 12
PMCID: PMC8439106  PMID: 34533543

Abstract

Background: Vaccinations against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) are intended to induce an immune response to protect against infection/disease. Allergen immunotherapy (AIT) is thought to induce a (different) immune response, e.g., to induce tolerance to allergens. In this position paper we clarify how to use AIT in temporal relation to COVID-19 vaccination. Four SARS-CoV-2 vaccines are currently approved in the EU, and their possible immunological interactions with AIT are described together with practical recommendations for use. Materials and methods: Based on the internationally published literature, this position paper provides specific recommendations for the use of AIT in temporal relation to a SARS-CoV-2 vaccination. Results: AIT is used in 1) allergic rhinitis, 2) allergic bronchial asthma, 3) insect venom allergy, 4) food allergy (peanut). Conclusion: For the continuation of an ongoing AIT, we recommend an interval of 1 week before and after vaccination for subcutaneous immunotherapy (SCIT). For sublingual immunotherapy (SLIT) and oral immunotherapy (OIT), we recommend taking them up to the day before vaccination and a break of 2 – 7 days after vaccination. Initiation of a new SCIT, SLIT, or OIT should be delayed until 1 week after the day of the second vaccination. For SCIT, we generally recommend an interval of ~ 1 week to COVID-19 vaccination.

Keywords: allergen immunotherapy, allergic rhinitis, asthma, COVID-19, SARS-CoV-2

German version published in Allergologie, Vol. 44, No. 5/2020, pp. 339-348.

Introduction

Allergen immunotherapy

Allergen immunotherapy (AIT) is the only causally effective therapy for which long-term clinical benefit has been demonstrated in allergic respiratory diseases, for example, allergic bronchial asthma or allergic rhinoconjunctivitis and other allergic diseases [1]. Since its first description more than 100 years ago (1911) [2], AIT has been an established and internationally recognized procedure for the treatment of allergies.

AIT induces immune tolerance to a specific, individually relevant allergen [3]. Systematic meta-analyses have confirmed that AIT significantly reduces symptoms of allergic disease and the amount of necessary antisymptomatic medication in patients with allergic asthma [4] and allergic rhinoconjunctivitis [5].

This is true for both subcutaneous immunotherapy (SCIT) [6, 7] and sublingual immunotherapy (SLIT) [8].

The risk of patients with allergic rhinitis developing asthma is reduced by AIT [9, 10]. AIT is also effective in patients with IgE-mediated food allergy [11, 12] and insect venom allergy [13]. In addition, the cost-saving effect of this disease-modifying therapeutic option [14, 15, 16] has been demonstrated.

After the World Health Organization (WHO) declared the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2)-transmitted corona virus 19 (COVID-19) infectious disease pandemic in March 2020 [17], numerous position papers and recommendations for action from international and national allergological societies on the management of allergological diseases and their therapies in the pandemic have been published [18, 19, 20, 21, 22, 23, 24, 25, 26, 58, 59, 60, 61, 62, 63].

For the two mRNA-based vaccines currently approved in Europe (Comirnaty from BioNTech [27]; MRNA-1273 from Moderna [28]) and two vector-based vaccines (CHAdOx1-S from AstraZeneca [29]; Ad26. COV2-S from Johnson & Johnson [30]), recommendations for allergological risk assessment of COVID-19 vaccinations have been published in cooperation of AeDA (Ärzteverband Deutscher Allergologen), DGAKI (Deutscher Gesellschaft für Allergologie und Klinische Immunologie), and GPA (Gesellschaft für Pädiatrische Allergologie und Umweltmedizin) [31, 32, 33].

Based on the technical and directions for use of the four approved COVID-19 vaccines, AIT is not a contraindication [27, 28, 29, 30].

On this basis, scientific societies have published recommendations for COVID-19 vaccinations for patients undergoing biologic therapy [25, 26, 64].

The aim of this position paper is to present the use of AIT in its different forms of application (SCIT, SLIT, oral (OIT)) in the context of COVID-19 vaccination and to provide detailed recommendations for action (Figure 1).

Figure 1. Recommendations for subcutaneous immunotherapy (SCIT) and sublingual immunotherapy SLIT. During the phases marked in green, vaccination can be carried out; during the phases marked in blue, there should be no vaccination.

Figure 1

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Immune responses in AIT

AIT attempts to induce a tolerogenic response to an individual antigen dose by continuous administration of that antigen. The main mechanisms include early desensitization of effector cells and progressive onset of a regulatory B and T cell response [34, 35, 36]. Although the main changes of specific immunotherapy are antigen-specific, recent data support a beneficial effect in restoring the general balance of the immune system altered toward Th2 immune response [37, 38]. A recent review analyzes the impact of the COVID-19 pandemic on the management of AIT in routine practice [39].

Because AIT is administered over a period of several years, there is considerable experience in coadministration with antiviral and other antimicrobial vaccines. Here, negative influences have not become known. On the contrary, immunologically, a restored balance of the innate immune system could improve its protective function [40].

General information on COVID-19 vaccines

COVID-19 has caused circa 110 million illnesses worldwide and claimed 2.5 million lives as of the writing of this review [41].

Effective vaccination against the novel virus represents an essential strategy to achieve maintenance of health care and public life while reducing social constraints [42].

Four vaccination goals exist in the context of COVID-19 vaccination. Most important is the prevention of severe COVID-19 courses and deaths. In addition, the protection of individuals at particularly high occupational risk of infection, prevention of disease transmission, and maintenance of public life are also important [43].

Due to extensive collaborations between academia and industry, new vaccine platforms were developed at an unprecedented pace less than a year after the discovery of the SARS-CoV-2 viral sequence, extensively and comprehensively tested in clinical trial programs, and approved (some provisionally or conditionally) after thorough review by regulatory authorities.

COVID-19 vaccines approved in Germany

Worldwide, 66 COVID-19 vaccines are currently in clinical development and another 176 are in a preclinical development phase [44].

Vaccines against viral infectious diseases are designed to induce humoral and cellular immune responses against the vaccinated antigen. For this purpose, classical technologies are used, but also vaccine variants that have never been approved for human pharmacology [44].

The most common route of vaccine application is intramuscular injection, which induces strong priming of dendritic cells. However, vaccines using other routes of application are also currently being developed and their pharmacological properties and effects in terms of immune induction remain to be seen [45].

Traditionally, either complete viruses are used, or pathoimmunologically significant parts of the virus (for example, those necessary for entry into somatic cells).

The mRNA-based SARS-CoV-2 vaccines from BioNTech/Pfizer and Moderna break new ground in terms of vaccine antigen delivery. BNT162b2 and mRNA-1273 are mRNA-based vaccines that do not introduce the antigen against which an immune response is to be induced (surface protein of the SARS-CoV-2 virus) but the blueprint (the mRNA) to produce the target protein in human cells. Primarily, the mRNA is taken up in muscle cells, but dendritic cells are critically involved in the presentation of the antigen. Regional lymph nodes are then where the immune response predominantly occurs. The target cells produce the viral antigen based on the information of the mRNA by transcription into the amino acid sequence of the protein structure, which becomes visible to the immune system of the vaccinee as a surface protein of such “transduced” cells. The immune system recognizes the surface protein of the SARS-CoV-2 as foreign and starts a humoral and cellular immune response. Degradation products of the produced proteins (peptides) are presented to the T cells, which are thus activated. This enables them to recognize and kill virus-infected cells. Furthermore, activated T cells support the antibody-producing B cells.

Due to the rapid degradation of mRNA, it must be packaged in liposomes as a protective envelope so that uptake into the body’s own cells (the transfection) works. Their production has been improved in recent years, but liposomes and the mRNA they contain break down very easily, so these vaccines must be stored at very low temperatures (–20 °C (mRNA-1273) to –70 °C (BNT162b2) between production and use in humans. The lipid nanoparticles and their components also appear to be responsible for the severe allergic reactions to mRNA vaccines [32, 33].

Vector vaccines are another new class of vaccines. The AstraZeneca vaccine (ChAdOx1-S-(AZD1222)), the vaccine Ad26COV2.S from Janssen Pharmaceutical (Johnson & Johnson), and Sputnik V (Gam-COVID-Vac Adeno-based (rAd26-S+rAdS-S)) from the Moscow Gamaleja Institute are based on harmless human or monkey viruses that are unable to self-replicate and contain the SARS-CoV-2 surface protein [46].

The adenovirus-based vector vaccines can be stored in the refrigerator at 4 °C for several months without losing their efficacy.

A disadvantage of virus vector vaccines in general is that they cannot be used to vaccinate several times in succession, because the vaccinee develops neutralizing antibodies against the vector itself. As a result, booster vaccinations can be only reduced or no longer effective. This is not a problem with Janssen Pharmaceutical’s Ad26COV2.S vaccine, which only needs to be administered once. When booster vaccination is necessary, an alternative strategy in cases of initial immunization with vector virus type A is booster using a heterologous vector type B vaccine. This has already become a reality in the randomized placebo-controlled trial with the Sputnik V vaccine developed in Russia recently [46].

Immunology of type 1 allergies

The type1 allergic reaction is based on a T2 immune response in which immunoglobulin E (IgE) and the cytokines interleukin (IL)-4, IL-5, and IL-13 in particular are significantly involved. From the use of biologics, we know that these key elements of T2 inflammation do not play a role in the antiviral immune response with respect to either IgE or the aforementioned cytokines. The immune response to anti-viral vaccination was not attenuated [47, 48], whereas anti-IgE treatment increased the production of type 1 interferon from dendritic cells, thereby enhancing the antiviral response [26, 49, 50].

Practical recommendations for allergen immunotherapy

SCIT/SLIT/OIT in temporal connection with COVID-19 vaccinations

In principle, manufacturer-specific guidelines Summary of Product Characteristics must be taken into account in the temporal connection of AIT and vaccinations. Thus, there should generally be an interval of ~ 1 week between SCIT and COVID-19 vaccination. Based on experience with other vaccinations, the following procedure has proven effective [25, 40, 51].

Induction phase

If it is possible to carry out the boosting phase of AIT completely before the planned vaccination date, this can be done as usual, and the recommendations given under “Maintenance therapy” then apply. If vaccination is imminent, initiation of SCIT, SLIT, or OIT should be delayed until 1 week after the second vaccination date [25].

Maintenance therapy

For continuation of ongoing AIT, we recommend a period of ~ 1 week between SCIT and vaccination, analogous to the above procedure, as well as at least 1 week interval after vaccination, observing the minimum interval between 2 SCIT applications recommended by the manufacturer.

For SLIT or OIT, there are different recommendations from different manufacturers on the interval between vaccination and previous and subsequent SLIT or OIT administration. Therefore, no general recommendation can be given, but the information in the Summary of Product Characteristics should be considered and an individual decision should be made thereafter. In order to be able to limit possible side effects of the SLIT or OIT or the vaccination, we recommend to pause the SLIT or OIT on the day of the vaccination and to continue it with a certain time lag (2 – 7 days). In this case, SLIT or OIT can be applied up to the day before the vaccination [25].

Allergic reactions to vaccines are very rare, occurring at 1 per 1,000,000 – 30 per 100,000 vaccinations [52, 53, 54, 55, 56, 57].

To date, there is no evidence that they are increased under AIT [25, 40].

Discussion and summary

Currently, there is no scientifically substantiated evidence for clinically relevant interactions between AIT and the COVID-19 vaccines currently available in Germany.

Both mRNA vaccines against SARS-CoV-2 are based on the same lipid-based nanoparticle carrier technology; the other two vaccines are vector vaccines.

Additional vaccines are expected to be licensed in the coming months, and it is almost inevitable that adverse drug reactions will occur in the coming months that were not observed in the studies conducted for marketing authorization. Such real-life data will play a significant role in assessing interactions with other drugs – including AIT.

Vaccine safety requires a proactive approach to maintain public confidence and reduce reluctance to vaccination among segments of the population. Vigilance, careful response, documentation, and characterization of these events are necessary to allow definition of mechanisms and appropriate approaches for prediction, prevention, and treatment. This is especially true for potential interactions of allergy therapies such as AIT.

Funding

This work has been funded by German Allergy Societies AeDA and DGAKI.

Conflict of interest

L. Klimek reports research funding, grants, and/or honoraria in the last 3 years from Allergopharma, Bioprojet, Biomay, Circassia, Viatris, HAL Allergie, ALK Abelló, Aimmune, Immunotek S.L., LETI Pharma, Stallergenes, Quintiles, Sanofi, ASIT Biotech, Lofarma, Thermofisher, Roxall, Allergy Therapeutics, AstraZeneca, GSK, Inmunotek, AeDA, Pohl Boskamp GmbH, Paul Martini Foundation, outside the submitted work; and is a member of the following organizations: AeDA, DGHNO, German Academy of Allergology and Clinical Immunology, German Allergy League; ENT-BV, GPA, EAACI.

O. Pfaar reports grants and/or honoraria from ALK-Abelló, Allergopharma, Stallergenes Greer, HAL Allergy Holding B. V./HAL Allergie GmbH, Bencard Allergie GmbH/Allergy Therapeutics, Inmunotek S.L., Lofarma, Biomay, Circassia, ASIT Biotech Tools S. A., Laboratorios LETI/LETI Pharma, MEDA Pharma/MYLAN, Anergis S. A., Mobile Chamber Experts (a GA2LEN Partner), Indoor Biotechnologies, GlaxoSmithKline, Astellas Pharma Global, EUFOREA, ROXALL Medizin, Novartis, Sanofi Aventis, Sanofi Genzyme, Med Update Europe GmbH, streamedup! GmbH, Pohl-Boskamp GmbH, John Wiley and Sons AS, Paul Martini Foundation (PMS), Regeneron Pharmaceuticals Inc., Ingress-Health HWM during the last 36 months and all outside the present work.

R. Brehler reports honoraria from ALK Abelló, Allergopharma, Allmiral, AstraZeneca, Bencard, Gesellschaft zur Förderung der Dermatologischen Forschung und Fortbildung e.V., GSK, HAL Allergie, LETI Pharma, MedUpdate, Merck, Novartis, Sanofi, Stallergenes, outside the submitted work; and membership in the following organizations: AeDA, DGAKI, EAACI, ABD.

M. Wagenmann reports honoraria from ALK-Abello, Allergopharma, AstraZeneca, Bencard, Genzyme, GlaxoSmithKline, HAL Allergy, LETI, Meda Pharma, Novartis, Sanofi Aventis, Stallergenes, all outside the present work.

M. Worm reports other/other conflicts of interest by Regeneron Pharmaceuticals, DBV Technologies S.A, Stallergenes GmbH, HAL Allergy GmbH, Bencard Allergie GmbH, Allergopharma GmbH & Co. KG, ALK-Abelló Arzneimittel GmbH, Mylan Germany GmbH, Leo Pharma GmbH, Sanofi-Aventis Deutschland GmbH, Aimmune Therapeutics UK Limited, Actelion Pharmaceuticals Deutschland GmbH, Novartis AG, Biotest AG, AbbVie Deutschland GmbH & Co. KG, Lilly Deutschland GmbH, all outside the scope of the present work.

S. Becker reports honoraria from HAL Allergie GmbH, Bencard Allergie GmbH, Allergopharma GmbH & Co. KG, ALK-Abelló Arzneimittel GmbH, Mylan Germany GmbH, Sanofi-Aventis Deutschland GmbH, Novartis AG, AstraZeneca, Ambu, Karl Storz, outside the submitted work.

N. Novak reports honoraria from Alk Abello, Stallergens Geer, Hal Allergy, Leti Pharma, Sanofi Genzyme, Abbvie, Leo Pharma, Novartis, streamed up, and Blueprint outside the submitted work.

The other authors declare no conflicts of interest.

References

  • 1.Bousquet J Lockey R Malling HJ Allergen immunotherapy: therapeutic vaccines for allergic diseases. A WHO position paper. J Allergy Clin Immunol. 1998; 102: 558–562. [DOI] [PubMed] [Google Scholar]
  • 2.Durham SR Leung DY One hundred years of allergen immunotherapy: time to ring the changes. J Allergy Clin Immunol. 2011; 127: 3–7. [DOI] [PubMed] [Google Scholar]
  • 3.Jutel M Van de Veen W Agache I Azkur KA Akdis M Akdis CA Mechanisms of allergen-specific immunotherapy and novel ways for vaccine development. Allergol Int. 2013; 62: 425–433. [DOI] [PubMed] [Google Scholar]
  • 4.Dhami S Kakourou A Asamoah F Agache I Lau S Jutel M Muraro A Roberts G Akdis CA Bonini M Cavkaytar O Flood B Gajdanowicz P Izuhara K Kalayci Ö Mosges R Palomares O Pfaar O Smolinska S Sokolowska M Allergen immunotherapy for allergic asthma: A systematic review and meta-analysis. Allergy. 2017; 72: 1825–1848. [DOI] [PubMed] [Google Scholar]
  • 5.Dhami S Nurmatov U Arasi S Khan T Asaria M Zaman H Agarwal A Netuveli G Roberts G Pfaar O Muraro A Ansotegui IJ Calderon M Cingi C Durham S van Wijk RG Halken S Hamelmann E Hellings P Jacobsen L Allergen immunotherapy for allergic rhinoconjunctivitis: A systematic review and meta-analysis. Allergy. 2017; 72: 1597–1631. [DOI] [PubMed] [Google Scholar]
  • 6.Klimek L Brehler R Hamelmann E Kopp M Ring J Treudler R Jakob T Worm M Pfaar O Development of subcutaneous allergen immunotherapy (part 2): preventive aspects and innovations. Allergo J Int. 2019; 28: 107–119. [Google Scholar]
  • 7.Klimek L Brehler R Hamelmann E Kopp M Ring J Treudler R Jakob T Worm M Pfaar O Evolution of subcutaneous allergen immunotherapy (part 1): from first developments to mechanism-driven therapy concepts. Allergo J Int. 2019; 28: 78–95. [Google Scholar]
  • 8.Durham SR Emminger W Kapp A de Monchy JG Rak S Scadding GK Wurtzen PA Andersen JS Tholstrup B Riis B Dahl R SQ-standardized sublingual grass immunotherapy: confirmation of disease modification 2 years after 3 years of treatment in a randomized trial. J Allergy Clin Immunol. 2012; 129: 717–725.e5. [DOI] [PubMed] [Google Scholar]
  • 9.Nurmatov U Dhami S Arasi S Roberts G Pfaar O Muraro A Ansotegui IJ Calderon M Cingi C Durham S van Wijk RG Halken S Hamelmann E Hellings P Jacobsen L Knol E Larenas-Linnemann D Lin SY Maggina V Oude-Elberink H Allergen immunotherapy for allergic rhinoconjunctivitis: a systematic overview of systematic reviews. Clin Transl Allergy. 2017; 7: 9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Queisser A Hagedorn S Wang H Schaefer T Konantz M Alavi S Deng M Vogel W von Mässenhausen A Kristiansen G Duensing S Kirfel J Lengerke C Perner S Ecotropic viral integration site 1, a novel oncogene in prostate cancer. Oncogene. 2017; 36: 1573–1584. [DOI] [PubMed] [Google Scholar]
  • 11.Blumchen K Trendelenburg V Ahrens F Gruebl A Hamelmann E Hansen G Heinzmann A Nemat K Holzhauser T Roeder M Rosenfeld L Hartmann O Niggemann B Beyer K Efficacy, safety, and quality of life in a multicenter, randomized, placebo-controlled trial of low-dose peanut oral immunotherapy in children with peanut allergy. J Allergy Clin Immunol Pract. 2019; 7: 479–491.e10. [DOI] [PubMed] [Google Scholar]
  • 12.Chu DK Wood RA French S Fiocchi A Jordana M Waserman S Brożek JL Schünemann HJ Oral immunotherapy for peanut allergy (PACE): a systematic review and meta-analysis of efficacy and safety. Lancet. 2019; 393: 2222–2232. [DOI] [PubMed] [Google Scholar]
  • 13.Dhami S Zaman H Varga EM Sturm GJ Muraro A Akdis CA Antolín-Amérigo D Bilò MB Bokanovic D Calderon MA Cichocka-Jarosz E Oude Elberink JN Gawlik R Jakob T Kosnik M Lange J Mingomataj E Mitsias DI Mosbech H Ollert M Allergen immunotherapy for insect venom allergy: a systematic review and meta-analysis. Allergy. 2017; 72: 342–365. [DOI] [PubMed] [Google Scholar]
  • 14.Asaria M Dhami S van Ree R Gerth van Wijk R Muraro A Roberts G Sheikh A Health economic analysis of allergen immunotherapy for the management of allergic rhinitis, asthma, food allergy and venom allergy: A systematic overview. Allergy. 2018; 73: 269–283. [DOI] [PubMed] [Google Scholar]
  • 15.Jutel M Agache I Bonini S Burks AW Calderon M Canonica W Cox L Demoly P Frew AJ O’Hehir R Kleine-Tebbe J Muraro A Lack G Larenas D Levin M Martin BL Nelson H Pawankar R Pfaar O van Ree R International consensus on allergen immunotherapy II: Mechanisms, standardization, and pharmacoeconomics. J Allergy Clin Immunol. 2016; 137: 358–368. [DOI] [PubMed] [Google Scholar]
  • 16.Meadows A Kaambwa B Novielli N Huissoon A Fry-Smith A Meads C Barton P Dretzke J A systematic review and economic evaluation of subcutaneous and sublingual allergen immunotherapy in adults and children with seasonal allergic rhinitis. Health Technol Assess. 2013; 17: vi xi 1–xiv 322.. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 17.WHO. Coronavirus disease (COVID-19) weekly epidemiological update and weekly operational update. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports(Date of access: 23.03.2021).
  • 18.Pfaar O Torres MJ Akdis CA COVID-19: A series of important recent clinical and laboratory reports in immunology and pathogenesis of SARS-CoV-2 infection and care of allergy patients. Allergy. 2021; 76: 622–625. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Cardinale F Ciprandi G Barberi S Bernardini R Caffarelli C Calvani M Cavagni G Galli E Minasi D Del Giudice MM Moschese V Novembre E Paravati F Peroni DG Tosca MA Traina G Tripodi S Marseglia GL Consensus statement of the Italian society of pediatric allergy and immunology for the pragmatic management of children and adolescents with allergic or immunological diseases during the COVID-19 pandemic. Ital J Pediatr. 2020; 46: 84. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Shaker MS Oppenheimer J Grayson M Stukus D Hartog N Hsieh EWY Rider N Dutmer CM Vander Leek TK Kim H Chan ES Mack D Ellis AK Lang D Lieberman J Fleischer D Golden DBK Wallace D Portnoy J Mosnaim G COVID-19: pandemic contingency planning for the allergy and immunology clinic. J Allergy Clin Immunol Pract. 2020; 8: 1477–1488.e5. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Riggioni C Comberiati P Giovannini M Agache I Akdis M Alves-Correia M Antó JM Arcolaci A Azkur AK Azkur D Beken B Boccabella C Bousquet J Breiteneder H Carvalho D De Las Vecillas L Diamant Z Eguiluz-Gracia I Eiwegger T Eyerich S A compendium answering 150 questions on COVID-19 and SARS-CoV-2. Allergy. 2020; 75: 2503–2541. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 22.Pfaar O Klimek L Jutel M Akdis CA Bousquet J Breiteneder H Chinthrajah S Diamant Z Eiwegger T Fokkens WJ Fritsch HW Nadeau KC O’Hehir RE O’Mahony L Rief W Sampath V Schedlowski M Torres MJ Traidl-Hoffmann C Wang Y COVID-19 pandemic: Practical considerations on the organization of an allergy clinic-An EAACI/ARIA Position Paper. Allergy. 2021; 76: 648–676. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Klimek L Pfaar O Worm M Eiwegger T Hagemann J Ollert M Untersmayr E Hoffmann-Sommergruber K Vultaggio A Agache I Bavbek S Bossios A Casper I Chan S Chatzipetrou A Vogelberg C Firinu D Kauppi P Kolios A Kothari A Anwendung von Biologika bei allergischen und Typ-2-entzündlichen Erkrankungen in der aktuellen Covid-19-Pandemiea, b, c: Positionspapier des Ärzteverbands Deutscher Allergologen (AeDA)A, der Deutschen Gesellschaft für Allergologie und klinische Immunologie (DGAKI)B, der Gesellschaft für Pädiatrische Allergologie und Umweltmedizin (GPA)C, der Österreichischen Gesellschaft für Allergologie und Immunologie (ÖGAI)D, der Luxemburgischen Gesellschaft für Allergologie und Immunologie (LGAI)E, der Österreichischen Gesellschaft für Pneumologie (ÖGP)F in Kooperation mit der deutschen, österreichischen, und schweizerischen ARIA-GruppeG und der Europäischen Akademie für Allergologie und Klinische Immunologie (EAACI)H. Allergo J. 2020; 29: 14–27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24.Klimek L Pfaar O Worm M Bergmann KC Bieber T Buhl R Buters J Darsow U Keil T Kleine-Tebbe J Lau S Maurer M Merk H Mösges R Saloga J Staubach P Stute P Rabe K Rabe U Vogelmeier C Allergen immunotherapy in the current COVID-19 pandemic: A position paper of AeDA, ARIA, EAACI, DGAKI and GPA: Position paper of the German ARIA GroupA in cooperation with the Austrian ARIA GroupB, the Swiss ARIA GroupC, German Society for Applied Allergology (AEDA)D, German Society for Allergology and Clinical Immunology (DGAKI)E, Society for Pediatric Allergology (GPA)F in cooperation with AG Clinical Immunology, Allergology and Environmental Medicine of the DGHNO-KHCG and the European Academy of Allergy and Clinical Immunology (EAACI)H. Allergol Select. 2020; 4: 44–52. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25.Klimek L Bergmann KC Brehler R Pfützner W Worm M Hartmann K Allergologische Diagnostik und Therapien bei COVID-19 Impfungen: Praktische Handlungsempfehlungen. Empfehlungen von AeDA, DGAKI und GPA. Allergo J Int. 2011; 19: 1-17. [Google Scholar]
  • 26.Pfaar O Klimek L Hamelmann E Kleine-Tebbe J Taube C Wagenmann M Werfel T Brehler R Novak N Mülleneisen N Becker S Worm M COVID-19 vaccination of patients with allergies and type-2 inflammation with concurrent antibody therapy (biologicals) – A Position Paper of the German Society of Allergology and Clinical Immunology (DGAKI) and the German Society for Applied Allergology (AeDA). Allergol Select. 2021; 5: 140–147. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27.EMA. Anhang I – Zusammenfassung der Merkmale des Arzneimittels – Comirnaty Konzentrat zur Herstellung einer Injektionsdispersion COVID-19-­mRNA-Impfstoff (Nukleosid-modifiziert). https://www.ema.europa.eu/en/documents/product-information/comirnaty-epar-product-information_de.pdf(Date of access: January 11, 2021).
  • 28.EMA. Summary of product characteristics: Comirnaty concentrate for dispersion for injection COVID-19 mRNA Vaccine (nucleoside modified). https://www.ema.europa.eu/en/documents/product-information/comirnaty-epar-product-information_en.pdf.(Date of access: March 23, 2021).
  • 29.EMA. Summary of product characteristics: COVID-­19 Vaccine AstraZeneca suspension for injection https://www.ema.europa.eu/en/documents/product-information/covid-19-vaccine-astrazeneca-epar-product-information_en.pdf(Date of access: March 23, 2021).
  • 30.EMA. Summary of product characteristics: COVID-19 Vaccine Janssen suspension for injection COVID-19 vaccine (Ad26.COV2-S [recombinant]) https://www.ema.europa.eu/en/documents/product-information/covid-19-vaccine-janssen-epar-product-information_en.pdfDate of access: March 23, 2021.
  • 31.Worm M Ring J Klimek L Jakob T Lange L Treudler R Beyer K Werfel T Biedermann T Bircher A Fischer M Fuchs T Heller AR Hoffmann F Huttegger I Kopp MV Kugler C Lommatzsch M Pfaar O Rietschel E [Covid-19 vaccination and risk of anaphylaxis – Recommendations for practical management]. MMW Fortschr Med. 2021; 163: 48–51. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 32.Klimek L Novak N Hamelmann E Werfel T Wagenmann M Taube C Bauer A Merk H Rabe U Jung K Schlenter W Ring J Chaker A Wehrmann W Becker S Mülleneisen N Nemat K Czech W Wrede H Brehler R Severe allergic reactions after COVID-19 vaccination with the Pfizer/BioNTech vaccine in Great Britain and USA: Position statement of the German Allergy Societies: Medical Association of German Allergologists (AeDA), German Society for Allergology and Clinical Immunology (DGAKI) and Society for Pediatric Allergology and Environmental Medicine (GPA). Allergo J Int. 2021; 30: 51–55. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Klimek L Worm M Lange L Beyer K Rietschel E Vogelberg C Schnadt S Stöcker B Brockow K Hagemann J Bieber T Wehrmann W Becker S Freudelsperger L Mülleneisen NK Nemat K Czech W Wrede H Brehler R Fuchs T Management von Anaphylaxie gefährdeten Patienten während der Covid-19-Pandemie. Allergo J Int. 2020; 29: 16–26. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Barker-Tejeda TC Bazire R Obeso D Mera-Berriatua L Rosace D Vazquez-Cortes S Ramos T Rico MDP Chivato T Barbas C Villaseñor A Escribese MM Fernández-Rivas M Blanco C Barber D Exploring novel systemic biomarker approaches in grass-pollen sublingual immunotherapy using omics. Allergy. 2021; 76: 1199–1212. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35.Varona R Ramos T Escribese MM Jimeno L Galán A Würtzen PA Vega F Marín A Martín S Carrera AC Blanco C Barber D Persistent regulatory T-cell response 2 years after 3 years of grass tablet SLIT: Links to reduced eosinophil counts, sIgE levels, and clinical benefit. Allergy. 2019; 74: 349–360. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36.Celebi Sözener Z Mungan D Cevhertas L Ogulur I Akdis M Akdis C Tolerance mechanisms in allergen immunotherapy. Curr Opin Allergy Clin Immunol. 2020; 20: 591–601. [DOI] [PubMed] [Google Scholar]
  • 37.Eljaszewicz A Ruchti F Radzikowska U Globinska A Boonpiyathad T Gschwend A Morita H Helbling A Arasi S Kahlert H Berek N Nandy A Akdis M Willers C Moniuszko M Akdis CA Sokolowska M Trained immunity and tolerance in innate lymphoid cells, monocytes, and dendritic cells during allergen-specific immunotherapy. J Allergy Clin Immunol. 2021; 147: 1865–1877. [DOI] [PubMed] [Google Scholar]
  • 38.Golebski K Layhadi JA Sahiner U Steveling-Klein EH Lenormand MM Li RCY Bal SM Heesters BA Vilà-Nadal G Hunewald O Montamat G He FQ Ollert M Fedina O Lao-Araya M Vijverberg SJH Maitland-van der Zee AH van Drunen CM Fokkens WJ Durham SR Induction of IL-10-producing type 2 innate lymphoid cells by allergen immunotherapy is associated with clinical response. Immunity. 2021; 54: 291–307.e7. [DOI] [PubMed] [Google Scholar]
  • 39.Klimek L Jutel M Akdis C Bousquet J Akdis M Bachert C Agache I Ansotegui I Bedbrook A Bosnic-Anticevich S Canonica GW Chivato T Cruz AA Czarlewski W Del Giacco S Du H Fonseca JA Gao Y Haahtela T Hoffmann-Sommergruber K Handling of allergen immunotherapy in the COVID-19 pandemic: An ARIA-EAACI statement. Allergy. 2020; 75: 1546–1554. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 40.Klimek L Pfaar O Worm M Bergmann K-C Bieber T Buhl R Buters J Darsow U Keil T Kleine-Tebbe J Lau S Maurer M Merk H Mösges R Saloga J Staubach P Poethig D Rabe K Rabe U Vogelmeier C Allergen-Immuntherapie in der aktuellen Covid-19-Pandemie. Allergo J. 2020; 29: 17–25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 41.Hodgson SH Mansatta K Mallett G Harris V Emary KRW Pollard AJ What defines an efficacious COVID-19 vaccine? A review of the challenges assessing the clinical efficacy of vaccines against SARS-CoV-2. Lancet Infect Dis. 2021; 21: e26–e35. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42.Pollard AJ Bijker EM A guide to vaccinology: from basic principles to new developments. Nat Rev Immunol. 2021; 21: 83–100. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43.RKI: Epidemiologisches Bulletin. https://www.rki.de/DE/Content/Infekt/EpidBull/epid_bull_node.htmlDate of access: March 23, 2021.
  • 44.WHO. Draft landscape and tracker of COVID-19 candidate vaccines. https://www.who.int/publica­tions/m/item/draft-landscape-of-covid-19-candidate-vaccinesDate of access: March 23, 2021.
  • 45.Krammer F SARS-CoV-2 vaccines in development. Nature. 2020; 586: 516–527. [DOI] [PubMed] [Google Scholar]
  • 46.Logunov DY Dolzhikova IV Zubkova OV Tukhvatulin AI Shcheblyakov DV Dzharullaeva AS Grousova DM Erokhova AS Kovyrshina AV Botikov AG Izhaeva FM Popova O Ozharovskaya TA Esmagambetov IB Favorskaya IA Zrelkin DI Voronina DV Shcherbinin DN Semikhin AS Simakova YV Safety and immunogenicity of an rAd26 and rAd5 vector-based heterologous prime-boost COVID-19 vaccine in two formulations: two open, non-randomised phase 1/2 studies from Russia. Lancet. 2020; 396: 887–897. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 47.Blauvelt A Simpson EL Tyring SK Purcell LA Shumel B Petro CD Akinlade B Gadkari A Eckert L Graham NMH Pirozzi G Evans R Dupilumab does not affect correlates of vaccine-induced immunity: A randomized, placebo-controlled trial in adults with moderate-to-severe atopic dermatitis. J Am Acad Dermatol. 2019; 80: 158–167.e1. [DOI] [PubMed] [Google Scholar]
  • 48.Zeitlin PL Leong M Cole J Mallory RM Shih VH Olsson RF Goldman M Benralizumab does not impair antibody response to seasonal influenza vaccination in adolescent and young adult patients with moderate to severe asthma: results from the Phase IIIb ALIZE trial. J Asthma Allergy. 2018; 11: 181–192. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 49.Durrani SR Montville DJ Pratt AS Sahu S DeVries MK Rajamanickam V Gangnon RE Gill MA Gern JE Lemanske RF Jackson DJ Innate immune responses to rhinovirus are reduced by the high-affinity IgE receptor in allergic asthmatic children. J Allergy Clin Immunol. 2012; 130: 489–495. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 50.Esquivel A Busse WW Calatroni A Togias AG Grindle KG Bochkov YA Gruchalla RS Kattan M Kercsmar CM Khurana Hershey G Kim H Lebeau P Liu AH Szefler SJ Teach SJ West JB Wildfire J Pongracic JA Gern JE Effects of omalizumab on rhinovirus infections, illnesses, and exacerbations of asthma. Am J Respir Crit Care Med. 2017; 196: 985–992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 51.Jakob T Klimek L Allergologie in Zeiten von Covid-19. Allergo J. 2020; 29: 9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 52.Caubet J-C Ponvert C Vaccine allergy. Immunol Allergy Clin North Am. 2014; 34: 597–613. [DOI] [PubMed] [Google Scholar]
  • 53.Dreskin SC Halsey NA Kelso JM Wood RA Hummell DS Edwards KM Caubet JC Engler RJ Gold MS Ponvert C Demoly P Sanchez-Borges M Muraro A Li JT Rottem M Rosenwasser LJ International Consensus (ICON): allergic reactions to vaccines. World Allergy Organ J. 2016; 9: 32. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 54.McNeil MM DeStefano F Vaccine-associated hypersensitivity. J Allergy Clin Immunol. 2018; 141: 463–472. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 55.Nilsson L Brockow K Alm J Cardona V Caubet J-C Gomes E Jenmalm MC Lau S Netterlid E Schwarze J Sheikh A Storsaeter J Skevaki C Terreehorst I Zanoni G Vaccination and allergy: EAACI position paper, practical aspects. Pediatr Allergy Immunol. 2017; 28: 628–640. [DOI] [PubMed] [Google Scholar]
  • 56.Wood RA Allergic reactions to vaccines. Pediatr Allergy Immunol. 2013; 24: 521–526. [DOI] [PubMed] [Google Scholar]
  • 57.Ring J Beyer K Biedermann T Bircher A Fischer M Fuchs T Heller A Hoffmann F Huttegger I Jakob T Klimek L Kopp MV Kugler C Lange L Pfaar O Rietschel E Rueff F Schnadt S Seifert R Stöcker B Guideline (S2k) on acute therapy and management of anaphylaxis: 2021 update: S2k-Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Medical Association of German Allergologists (AeDA), the Society of Pediatric Allergology and Environmental Medicine (GPA), the German Academy of Allergology and Environmental Medicine (DAAU), the German Professional Association of Pediatricians (BVKJ), the Society for Neonatology and Pediatric Intensive Care (GNPI), the German Society of Dermatology (DDG), the Austrian Society for Allergology and Immunology (ÖGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Anaesthesiology and Intensive Care Medicine (DGAI), the German Society of Pharmacology (DGP), the German Respiratory Society (DGP), the patient organization German Allergy and Asthma Association (DAAB), the German Working Group of Anaphylaxis Training and Education (AGATE). Allergo J Int. 2021; 30: 1–25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 58.Bousquet J Agache I Blain H Jutel M Ventura MT Worm M Del Giacco S Benetos A Bilo MB Czarlewski W Abdul Latiff AH Al-Ahmad M Angier E Annesi-Maesano I Atanaskovic-Markovic M Bachert C Barbaud A Bedbrook A Bennoor KS Berghea EC Management of anaphylaxis due to COVID-19 vaccines in the elderly. Allergy. 2021; epub ahead of print. [DOI] [PMC free article] [PubMed]
  • 59.Pfaar O Mahler V Allergic reactions to COVID-19 -vaccinations – unveiling the secret(s). Allergy. 2021; 76: 1621–1623. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 60.Pfaar O Agache I Bonini M Brough HA Chivato T Del Giacco SR Gawlik R Gelincik A Hoffmann-Sommergruber K Jutel M Klimek L Knol EF Lauerma A Ollert M O’Mahony L Mortz CG Palomares O Riggioni C Schwarze J Skypala I COVID-19 pandemic and allergen immunotherapy – an EAACI survey. Allergy. 2021; epub ahead of print. [DOI] [PMC free article] [PubMed]
  • 61.Klimek L Novak N Cabanillas B Jutel M Bousquet J Akdis CA Allergenic components of the mRNA-1273 vaccine for COVID-19: possible involvement of polyethylene glycol and IgG-mediated complement activation. Allergy. 2021; epub ahead of print. [DOI] [PMC free article] [PubMed]
  • 62.Hagemann J Onorato GL Jutel M Akdis CA Agache I Zuberbier T Czarlewski W Mullol J Bedbrook A Bachert C Bennoor KS Bergmann KC Braido F Camargos P Caraballo L Cardona V Casale T Cecchi L Chivato T Chu DK Differentiation of COVID-19 signs and symptoms from allergic rhinitis and common cold: An ARIA-EAACI-GA2 LEN consensus. Allergy. 2021; 76: 2354-2366. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 63.Cabanillas B Akdis C Novak N Allergic reactions to the first COVID-19 vaccine: a potential role of Polyethylene glycol? Allergy. 2020; epub ahead of print. [DOI] [PubMed]
  • 64.Vultaggio A Agache I Akdis CA Akdis M Bavbek S Bossios A Bousquet J Boyman O Chaker AM Chan S Chatzipetrou A Feleszko W Firinu D Jutel M Kauppi P Klimek L Kolios A Kothari A Kowalski ML Matucci A Considerations on biologicals for patients with allergic disease in times of the COVID-19 pandemic: An EAACI statement. Allergy. 2020; 75: 2764–2774. [DOI] [PMC free article] [PubMed] [Google Scholar]

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