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

被引：11

作者：

Greenhawt, Matthew ^{[1
]}

Dribin, Timothy E. ^{[2
,3
]}

Abrams, Elissa M. ^{[5
]}

Shaker, Marcus ^{[6
,7
]}

Chu, Derek K. ^{[8
,9
,12
,13
]}

Golden, David B. K. ^{[14
]}

Akin, Cem ^{[15
]}

Anagnostou, Akterini ^{[16
,17
]}

Almuhizi, Faisal ^{[19
]}

Alqurashi, Waleed ^{[20
]}

Arkwright, Peter ^{[21
]}

Baldwin, James L. ^{[15
]}

Banerji, Aleena ^{[22
]}

Begin, Philippe ^{[23
]}

Ben-Shoshan, Moshe ^{[24
]}

Bernstein, Jonathan ^{[4
]}

Bingemann, Theresa A. ^{[26
]}

Bindslev-Jensen, Carsten ^{[28
,29
]}

Blumenthal, Kim ^{[22
]}

Byrne, Aideen ^{[30
]}

Cahill, Julia ^{[32
]}

Cameron, Scott ^{[33
]}

Campbell, Dianne ^{[34
]}

Campbell, Ronna ^{[36
]}

Cavender, Michael ^{[38
]}

Chan, Edmond S. ^{[39
]}

Chinthrajah, Sharon ^{[40
,41
,42
]}

Comberiati, Pasquale ^{[43
]}

Eastman, Jacqueline J. ^{[44
,45
]}

Ellis, Anne K. ^{[46
]}

Fleischer, David M. ^{[1
]}

Fox, Adam ^{[47
]}

Frischmeyer-Guerrerio, Pamela A. ^{[51
]}

Gagnon, Remi ^{[52
]}

Garvey, Lene H. ^{[53
,54
]}

Grayson, Mitchell H. ^{[55
]}

Isabwe, Ghislaine Annie Clarisse ^{[24
]}

Hartog, Nicholas ^{[44
,45
]}

Hendron, David ^{[56
]}

Horner, Caroline C. ^{[57
]}

Hourihane, Johnathan O'B ^{[31
]}

Iglesia, Edward ^{[58
]}

Kan, Manstein ^{[60
]}

Kaplan, Blanka ^{[61
]}

Katelaris, Constance H. ^{[35
]}

Kim, Harold ^{[8
,64
]}

Kelso, John M. ^{[67
]}

Khan, David A. ^{[68
]}

Lang, David ^{[69
]}

Ledford, Dennis ^{[70
,72
]}

机构：

[1] Univ Colorado, Sch Med, Childrens Hosp Colorado, Sect Allergy & Clin Immunol, Aurora, CO USA

[2] Cincinnati Childrens Hosp Med Ctr, Div Emergency Med, Cincinnati, OH USA

[3] Univ Cincinnati, Coll Med, Dept Pediat, Cincinnati, OH 45221 USA

[4] Univ Cincinnati, Dept Internal Med, Div Immunol, Cincinnati, OH 45221 USA

[5] Univ Manitoba, Sect Allergy & Immunol, Dept Pediat & Child Hlth, Winnipeg, MB, Canada

[6] Dartmouth Hitchcock Med Ctr, Sect Allergy & Immunol, Lebanon, NH USA

[7] Dartmouth Geisel Sch Med, Hanover, NH USA

[8] McMaster Univ, Fac Med, Hamilton, ON, Canada

[9] McMaster Univ, Dept Hlth Res Methods Evidence & Impact, Hamilton, ON, Canada

[10] McMaster Univ, Dept Pediat, Hamilton, ON, Canada

[11] McMaster Univ, Dept Med, Div Clin Immunol & Allergy, Hamilton, ON, Canada

[12] Res Inst St Joes Hamilton, Hamilton, ON, Canada

[13] McMaster Univ Med Ctr, Evidence Allergy Grp, Hamilton, ON, Canada

[14] Johns Hopkins Univ, Sch Med, Div Allergy & Clin Immunol, Baltimore, MD USA

[15] Univ Michigan Sch, Dept Internal Med, Div Allergy & Clin Immunol, Ann Arbor, MI USA

[16] Baylor Coll Med, Dept Pediat, Sect Immunol Allergy & Retrovirol, Houston, TX USA

[17] Texas Childrens Hosp, Dept Pediat, Sect Immunol Allergy & Retrovirol, Houston, TX USA

[18] Univ Texas MD Anderson Canc Ctr, Div Internal Med, Dept Pulm Med, Houston, TX USA

[19] Secur Forces Hosp Program, Div Allergy & Clin Immunol, Dept Internal Med, Riyadh, Saudi Arabia

[20] Univ Ottawa, Dept Pediat & Emergency Med, Ottawa, ON, Canada

[21] Univ Manchester, Lydia Becker Inst Immunol & Inflammat, Manchester, Lancs, England

[22] Harvard Med Sch, Massachusetts Gen Hosp, Dept Med, Div Rheumatol Allergy & Immunol, Boston, MA USA

[23] Ctr Hosp Univ St Justine, Montreal, PQ, Canada

[24] McGill Univ Hlth Ctr, Montreal Childrens Hosp, Dept Pediat, Div Allergy Immunol & Dermatol, Montreal, PQ, Canada

[25] Univ Montreal, Hosp Maisonneuve Rosemont, Montreal, PQ, Canada

[26] Univ Rochester, Sch Med & Dent, Div Allergy Immunol & Rheumatol, Rochester, NY 14627 USA

[27] Univ Rochester, Sch Med & Dent, Rochester Reg Hlth, Rochester, NY 14627 USA

[28] Trinity Coll Dublin, Odense Res Ctr Anaphylaxis, Dept Dermatol, Dublin, Ireland

[29] Trinity Coll Dublin, Odense Res Ctr Anaphylaxis, Allergy Ctr, Dublin, Ireland

[30] Trinity Coll Dublin, Sch Med, Dept Paediat, Dublin, Ireland

[31] Royal Coll Surg, Dept Paediat, Dublin, Ireland

[32] Univ Alberta, Fac Med, Calgary, AB, Canada

[33] Allergy Victoria, Sydney, NSW, Australia

[34] Western Sydney Univ, Childrens Hosp Westmead, Sydney, NSW, Australia

[35] Western Sydney Univ, Campbelltown Hosp, Sydney, NSW, Australia

[36] Mayo Clin, Dept Emergency Med, Rochester, MN USA

[37] Mayo Clin, Div Allerg Dis, Rochester, MN USA

[38] Caril Clin, Verona, Italy

[39] Univ British Columbia, BC Childrens Hosp, Div Allergy & Immunol, Vancouver, BC, Canada

[40] Stanford Univ, Sch Med, Dept Med, Div Pulm Allergy & Crit Care, Palo Alto, CA USA

[41] Stanford Univ, Sch Med, Dept Pediat, Div Allergy Immunol & Rheumatol, Palo Alto, CA USA

[42] Stanford Univ, Sch Med, Sean N Parker Ctr Allergy & Asthma Res, Palo Alto, CA USA

[43] Univ Pisa, Sect Pediat, Dept Clin & Expt Med, Pisa, Italy

[44] Corewell Hlth Allergy & Immunol, Grand Rapids, MI USA

[45] Michigan State Univ, Coll Human Med, Grand Rapids, MI USA

[46] Queens Univ, Div Allergy & Immunol, Dept Med, Kingston, ON, Canada

[47] Guyss & St Tomass Hosp Natl Hlth Serv Fdn Trust, London, England

[48] Imperial Coll Healthcare Natl Hlth Serv Trust, London, England

[49] Royal Brompton & Harefield Natl Hlth Serv Fdn Tru, London, England

[50] Imperial Coll London, Natl Heart & Lung Inst, Fac Med, Inflammat Repair & Dev Sect, London, England

来源：

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY | 2023年 / 152卷 / 02期

基金：

美国国家卫生研究院;

关键词：

SARS-CoV-2; COVID-19; vaccination; mRNA COVID-19 vaccine; anaphylaxis; allergic reactions; repeat allergic reactions; polyethylene glycol; polysorbate; 80; skin testing; MESSENGER-RNA VACCINES; ADVERSE-REACTIONS; IMMEDIATE REACTIONS; ANAPHYLAXIS; VACCINATION; BNT162B2; DEFINITION; GUIDELINES; STRENGTH; CHILDREN;

D O I：

10.1016/j.jaci.2023.05.019

中图分类号：

R392 [医学免疫学];

学科分类号：

100102 ;

摘要：

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.

引用

页码：309 / 325

页数：17

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