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Management of anaphylaxis due to COVID-19 vaccines in the elderly

Bousquet J 1 , Agache I 2 , Blain H 3 , Jutel M 4 , Ventura MT 5 , Worm M 1 Show all authors , Del Giacco S 6 , Benetos A 7 , Bilo BM 8 , Czarlewski W 9 , Abdul Latiff AH 10 , Al-Ahmad M 11 , Angier E 12 , Annesi-Maesano I 13 , Atanaskovic-Markovic M 14 , Bachert C 15 , Barbaud A 16 , Bedbrook A 10 , Bennoor KS 17 , Berghea EC 18 , Bindslev-Jensen C 19 , Bonini S 20 , Bosnic-Anticevich S 21 , Brockow K 22 , Brussino L 23 , Camargos P 24 , Canonica GW 25 , Cardona V 26 , Carreiro-Martins P 27 , Carriazo A 28 , Casale T 29 , Caubet JC 30 , Cecchi L 31 , Cherubini A 32 , Christoff G 33 , Chu DK 34 , Cruz AA 35 , Dokic D 36 , El-Gamal Y 37 , Ebisawa M 38 , Eberlein B 22 , Farrell J 39 , Fernandez-Rivas M 40 , Fokkens WJ 41 , Fonseca JA 42 , Gao Y 43 , Gavazzi G 44 , Gawlik R 45 , Gelincik A 46 , Gemicioğlu B 47 , Gotua M 48 , Guérin O 49 , Haahtela T 50 , Hoffmann-Sommergruber K 51 , Hoffmann HJ 52 , Hofmann M 1 , Hrubisko M 53 , Illario M 54 , Irani C 55 , Ispayeva Z 56 , Ivancevich JC 57 , Julge K 58 , Kaidashev I 59 , Khaitov M 60 , Knol E 61 , Kraxner H 62 , Kuna P 63 , Kvedariene V 64 , Lauerma A 65 , Le LTT 66 , Le Moing V 67 , Levin M 68 , Louis R 69 , Lourenco O 70 , Mahler V 71 , Martin FC 72 , Matucci A 73 , Milenkovic B 74 , Miot S 3 , Montella E 54 , Morais-Almeida M 75 , Mortz CG 19 , Mullol J 76 , Namazova-Baranova L 77 , Neffen H 78 , Nekam K 79 , Niedoszytko M 80 , Odemyr M 81 , O'Hehir RE 82 , Okamoto Y 83 , Ollert M 84 , Palomares O 85 , Papadopoulos NG 86 , Panzner P 87 , Passalacqua G 88 , Patella V 89 , Petrovic M 90 , Pfaar O 91 , Pham-Thi N 92 , Plavec D 93 , Popov TA 94 , Recto MT 95 , Regateiro FS 96 , Reynes J 67 , Roller-Winsberger RE 97 , Rolland Y 98 , Romano A 99 , Rondon C 100 , Rottem M 101 , Rouadi PW 102 , Salles N 103 , Samolinski B 104 , Santos AF 105 , S Sarquis F 106 , Sastre J 107 , M G A Schols J 108 , Scichilone N 109 , Sediva A 110 , Shamji MH 111 , Sheikh A 112 , Skypala I 113 , Smolinska S 114 , Sokolowska M 115 , Sousa-Pinto B 42 , Sova M 116 , Stelmach R 117 , Sturm G 118 , Suppli Ulrik C 119 , Todo-Bom AM 120 , Toppila-Salmi S 50 , Tsiligianni I 121 , Torres M 122 , Untersmayr E 51 , Urrutia Pereira M 123 , Valiulis A 124 , Vitte J 125 , Vultaggio A 73 , Wallace D 126 , Walusiak-Skorupa J 127 , Wang DY 128 , Waserman S 34 , Yorgancioglu A 129 , Yusuf OM 130 , Zernotti M 131 , Zidarn M 132 , Chivato T 133 , Akdis CA 134 , Zuberbier T 1 , Klimek L 135

Affiliations 

  • 1 Department of Dermatology and Allergy, Comprehensive Allergy Center, Charité Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
  • 2 Faculty of Medicine, Transylvania University, Brasov, Romania
  • 3 Department of Geriatrics, Montpellier University Hospital, Montpellier, France
  • 4 Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland
  • 5 University of Bari Medical School, Unit of Geriatric Immunoallergology, Bari, Italy
  • 6 Department of Medical Sciences and Public Health, Unit of Allergy and Clinical Immunology, University Hospital "Duilio Casula", University of Cagliari, Cagliari, Italy
  • 7 Department of Geriatrics, CHRU de Nancy and Inserm DCAC, Université de Lorraine, Nancy, France
  • 8 Allergy Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
  • 9 Medical Consulting Czarlewski, Levallois, France
  • 10 Department of Pediatrics, Allergy & Immunology Centre, Pantai Hospital, Universiti Putra Malaysia Teaching Hospital, Kuala Lumpur, Malaysia
  • 11 Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
  • 12 Primary Care and Population Sciences, University of Southampton, Southampton, UK
  • 13 Institut Desbrest d'Epidémiologie et Santé Publique (IDESP), INSERM et Université de Montpellier, Montpellier, France
  • 14 Faculty of Medicine, University Children's Hospital, University of Belgrade, Belgrade, Serbia
  • 15 Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium
  • 16 Division of Service de Dermatologie et Allergologie, Hôpital Tenon, Paris, France
  • 17 Department of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh
  • 18 Allergology and Clinical Immunology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  • 19 Department of Dermatology and Allergy Centre, Odense University Hospital, Odense Research Center for Anaphylaxis (ORCA), Odense, Denmark
  • 20 Institute of Translational Pharmacology, Italian National Research Council, Rome, Italy
  • 21 Woolcock Institute of Medical Research, University of Sydney, Glebe, NSW, Australia
  • 22 Department of Dermatology and Allergy Biederstein, School of Medicine, Technical University of Munich, Munich, Germany
  • 23 Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy
  • 24 Department of Pediatrics, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
  • 25 Department of Biomedical Sciences, Humanitas University, Milan, Italy
  • 26 Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain
  • 27 Serviço de Imunoalergologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
  • 28 Regional Ministry of Health of Andalusia, Seville, Spain
  • 29 Division of Allergy/Immunology, University of South Florida, Tampa, FL, USA
  • 30 Pediatric Allergy Unit, Department of Child and Adolescent, Geneva University Hospital, Geneva, Switzerland
  • 31 SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
  • 32 Geriatria, Accettazione Geriatrica e Centro di Ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy
  • 33 Faculty of Public Health, Medical University, Sofia, Bulgaria
  • 34 Department of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada
  • 35 Fundação ProAR, Federal University of Bahia and GARD/WHO Planning Group, Salvador, BA, Brazil
  • 36 Medical Faculty, University Clinic of Pulmology and Allergy, Skopje, Republic of Macedonia
  • 37 Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
  • 38 Clinical Research Center for Allergy and Rheumatology, NHO Sagamihara National Hospital, Sagamihara, Japan
  • 39 LANUA International Healthcare Consultancy, Down, UK
  • 40 Allergy Department Hospital Clínico San Carlos, UCM, IdISSC, Madrid, Spain
  • 41 Department of Otorhinolaryngology, Academic Medical Centers, AMC, Amsterdam, The Netherland
  • 42 Faculdade de Medicina, CINTESIS, Center for Health Technology and Services Research, Universidade do Porto, Porto, Portugal
  • 43 Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
  • 44 Service Gériatrie Clinique, Centre Hospitalo-Universitaire Grenoble-Alpes, GREPI (TIMC-IMAG, CNRS 5525, Université Grenoble-Alpes, Grenoble, France
  • 45 Department of Internal Medicine, Allergy and Clin Immunology, Silesian University of Medicine, Katowice, Poland
  • 46 Division of Immunology and Allergic Diseases, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
  • 47 Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
  • 48 Center of Allergy and Immunology, Georgian Association of Allergology and Clinical Immunology, Tbilisi, Georgia
  • 49 Service de Gériatrie, CHRU, Nice, France
  • 50 Skin and Allergy Hospital, Helsinki University Hospital, University of Helsinki University, Helsinki, Finland
  • 51 Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
  • 52 Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
  • 53 Department of Clinical Immunology and Allergy, Oncology Institute of St Elisabeth, Bratislava, Slovakia
  • 54 Department of Public Health and Research and Development Unit, Federico II University & Hospital, Naples, Italy
  • 55 Department of Internal Medicine and Infectious Diseases, St Joseph University, Hotel Dieu de France Hospital, Beirut, Lebanon
  • 56 President of Kazakhstan Association of Allergology and Clinical Immunology, Department of Allergology and Clinical Immunology, Kazakh National Medical University, Almaty, Kazakhstan
  • 57 Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina
  • 58 Tartu University Institute of Clinical Medicine, Children's Clinic, Tartu, Estonia
  • 59 Ukrainina Medical Stomatological Academy, Poltava, Ukraine
  • 60 National Research Center, Institute of Immunology, Federal Medicobiological Agency, Laboratory of Molecular Immunology, Moscow, Russia
  • 61 Departments of Immunology and Dermatology/Allergology, University Medical Center, Utrecht, The Netherlands
  • 62 Department of Otorhinolaryngology, Head and Neck Surgery, Semmelweis University, Budapest, Hungary
  • 63 Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
  • 64 Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
  • 65 Department of Dermatology and Allergology, University of Helsinki and Helsinki University, Helsinki, Finland
  • 66 University of Medicine and Pharmacy, Hochiminh City, Vietnam
  • 67 Department of Infectiology, Montpellier University Hospital, Montpellier, France
  • 68 Division Paediatric Allergology, University of Cape Town, Cape Town, South Africa
  • 69 Department of Pulmonary Medicine, CHU Sart-Tilman, GIGA I3 Research Group, Liege, Belgium
  • 70 Faculty of Health Sciences, CICS - UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
  • 71 Paul-Ehrlich-Institut, Langen, Germany
  • 72 Emeritus Geriatrician and Professor of Medical Gerontology Population Health Sciences I, King's College London, London, UK
  • 73 Immunoallergology Unit, Careggi University Hospital, Florence, Italy
  • 74 Clinic for Pulmonary Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Serbian Association for Asthma and COPD, Belgrade, Serbia
  • 75 Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal
  • 76 Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Spain
  • 77 Pediatrics and Child Health Research Institute, Central Clinical Hospital of the Russian Academy of Sciences, Russian National Research Medical University, Moscow, Russia
  • 78 Director of Center of Allergy, Immunology and Respiratory Diseases, Santa Fe, Argentina
  • 79 Hospital of the Hospitaller Brothers in Buda, Budapest, Hungary
  • 80 Department of Allergology, Medical University of Gdańsk, Gdańsk, Poland
  • 81 EFA European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
  • 82 Department of Allergy, Immunology and Respiratory Medicine, Central Clinical School, Monash University, Alfred Health, Melbourne, Vic., Australia
  • 83 Department of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan
  • 84 Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
  • 85 Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University of Madrid, Madrid, Spain
  • 86 Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou", University of Athens, Athens, Greece
  • 87 Department of Immunology and Allergology, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Pilsen, Czech Republic
  • 88 Allergy and Respiratory Diseases, Ospedale Policlino San Martino -University of Genoa, Genoa, Italy
  • 89 Division of Allergy and Clinical Immunology, Department of Medicine, Agency of Health ASL Salerno, "Santa Maria della Speranza" Hospital, Salerno, Italy
  • 90 Department of Internal Medicine and Paediatrics, Section of Geriatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
  • 91 Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
  • 92 Ecole polytechnique Palaiseau, IRBA (Institut de Recherche bio-Médicale des Armées), Bretigny, France
  • 93 Children's Hospital Srebrnjak, Zagreb, Croatia
  • 94 University Hospital, Sv Ivan Rilski', Sofia, Bulgaria
  • 95 Asian Hospital and Medical Center, Manilla, Philippines
  • 96 Allergy and Clinical Immunology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
  • 97 Medical University of Graz, Graz, Austria
  • 98 Gérontopôle de Toulouse, INSERM 1027, Toulouse, France
  • 99 Oasi Research Institute-IRCCS, Troina, Italy
  • 100 Allergy Unit, Hospital Regional Universitario de Malaga, Malaga, Spain
  • 101 Division of Allergy Asthma and Clinical Immunology, Emek Medical Center, Afula, Israel
  • 102 Department of Otolaryngology-Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
  • 103 Société Française de Gériatrie et Gérontologie, Paris, France
  • 104 Department of Prevention of Environmental Hazards, Allergology & Immunology, Medical University of Warsaw, Warsaw, Poland
  • 105 Department of Women and Children's Health (Paediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
  • 106 Asthma Reference Center, School of Medicine of Santa Casa de Misericórdia of Vitória, Espírito Santo, Brazil
  • 107 Faculty of Medicine, Fundacion Jimenez Diaz, CIBERES, Autonoma University of Madrid, Madrid, Spain
  • 108 Department of Health Services Research, Department of Family Medicine Caphri - Care and Public Health Research Institute, Maastricht University, Maastrich, NL, USA
  • 109 PROMISE Department, University of Palermo, Palermo, Italy
  • 110 Department of Immunology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
  • 111 Immunomodulation and Tolerance Group, Imperial College London, London, UK
  • 112 Usher Institute, The University of Edinburgh, Edinburgh, UK
  • 113 Royal Brompton and Harefield NHS Foundation Trust, London, UK
  • 114 Department of Clinical Immunology, Wroclaw Medical University, Wroclaw, Poland
  • 115 Christine Kühne - Center for Allergy Research and Education, CK-CARE, Davos, Switzerland
  • 116 Department of Respiratory Medicine, University Hospital Olomouc, Olomouc, Czech Republic
  • 117 Pulmonary Division, Heart Institute (InCor, Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
  • 118 Department of Dermatology and Venerology, Medical University of Graz, Graz, Austria
  • 119 Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
  • 120 Imunoalergologia, Centro Hospitalar Universitário de Coimbra and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
  • 121 Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece
  • 122 Allergy Unit, Málaga Regional University Hospital-IBIMA, Málaga, Spain
  • 123 Federal University of Pampa, Uruguaiana, Brazil
  • 124 Faculty of Medicine, Vilnius University, Institute of Clinical Medicine & Institute of Health Sciences, Vilnius, Lithuania
  • 125 Aix-Marseille University, IRD, APHM, MEPHI, Marseille, France
  • 126 Nova Southeastern University, Fort Lauderdale, FL, USA
  • 127 Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
  • 128 Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  • 129 Department of Pulmonary Diseases, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
  • 130 The Allergy and Asthma Institute, Islamabad, Pakistan
  • 131 Universidad Católica de Córdoba, Universidad Nacional de Villa Maria, Villa Maria, Argentina
  • 132 University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
  • 133 School of Medicine, University CEU San Pablo, Madrid, Spain
  • 134 Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
  • 135 Department of Otolaryngology, Head and Neck Surgery, Universitätsmedizin Mainz, Mainz, Germany
Allergy, 2021 10;76(10):2952-2964.
PMID: 33811358 DOI: 10.1111/all.14838

Abstract

Older adults, especially men and/or those with diabetes, hypertension, and/or obesity, are prone to severe COVID-19. In some countries, older adults, particularly those residing in nursing homes, have been prioritized to receive COVID-19 vaccines due to high risk of death. In very rare instances, the COVID-19 vaccines can induce anaphylaxis, and the management of anaphylaxis in older people should be considered carefully. An ARIA-EAACI-EuGMS (Allergic Rhinitis and its Impact on Asthma, European Academy of Allergy and Clinical Immunology, and European Geriatric Medicine Society) Working Group has proposed some recommendations for older adults receiving the COVID-19 vaccines. Anaphylaxis to COVID-19 vaccines is extremely rare (from 1 per 100,000 to 5 per million injections). Symptoms are similar in younger and older adults but they tend to be more severe in the older patients. Adrenaline is the mainstay treatment and should be readily available. A flowchart is proposed to manage anaphylaxis in the older patients.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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