IMPORTANCE Allergic reactions among some individuals who received the Pfizer-BioNTech (BNT162b2) COVID-19 vaccine discourage patients with allergic conditions from receiving this vaccine and physicians from recommending the vaccine.OBJECTIVE To describe the assessment and immunization of highly allergic individuals with the BNT162b2 vaccine. DESIGN, SETTING, AND PARTICIPANTSIn a prospective cohort study from December 27, 2020, to February 22, 2021, 8102 patients with allergies who applied to the COVID 19 vaccine referral center at the Sheba Medical Center underwent risk assessment using an algorithm that included a detailed questionnaire. High-risk patients (n = 429) were considered "highly allergic" and were immunized under medical supervision. EXPOSURES Pfizer-BioNTech (BNT162b2) COVID-19 vaccine. MAIN OUTCOMES AND MEASURESAllergic and anaphylactic reactions after the first and second doses of BNT162b2 vaccine among highly allergic patients. RESULTSOf the 429 individuals who applied to the COVID-19 referral center and were defined as highly allergic, 304 (70.9%) were women and the mean (SD) age was 52 ( 16) years. This highly allergic group was referred to receive immunization under medical supervision. After the first dose of the BNT162b2 vaccine, 420 patients (97.9%) had no immediate allergic event, 6 (1.4%) developed minor allergic responses, and 3 (0.7%) had anaphylactic reactions. During the study period, 218 highly allergic patients (50.8%) received the second BNT162b2 vaccine dose, of which 214 (98.2%) had no allergic reactions and 4 patients (1.8%) had minor allergic reactions. Other immediate and late reactions were comparable with those seen in the general population, except for delayed itch and skin eruption, which were more common among allergic patients. CONCLUSIONS AND RELEVANCEThe rate of allergic reactions to BNT162b2 vaccine, is higher among patients with allergies, particularly among a subgroup with a history of high-risk allergies. This study suggests that most patients with a history of allergic diseases and, particularly, highly allergic patients can be safely immunized by using an algorithm that can be implemented in different medical facilities and includes a referral center, a risk assessment questionnaire, and a setting for immunization under medical supervision of highly allergic patients. Further studies are required to define more specific risk factors for allergic reactions to the BNT162b2 vaccine.

Innate immunity is one of two immune defence system arms. It is present at birth and does not require ‘learning’ through exposure to foreign organisms. It activates various mechanisms collectively to eliminate pathogens and hold an infection until the adaptive response are mounted. The innate immune system consists of four elements: the epithelial barrier, cells (e.g. macrophages, NK cells), plasma proteins (e.g. complement) and cytokines. These components act in concert to induce complex processes, as well as recruitment, activation and differentiation of adaptive responses. The innate response is more than just the ‘first line of defence’, as it essentially withholds the vast majority of any intruder, has a complex interplay with the adaptive arm and is crucial for survival of the host. Finally, yet importantly, a myriad of diseases has been linked with innate immune dysregulation. In this mini-review we will shed some light on these conditions, particularly regarding autoinflammatory ones.

Citation: Haj Yahia S, Hamburg A, Sher I, et al. Effect of stimulus intensity and visual field location on rod-and conemediated pupil response to focal light stimuli. Invest Ophthalmol Vis Sci. 2018;59:6027-6035. https://doi.org/ 10.1167/iovs.18-23767 PURPOSE.To assess the effect of stimulus intensity on rod-and cone-mediated pupil light reflex (PLR) to small stimuli presented at central and peripheral visual field (VF) locations.METHODS. The PLR to small (0.438) chromatic stimuli was tested in the right eye of healthy subjects. Blue (485 6 20 nm) and red (625 6 15 nm) stimuli were presented at incremental light intensities (0.5-3.75 log cd/m 2 ) at peripheral (21.218) and central (4.248) VF locations using a chromatic pupilloperimeter under mesopic or blue light adaptation conditions. The percentage of pupil contraction (PPC), maximal pupil contraction velocity (MCV), latency of MCV (LMCV) and the ratio of central to peripheral responses for PPC (Q PPC value) were determined.RESULTS. Under mesopic light adaptation conditions, the mean PPC recorded in response to red stimuli was lower than blue stimuli in all VF locations and light intensities, and the Q PPC values were higher in response to red compared with blue light stimuli across the light intensity range tested. With blue background light, the pupil responses for red and blue light stimuli were approximately the same in the peripheral VF. LMCV was nearly constant in all VF locations for blue and red stimuli, respectively.CONCLUSIONS. The chromatic pupilloperimeter enables the assessment of rod-and conecontribution to the PLR in different VF locations. The optimal light intensities determined here for the assessment of focal activation of the two photoreceptor systems may be used for clinical evaluation of photoreceptor health.