Antonella Muraro, Margitta Worm and Graham Roberts equally contributed as guideline chairs.This paper sets out the updated European Academy of Allergy and Clinical Immunology's (EAACI) guideline regarding the diagnosis, acute management, and prevention of anaphylaxis. Anaphylaxis is a clinical emergency and all healthcare professionals need to be familiar with its recognition and management. Anaphylaxis is a lifethreatening reaction characterized by acute onset of symptoms involving different organ systems and requiring immediate medical intervention. 1 Although the fatality rate due to anaphylaxis remains low, 2 the frequency of hospitalization from food and drug-induced anaphylaxis has been increasing in recent years. 3 The symptoms of anaphylaxis are highly variable. 4,5 Data from patients experiencing anaphylaxis revealed that skin and mucosal symptoms occur most frequently (>90% of cases) followed by symptoms involving the respiratory and cardiovascular systems (>50%). Food, drug, and Hymenoptera venom are the most common elicitors of anaphylactic reactions. 5,6 The prevalence of the various causes of anaphylaxis are age-dependent and vary in different geographical regions. In Europe, typical causes of food-induced anaphylaxis in children are peanut, hazelnut, milk, and egg and in adults, wheat, celery, and shellfish; fruits such as peach are also typical causes of food-induced anaphylaxis in adults in some European countries such as Spain and Italy. 7,8 Venom-induced anaphylaxis is typically caused by wasp and bee venom. 9 Drug-induced anaphylaxis is typically caused by antibiotics and non-steroidal anti-inflammatory drugs. 10,11 Among antibiotics, beta-lactam antibiotics are the leading eliciting allergens. 12 At times, there is an occupational cause. 13 Co-factors may be aggravating factors in anaphylaxis, examples are exercise, stress, infection, non-steroidal anti-inflammatory drugs, and alcohol. [14][15][16] In some cases, the cause is not obvious (idiopathic anaphylaxis) and investigations for rarer allergens or differential diagnoses should be considered. [17][18][19] This guideline, updated from 2014, 20 provides evidence-based guidance to help manage anaphylaxis. The primary audience is clinical allergists (specialists and subspecialists), primary care, paediatricians, emergency physicians, anaesthetists and intensivists, nurses, dieticians, and other healthcare professionals. The guideline was

Aim and scopePediatric Allergy and Immunology publishes original contributions and comprehensive reviews related to the understanding and treatment of immune defi ciency, allergic infl ammatory and infectious diseases in children. Other areas of interest include development of specifi c and accessory immunity, and the immunological interaction during pregnancy and lactation between mother and child. As the journal is intended to promote communication between scientists engaged in basic research and clinicians working with children, both clinical and experimental work will be published.

The first approved COVID‐19 vaccines include Pfizer/BioNTech BNT162B2, Moderna mRNA‐1273 and AstraZeneca recombinant adenoviral ChAdOx1‐S. Soon after approval, severe allergic reactions to the mRNA‐based vaccines that resolved after treatment were reported. Regulatory agencies from the European Union, Unites States and the United Kingdom agree that vaccinations are contraindicated only when there is an allergy to one of the vaccine components or if there was a severe allergic reaction to the first dose. This position paper of the European Academy of Allergy and Clinical Immunology (EAACI) agrees with these recommendations and clarifies that there is no contraindication to administer these vaccines to allergic patients who do not have a history of an allergic reaction to any of the vaccine components. Importantly, as is the case for any medication, anaphylaxis may occur after vaccination in the absence of a history of allergic disease. Therefore, we provide a simplified algorithm of prevention, diagnosis and treatment of severe allergic reactions and a list of recommended medications and equipment for vaccine centres. We also describe potentially allergenic/immunogenic components of the approved vaccines and propose a workup to identify the responsible allergen. Close collaboration between academia, regulatory agencies and vaccine producers will facilitate approaches for patients at risks, such as incremental dosing of the second injection or desensitisation. Finally, we identify unmet research needs and propose a concerted international roadmap towards precision diagnosis and management to minimise the risk of allergic reactions to COVID‐19 vaccines and to facilitate their broader and safer use.

Background The coronavirus disease 2019 (COVID‐19) has evolved into a pandemic infectious disease transmitted by the severe acute respiratory syndrome coronavirus (SARS‐CoV‐2). Allergists and other healthcare providers (HCPs) in the field of allergies and associated airway diseases are on the front line, taking care of patients potentially infected with SARS‐CoV‐2. Hence, strategies and practices to minimize risks of infection for both HCPs and treated patients have to be developed and followed by allergy clinics. Method The scientific information on COVID‐19 was analysed by a literature search in MEDLINE, PubMed, the National and International Guidelines from the European Academy of Allergy and Clinical Immunology (EAACI), the Cochrane Library, and the internet. Results Based on the diagnostic and treatment standards developed by EAACI, on international information regarding COVID‐19, on guidelines of the World Health Organization (WHO) and other international organizations, and on previous experience, a panel of experts including clinicians, psychologists, IT experts, and basic scientists along with EAACI and the “Allergic Rhinitis and its Impact on Asthma (ARIA)” initiative have developed recommendations for the optimal management of allergy clinics during the current COVID‐19 pandemic. These recommendations are grouped into nine sections on different relevant aspects for the care of patients with allergies. Conclusions This international Position Paper provides recommendations on operational plans and procedures to maintain high standards in the daily clinical care of allergic patients while ensuring the necessary safety measures in the current COVID‐19 pandemic.

In December 2019, China reported the first cases of the coronavirus disease 2019 (COVID-19). This disease, caused by the severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2), has developed into a pandemic. To date, it has resulted in ~9 million confirmed cases and caused almost 500 000 related deaths worldwide. Unequivocally, the COVID-19 pandemic is the gravest health and socioeconomic crisis of our time. In this context, numerous questions have emerged in demand of basic scientific information and evidence-based medical advice on SARS-CoV-2 and COVID-19. Although the majority of the patients show a very mild, self-limiting viral respiratory disease, many clinical manifestations in severe patients are unique to COVID-19, such as severe lymphopenia and eosinopenia, extensive pneumonia, a "cytokine storm" leading to acute respiratory distress syndrome, endothelitis, | 2505 RIGGIONI et al.