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)

Klimek, Ludger; Pfaar, Oliver; Hamelmann, Eckard; Kleine-Tebbe, Jörg; Taube, Christian; Wagenmann, Martin; Werfel, Thomas; Novak, Natalija; Mülleneisen, Norbert; Becker, Sven; Worm, Margitta

doi:10.5414/alx02245e

Cited by 21 publications

(23 citation statements)

References 57 publications

(60 reference statements)

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“… 189 AIT can be continued in SARS‐CoV‐2 negative confirmed patients but with a prolonged injection interval. 189 Switching from subcutaneous to sublingual immunotherapy may be considered for AIT during COVID‐19. 190 Skin manifestations of COVID‐19 may be similar to other viral infections and drug hypersensitivity reactions (DHRs).…”

Section: Management Of Allergic Diseases During the Covid‐19 Pandemicmentioning

confidence: 99%

Recent developments in the immunopathology of COVID‐19

Zhang

Sun

Wang

et al. 2022

Allergy

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There has been an important change in the clinical characteristics and immune profile of Coronavirus disease 2019 patients during the pandemic thanks to the extensive vaccination programs. Here, we highlight recent studies on COVID-19, from the clinical and immunological characteristics to the protective and risk factors for severity and mortality of COVID-19. The efficacy of the COVID-19 vaccines and potential allergic reactions after administration are also discussed. The occurrence of new variants of concerns such as Omicron BA.2, BA.4, and BA.5 and the global administration of COVID-19 vaccines have changed the clinical scenario of COVID-19. Multisystem inflammatory syndrome in children (MIS-C) may cause severe and heterogeneous disease but with a lower mortality rate. Perturbations in immunity of T cells, B cells, and mast cells, as well as autoantibodies and metabolic reprogramming may contribute to the long-term symptoms of COVID-19. There is conflicting evidence about whether atopic diseases, such as allergic asthma and rhinitis, are associated with a lower susceptibility and better outcomes of COVID-19. At the beginning of pandemic, the European Academy of Allergy and Clinical Immunology (EAACI) developed guidelines that provided timely information for the management of allergic diseases and preventive measures to reduce transmission in the allergic clinics. The global distribution of COVID-19 vaccines and emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with reduced pathogenic potential dramatically decreased the morbidity, severity, and mortality of COVID-19. Nevertheless, breakthrough infection remains a challenge for disease control. Hypersensitivity reactions (HSR) to COVID-19 vaccines are low compared to other vaccines, and these were addressed in EAACI statements that provided indications for the management of allergic reactions, including anaphylaxis to COVID-19 vaccines. We have gained a depth knowledge and experience in the over 2 years since the start of the pandemic, and yet a full eradication of SARS-CoV-2 is not on the horizon. Novel strategies are warranted to prevent severe disease in high-risk groups, the development of MIS-C and long COVID-19.

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Section: Management Of Allergic Diseases During the Covid‐19 Pandemicmentioning

confidence: 99%

Recent developments in the immunopathology of COVID‐19

Zhang

Sun

Wang

et al. 2022

Allergy

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show abstract

“…This was important in clinical spaces and the waiting room. Visitor limitations (with one adult allowed for children and none for adult patients when possible) were enacted 3402,3403 . Clinical care modifications included asking patients to fill out health information prior to visits, using telemedicine to obtain history to minimize in person time, and adjusting clinic schedule templates to allow for social distancing and room ventilation 3365 .…”

Section: Special Section On Covid‐19mentioning

confidence: 99%

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

Wise

Damask

Roland

et al. 2023

Int Forum Allergy Rhinol

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Background In the 5 years that have passed since the publication of the 2018 International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR‐Allergic Rhinitis 2018), the literature has expanded substantially. The ICAR‐Allergic Rhinitis 2023 update presents 144 individual topics on allergic rhinitis (AR), expanded by over 40 topics from the 2018 document. Originally presented topics from 2018 have also been reviewed and updated. The executive summary highlights key evidence‐based findings and recommendation from the full document. Methods ICAR‐Allergic Rhinitis 2023 employed established evidence‐based review with recommendation (EBRR) methodology to individually evaluate each topic. Stepwise iterative peer review and consensus was performed for each topic. The final document was then collated and includes the results of this work. Results ICAR‐Allergic Rhinitis 2023 includes 10 major content areas and 144 individual topics related to AR. For a substantial proportion of topics included, an aggregate grade of evidence is presented, which is determined by collating the levels of evidence for each available study identified in the literature. For topics in which a diagnostic or therapeutic intervention is considered, a recommendation summary is presented, which considers the aggregate grade of evidence, benefit, harm, and cost. Conclusion The ICAR‐Allergic Rhinitis 2023 update provides a comprehensive evaluation of AR and the currently available evidence. It is this evidence that contributes to our current knowledge base and recommendations for patient evaluation and treatment.

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“…Based on this knowledge, the use of the four approved COVID-19 vaccines does not represent a contraindication for AIT. However, to identify possible reactions to one of the two vaccines, it is advisable to space the two administrations by at least a week both in the case of a starting AIT or a treatment in progress [ 167 ].…”

Section: Causes Of Failure Biomarkers Of Efficacy and New Strategies ...mentioning

confidence: 99%

How the Immune System Responds to Allergy Immunotherapy

et al. 2022

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IgE-mediated diseases represent a highly diversified and multifactorial group of disorders that can deeply impact the patients’ quality of life. Currently, allergy immunotherapy (AIT) still remains the gold standard for the management of such pathologies. In this review, we comprehensively examine and discuss how AIT can affect both the innate and the adaptive immune responses at different cell levels and propose timing-scheduled alterations induced by AIT by hypothesizing five sequential phases: after the desensitization of effector non-lymphoid cells and a transient increase of IgE (phase 1), high doses of allergen given by AIT stimulate the shift from type 2/type 3 towards type 1 response (phase 2), which is progressively potentiated by the increase of IFN-γ that promotes the chronic activation of APCs, progressively leading to the hyperexpression of Notch1L (Delta4) and the secretion of IL-12 and IL-27, which are essential to activate IL-10 gene in Th1 and ILC1 cells. As consequence, an expansion of circulating memory Th1/Tr1 cells and ILC-reg characterizes the third phase addressed to antagonize/balance the excess of type 1 response (phase 3). The progressive increase of IL-10 triggers a number of regulatory circuits sustained by innate and adaptive immune cells and favoring T-cell tolerance (phase 4), which may also be maintained for a long period after AIT interruption (phase 5). Different administration approaches of AIT have shown a similar tailoring of the immune responses and can be monitored by timely, optimized biomarkers. The clinical failure of this treatment can occur, and many genetic/epigenetic polymorphisms/mutations involving several immunological mechanisms, such as the plasticity of immune responses and the induction/maintenance of regulatory circuits, have been described. The knowledge of how AIT can shape the immune system and its responses is a key tool to develop novel AIT strategies including the engineering of allergen or their epitopes. We now have the potential to understand the precise causes of AIT failure and to establish the best biomarkers of AIT efficacy in each phase of the treatment.

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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)

Cited by 21 publications

References 57 publications

Recent developments in the immunopathology of COVID‐19

Recent developments in the immunopathology of COVID‐19

International consensus statement on allergy and rhinology: Allergic rhinitis – 2023

How the Immune System Responds to Allergy Immunotherapy

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