SummaryTwo employees of the National Health Service (NHS) in England developed severe allergic reactions following administration of BNT162b2 vaccine against COVID-19 (coronavirus disease 2019). The British SmPC for the BNT162b2 vaccine already includes reference to a contraindication for use in individuals who have had an allergic reaction to the vaccine or any of its components. As a precautionary measure, the Medicines and Healthcare products Regulatory Agency (MHRA) has issued interim guidance to the NHS not to vaccinate in principle in “patients with severe allergies”. Allergic reactions to vaccines are very rare, but vaccine components are known to cause allergic reactions. BNT162b2 is a vaccine based on an mRNA embedded in lipid nanoparticles and blended with other substances to enable its transport into the cells. In the pivotal phase III clinical trial, the BNT162b2 vaccine was generally well tolerated, but this large clinical trial, used to support vaccine approval by the MHRA and US Food and Drug Administration, excluded individuals with a “history of a severe adverse reaction related to the vaccine and/or a severe allergic reaction (e.g., anaphylaxis) to a component of the study medication”. Vaccines are recognized as one of the most effective public health interventions. This repeated administration of a foreign protein (antigen) necessitates a careful allergological history before each application and diagnostic clarification and a risk–benefit assessment before each injection. Severe allergic reactions to vaccines are rare but can be life-threatening, and it is prudent to raise awareness of this hazard among vaccination teams and to take adequate precautions while more experience is gained with this new vaccine.

BackgroundFor the preventive treatment of the 2019 coronavirus disease (COVID-19) an unprecedented global research effort studied the safety and efficacy of new vaccine platforms that have not been previously used in humans. Less than one year after the discovery of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral sequence, these vaccines were approved for use in the European Union (EU) as well as in numerous other countries and mass vaccination efforts began. The so far in the EU approved mRNA vaccines BNT162b2 and mRNA-1273 are based on similar lipid-based nanoparticle carrier technologies; however, the lipid components differ. Severe allergic reactions and anaphylaxis after COVID-19 vaccination are very rare adverse events but have drawn attention due to potentially lethal outcomes and have triggered a high degree of uncertainty.MethodsCurrent knowledge on anaphylactic reactions to vaccines and specifically the new mRNA COVID-19 vaccines was compiled using a literature search in Medline, PubMed, as well as the national and international study and guideline registries, the Cochrane Library, and the Internet, with special reference to official websites of the World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC), Robert Koch Institute (RKI), and Paul Ehrlich Institute (PEI).ResultsBased on the international literature and previous experience, recommendations for prophylaxis, diagnosis and therapy of these allergic reactions are given by a panel of experts.ConclusionAllergy testing is not necessary for the vast majority of allergic patients prior to COVID-19 vaccination with currently licensed vaccines. In case of allergic/anaphylactic reactions after vaccination, allergy workup is recommended, as it is for a small potential risk population prior to the first vaccination. Evaluation and approval of diagnostic tests should be done for this purpose.

The main driving factor in viral infections, especially in the absence of herd immunity as in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the respiratory uptake of virus-containing particles that are produced when breathing, coughing, speaking, singing and sneezing. Whether an infection then occurs depends particularly on personal risks and the concentration of infectious viruses. Mobility, "super spreader" events and the recent appearance of highly infectious virus variants have contributed significantly to the increased incidences of corona virus disease 2019 .

Summary Background Beta-lactam antibiotics (BLA) are the treatment of choice for a large number of bacterial infections. Putative BLA allergies are often reported by patients, but rarely confirmed. Many patients do not receive BLA due to suspected allergy. There is no systematic approach to risk stratification in the case of a history of suspected BLA allergy. Methods Using the available stratification programs and taking current guidelines into account, an algorithm for risk stratification, including recommendations on the use of antibiotics in cases of compellingly indicated BLA despite suspected BLA allergy, was formulated by the authors for their maximum care university hospital. Results The hospital is in great need of recommendations on how to deal with BLA allergies. Patient-reported information in the history forms the basis for classifying the reactions into four risk categories: (1) BLA allergy excluded, (2) benign delayed reaction, (3) immediate reaction, and (4) severe cutaneous and extracutaneous drug reaction. Recommendations strictly depend on this classification and range from use of full-dose BLA or use of BLA under certain conditions (e.g., two-stage dose escalation, non-cross-reactive BLA only) to prohibiting all BLA and the use of alternative non-BLA. In case of suspected immediate or delayed allergic reactions, there is an additional recommendation regarding subsequent allergy testing during a symptom-free interval. Conclusion Triage of patients with suspected BLA is urgently required. While allergy testing, including provocation testing, represents the most reliable solution, this is not feasible in all patients due to the high prevalence of BLA allergies. The risk stratification algorithm developed for the authors’ hospital represents a tool suitable to making a contribution to rational antibiotic therapy.

Abstract BackgroundThe number of patients affected by allergies is increasing worldwide. The resulting allergic diseases are leading to significant costs for health care and social systems. Integrated care pathways are needed to enable comprehensive care within the national health systems. The ARIA (Allergic Rhinitis and its Impact on Asthma) initiative develops internationally applicable guidelines for allergic respiratory diseases.MethodsARIA serves to improve the care of patients with allergies and chronic respiratory diseases. In collaboration with other international initiatives, national associations and patient organizations in the field of allergies and respiratory diseases, real-life integrated care pathways have been developed for a digitally assisted, integrative, individualized treatment of allergic rhinitis (AR) with comorbid asthma. In the present work, these integrated care pathways have been adapted to the German situation and health system.ResultsThe present ICP (integrated care pathways) guideline covers key areas of the care of AR patients with and without asthma. It includes the views of patients and other healthcare providers.DiscussionA comprehensive ICP guideline can reflect real-life care better than traditional guideline models.

Angiotensin converting enzyme C1-INH C1 esterase inhibitor EACA Epsilon-aminocaproic acid FFP Fresh frozen

Heparins are unproblematic drugs from an allergist’s perspective, since despite frequent application heparin hypersensitivity is quite rarely in clinical routine. This article provides an overview of selected scientific articles and is based on a literature search in PubMed and specialist databases. Most commonly, heparin allergic patients develop lymphocyte-mediated, eczematous local reactions directly at the injection sites (usually on the lower abdomen) hours to days after initiating regular subcutaneous heparin injections. The high sensitivity of skin-prick and intradermal testing procedures means that subcutaneous provocation tests are seldom necessary for diagnosis. The “compartment allergy” phenomenon is a particular feature of heparin-induced local allergic reactions. Here, the route of application determines whether an allergic inflammatory reaction develops. In case of heparin-allergic individuals, injections into the subcutaneous tissue cause eczematous plaques, whereas intravenous injections or infusions are well tolerated. Since the introduction of low molecular weight heparin preparations, the incidence of potentially life-threatening heparin-induced thrombocytopenia caused by activating IgG (Ig: immunoglobulin) antibodies against heparin-platelet factor 4 (PF4) complexes on platelet membranes has declined. IgE-mediated heparin allergy with immediate-type anaphylactic reactions seems to be extremely rare.

Apart from the nutritional benefits, bivalves are also considered to be among a group of allergenic foods. Symptoms of allergy to bivalves are largely similar to those of allergic reactions reported for other shellfish. The identification of allergenic proteins in a particular species is an important step for the development of more accurate allergy tests and for the definition of more effective management of patients. Currently, studies regarding the allergens in bivalve species are lacking. This minireview is an overview of local scientific articles on identification of bivalve allergens by allergenomics methods including sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), two-dimensional gel electrophoresis (2-DE), immunoblotting and mass-spectrometry analysis. Tropomyosin has been the only well recognized allergen in a wide range of bivalve species. In addition to tropomyosin, our local study resulted in discovery of three novel bivalve major allergens; arginine kinase (40 kDa), actin (42 kDa) and troponin C (18 kDa). This minireview will provide a better understanding of each allergen derived from local bivalves which subsequently will help in the understanding of the specific immunoglobulin E(IgE)-mediated immune response.