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2. Updated guidance regarding the risk of allergic reactions to COVID-19 vaccines and recommended evaluation and management: A GRADE assessment and international consensus approach

Author

Greenhawt, Matthew, Dribin, Timothy E., Abrams, Elissa M., Shaker, Marcus, Chu, Derek K., Golden, David B.K., Akin, Cem, Anagnostou, Akterini, ALMuhizi, Faisal, Alqurashi, Waleed, Arkwright, Peter, Baldwin, James L., Banerji, Aleena, Bégin, Philippe, Ben-Shoshan, Moshe, Bernstein, Jonathan, Bingemann, Theresa A., Bindslev-Jensen, Carsten, Blumenthal, Kim, Byrne, Aideen, Cahill, Julia, Cameron, Scott, Campbell, Dianne, Campbell, Ronna, Cavender, Michael, Chan, Edmond S., Chinthrajah, Sharon, Comberiati, Pasquale, Eastman, Jacqueline J., Ellis, Anne K., Fleischer, David M., Fox, Adam, Frischmeyer-Guerrerio, Pamela A., Gagnon, Remi, Garvey, Lene H., Grayson, Mitchell H., Isabwe, Ghislaine Annie Clarisse, Hartog, Nicholas, Hendron, David, Horner, Caroline C., Hourihane, Johnathan O'B, Iglesia, Edward, Kan, Manstein, Kaplan, Blanka, Katelaris, Constance H., Kim, Harold, Kelso, John M., Khan, David A., Lang, David, Ledford, Dennis, Levin, Michael, Lieberman, Jay A., Loh, Richard, Mack, Douglas P., Mazer, Bruce, Mody, Ketan, Mosnaim, Gisele, Munblit, Daniel, Mustafa, S. Shahzad, Nanda, Anil, Nathan, Richard, Oppenheimer, John, Otani, Iris M., Park, Miguel, Pawankar, Ruby, Perrett, Kirsten P., Peter, Jonny, Phillips, Elizabeth J., Picard, Matthieu, Pitlick, Mitchell, Ramsey, Allison, Rasmussen, Trine Holm, Rathkopf, Melinda M., Reddy, Hari, Robertson, Kara, Rodriguez del Rio, Pablo, Sample, Stephen, Sheshadri, Ajay, Sheik, Javed, Sindher, Sayantani B., Spergel, Jonathan M., Stone, Cosby A., Stukus, David, Tang, Mimi L.K., Tracy, James M., Turner, Paul J., Vander Leek, Timothy K., Wallace, Dana V., Wang, Julie, Wasserman, Susan, Weldon, David, Wolfson, Anna R., Worm, Margitta, and Yacoub, Mona-Rita

Published
2023
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3. Group 2 innate lymphoid cells are recruited to the nasal mucosa in patients with aspirin-exacerbated respiratory disease

Author

Eastman, Jacqueline J, Cavagnero, Kellen J, Deconde, Adam S, Kim, Alex S, Karta, Maya R, Broide, David H, Zuraw, Bruce L, White, Andrew A, Christiansen, Sandra C, and Doherty, Taylor A

Subjects
Biomedical and Clinical Sciences, Immunology, Clinical Research, 2.1 Biological and endogenous factors, Aetiology, Inflammatory and immune system, Adult, Aged, Asthma, Aspirin-Induced, Cell Count, Cyclooxygenase Inhibitors, Desensitization, Immunologic, Dinoprost, Female, Humans, Ketorolac, Leukotriene E4, Lymphocytes, Male, Middle Aged, Nasal Mucosa, Group 2 innate lymphoid cells, aspirin-exacerbated respiratory disease, Allergy
Abstract

BackgroundAspirin-exacerbated respiratory disease (AERD) is characterized by tissue eosinophilia and mast cell activation, including abundant production of prostaglandin D2 (PGD2). Group 2 innate lymphoid cells (ILC2s), which promote tissue eosinophilia and mast cell responses, undergo chemotaxis and cytokine production in response to PGD2, but it is unknown whether ILC2s are active in patients with AERD.ObjectiveWe sought to determine whether ILC2 numbers change in peripheral blood and the nasal mucosa during COX-1 inhibitor-induced reactions in patients with AERD.MethodsBlood and nasal scrapings were collected at baseline, during reactions, and after completion of ketorolac/aspirin challenge/desensitization in 12 patients with AERD. ILC2s and eosinophils were quantitated by means of flow cytometry. Urine was also collected, and quantification of PGD2 metabolite and leukotriene E4 levels was done by using ELISA. Baseline and nonsteroidal anti-inflammatory drug reaction clinical data were correlated with cell changes.ResultsILC2 numbers significantly increased in nasal mucosal samples and decreased in blood at the time of COX-1 inhibitor reactions in 12 patients with AERD. These changes were not observed in 2 patients without AERD. Furthermore, eosinophil numbers decreased in blood concurrently with significant increases in urinary PGD2 metabolite and leukotriene E4 levels. The magnitude of increases in nasal mucosal ILC2 numbers positively correlated with maximum symptom scores during challenges. Furthermore, blood ILC2 numbers during the reaction correlated with time for the reaction to resolve, possibly reflecting reaction severity.ConclusionsILC2s are recruited to the nasal mucosa during COX-1 inhibitor-induced reactions in patients with AERD, correlating with enhanced production of prostaglandins and leukotrienes.

Published
2017

6. Updated guidance regarding the risk of allergic reactions to COVID-19 vaccines and recommended evaluation and management:A GRADE assessment and international consensus approach

Author

Greenhawt, Matthew, Dribin, Timothy E., Abrams, Elissa M., Shaker, Marcus, Chu, Derek K., Golden, David B.K., Akin, Cem, Anagnostou, Akterini, ALMuhizi, Faisal, Alqurashi, Waleed, Arkwright, Peter, Baldwin, James L., Banerji, Aleena, Bégin, Philippe, Ben-Shoshan, Moshe, Bernstein, Jonathan, Bingemann, Theresa A., Bindslev-Jensen, Carsten, Blumenthal, Kim, Byrne, Aideen, Cahill, Julia, Cameron, Scott, Campbell, Dianne, Campbell, Ronna, Cavender, Michael, Chan, Edmond S., Chinthrajah, Sharon, Comberiati, Pasquale, Eastman, Jacqueline J., Ellis, Anne K., Fleischer, David M., Fox, Adam, Frischmeyer-Guerrerio, Pamela A., Gagnon, Remi, Garvey, Lene H., Grayson, Mitchell H., Isabwe, Ghislaine Annie Clarisse, Hartog, Nicholas, Hendron, David, Horner, Caroline C., Hourihane, Johnathan O.B., Iglesia, Edward, Kan, Manstein, Kaplan, Blanka, Katelaris, Constance H., Kim, Harold, Kelso, John M., Khan, David A., Lang, David, Ledford, Dennis, Levin, Michael, Lieberman, Jay A., Loh, Richard, Mack, Douglas P., Mazer, Bruce, Mody, Ketan, Mosnaim, Gisele, Munblit, Daniel, Mustafa, S. Shahzad, Nanda, Anil, Nathan, Richard, Oppenheimer, John, Otani, Iris M., Park, Miguel, Pawankar, Ruby, Perrett, Kirsten P., Peter, Jonny, Phillips, Elizabeth J., Picard, Matthieu, Pitlick, Mitchell, Ramsey, Allison, Rasmussen, Trine Holm, Rathkopf, Melinda M., Reddy, Hari, Robertson, Kara, Rodriguez del Rio, Pablo, Sample, Stephen, Sheshadri, Ajay, Sheik, Javed, Sindher, Sayantani B., Spergel, Jonathan M., Stone, Cosby A., Stukus, David, Tang, Mimi L.K., Tracy, James M., Turner, Paul J., Vander Leek, Timothy K., Wallace, Dana V., Wang, Julie, Wasserman, Susan, Weldon, David, Wolfson, Anna R., Worm, Margitta, Yacoub, Mona Rita, Greenhawt, Matthew, Dribin, Timothy E., Abrams, Elissa M., Shaker, Marcus, Chu, Derek K., Golden, David B.K., Akin, Cem, Anagnostou, Akterini, ALMuhizi, Faisal, Alqurashi, Waleed, Arkwright, Peter, Baldwin, James L., Banerji, Aleena, Bégin, Philippe, Ben-Shoshan, Moshe, Bernstein, Jonathan, Bingemann, Theresa A., Bindslev-Jensen, Carsten, Blumenthal, Kim, Byrne, Aideen, Cahill, Julia, Cameron, Scott, Campbell, Dianne, Campbell, Ronna, Cavender, Michael, Chan, Edmond S., Chinthrajah, Sharon, Comberiati, Pasquale, Eastman, Jacqueline J., Ellis, Anne K., Fleischer, David M., Fox, Adam, Frischmeyer-Guerrerio, Pamela A., Gagnon, Remi, Garvey, Lene H., Grayson, Mitchell H., Isabwe, Ghislaine Annie Clarisse, Hartog, Nicholas, Hendron, David, Horner, Caroline C., Hourihane, Johnathan O.B., Iglesia, Edward, Kan, Manstein, Kaplan, Blanka, Katelaris, Constance H., Kim, Harold, Kelso, John M., Khan, David A., Lang, David, Ledford, Dennis, Levin, Michael, Lieberman, Jay A., Loh, Richard, Mack, Douglas P., Mazer, Bruce, Mody, Ketan, Mosnaim, Gisele, Munblit, Daniel, Mustafa, S. Shahzad, Nanda, Anil, Nathan, Richard, Oppenheimer, John, Otani, Iris M., Park, Miguel, Pawankar, Ruby, Perrett, Kirsten P., Peter, Jonny, Phillips, Elizabeth J., Picard, Matthieu, Pitlick, Mitchell, Ramsey, Allison, Rasmussen, Trine Holm, Rathkopf, Melinda M., Reddy, Hari, Robertson, Kara, Rodriguez del Rio, Pablo, Sample, Stephen, Sheshadri, Ajay, Sheik, Javed, Sindher, Sayantani B., Spergel, Jonathan M., Stone, Cosby A., Stukus, David, Tang, Mimi L.K., Tracy, James M., Turner, Paul J., Vander Leek, Timothy K., Wallace, Dana V., Wang, Julie, Wasserman, Susan, Weldon, David, Wolfson, Anna R., Worm, Margitta, and Yacoub, Mona Rita

Abstract

This guidance updates 2021 GRADE (Grading of Recommendations Assessment, Development and Evaluation) recommendations regarding immediate allergic reactions following coronavirus disease 2019 (COVID-19) vaccines and addresses revaccinating individuals with first-dose allergic reactions and allergy testing to determine revaccination outcomes. Recent meta-analyses assessed the incidence of severe allergic reactions to initial COVID-19 vaccination, risk of mRNA-COVID-19 revaccination after an initial reaction, and diagnostic accuracy of COVID-19 vaccine and vaccine excipient testing in predicting reactions. GRADE methods informed rating the certainty of evidence and strength of recommendations. A modified Delphi panel consisting of experts in allergy, anaphylaxis, vaccinology, infectious diseases, emergency medicine, and primary care from Australia, Canada, Europe, Japan, South Africa, the United Kingdom, and the United States formed the recommendations. We recommend vaccination for persons without COVID-19 vaccine excipient allergy and revaccination after a prior immediate allergic reaction. We suggest against >15-minute postvaccination observation. We recommend against mRNA vaccine or excipient skin testing to predict outcomes. We suggest revaccination of persons with an immediate allergic reaction to the mRNA vaccine or excipients be performed by a person with vaccine allergy expertise in a properly equipped setting. We suggest against premedication, split-dosing, or special precautions because of a comorbid allergic history.

Published
2023

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