Table 1.

Allergic risk assessment for COVID-19 vaccination in children

Low risk
Patient characteristics	Action
Allergic rhinoconjunctivitis and allergic well-controlled asthma Non-anaphylactic allergic reactions to food, insects, and latex	Proceed with vaccinations as usual, according to local guidelines. No allergic evaluation is needed. Therapies for allergies and/or asthma must be continued as usual. Children treated with allergen immunotherapy (AIT) should withhold administration for few days (see text).
Medium risk
Patient characteristics	Action
Anaphylactic allergic reactions to food, insects, and latex	Consider referral (or teleconsulting) to an allergist-immunologist to confirm the diagnosis and give proper indications. Reach the best possible asthma control and then proceed to vaccination. If asthma control is suboptimal, proceed to vaccination in a hospital setting with an observation of at least 60 minutes.
Idiopathic anaphylaxis and exercise-induced anaphylaxis
Uncontrolled asthma
Mastocytosis	Routine vaccination in an outpatient setting with emergency awareness and emergency medication available. Pre-medication with H1 antihistamine should be considered. For high-risk population (previous anaphylaxis, also to vaccinations, known or suspected allergy to excipients, systemic mastocytosis) see red zone.
Large local reaction to previous COVID-19 vaccination	Specific risk assessment (or teleconsulting) to exclude a possible allergy to PEG or another excipient. Routine vaccination in an outpatient setting with emergency awareness and emergency medication available. Pre-medication with H1 antihistamine should be considered. If skin tests are positive, see the red zone.
Immediate systemic allergic reactions to drugs or vaccines	Specific risk allergy assessment concerning a possible PEG (or other excipients) allergy. If skin tests are negative, vaccination should be performed in a hospital setting with an observation of at least 60 minutes. If skin tests are positive, see the red zone.
High risk
Patient characteristics	Action
- Positive skin tests to excipients - Previous allergic reaction to COVID-19 vaccine - Previous severe allergic reaction to a component of the vaccine or drugs, including PEG or trometamol	According to allergic risk assessment, the patient may be considered ineligible for a further vaccination or eligible for another vaccination, containing another excipient that resulted negative to the skin test. In all these cases, vaccination must be carried out under strict control in a hospital setting where emergency medical procedures for resuscitation are available.