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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.

Background: Anaphylaxis is the most acute and life‐threatening manifestation of allergic disorders. Currently, there is a need to improve its medical management and increase the understanding of its molecular mechanisms. This study aimed to quantify the extravasation underlying human anaphylactic reactions and propose new theragnostic approaches. Methods: Molecular determinations were performed in paired serum samples obtained during the acute phase and at baseline from patients presenting with hypersensitivity reactions. These were classified according to their severity as Grades 1, 2 and 3, the two latter being considered anaphylaxis. Tryptase levels were measured by ImmunoCAP, and serum protein concentration was quantified by Bradford assay. Human serum albumin (HSA) and haemoglobin beta subunit (HBB) levels were determined by Western blot and polyacrylamide gel electrophoresis, respectively. Results: A total of 150 patients were included in the study. Of them, 112 had experienced anaphylaxis (83 and 29 with Grade 2 and 3 reactions, respectively). Tryptase diagnostic efficiency substantially improved when considering patients' baseline values (33%–54%) instead of the acute value threshold (21%). Serum protein concentration and HSA significantly decreased in anaphylaxis (p <.0001). HSA levels dropped with the severity of the reaction (6% and 15% for Grade 2 and 3 reactions, respectively). Furthermore, HBB levels increased during the acute phase of all hypersensitivity reactions (p <.0001). Conclusions: For the first time, the extravasation underlying human anaphylaxis has been evaluated based on the severity of the reaction using HSA and protein concentration measurements. Additionally, our findings propose new diagnostic and potential therapeutic approaches for this pathological event. [ABSTRACT FROM AUTHOR]

Our research provides real-life data showing a significant reduction in the number of respiratory patients referred to allergy specialists, the number of new AIT administered and also changes in qualitative prescription patterns during the first COVID-19 pandemic peak, that only partially recovered after the lockdown. Indeed, a higher risk of prescribing less AIT was recorded among doctors reporting their patients having a different attitude towards AIT (OR 6.140 [95% IC 1.714-24.995], I p i = .005). COVID 19 crisis reduced the number of patients attended in allergy departments Aeroallergen immunotherapy prescriptions decreased during the COVID-19 pandemic Among SCIT prescribers, an increase in SLIT prescriptions has been recorded To the Editor, The COVID-19 pandemic represents a global health crisis and a challenge at all societal, economic and health levels. To assess how COVID-19 crisis affected aeroallergen AIT prescription patterns during the lockdown period and the following post peak period, we collected real world data from doctors in Spain and France. [Extracted from the article]

Background: Second-generation oral H 1 -antihistamines, including bilastine, represent the emerging treatments of allergic rhinitis (including rhinoconjunctivitis) and chronic urticaria in both adults and children. This study analyses available evidence supporting the use of bilastine amongst second-generation antihistamines for the symptomatic treatment of allergic rhinitis and urticaria in adults and children., Methods: Consensus amongst experts from 17 countries on the ideal treatment of rhinitis and urticaria, and the specific role of bilastine was measured by means of a modified Delphi process. A total of 12 statements were voted on by the experts using a five-point Likert scale (1 = strongly disagree; 2 = disagree; 3 = undecided; 4 = agree; 5 = strongly agree). The definition of consensus was set at a minimum of 80% concordance for 4+5 scores (agree or strongly agree)., Results: All proposed statements reached consensus, with a concordance of ≥98% for five statements and ≥96% for seven., Conclusions: The wide consensus obtained for the proposed statements suggests a prominent role for bilastine in the management of allergic rhinitis and urticaria., Competing Interests: Disclosure and potential conflicts of interest: GWC reports having received, in the last 3 years, research grants as well as lecture or advisory board fees from: Menarini, ALK-Abelló, Allergy Therapeutics, Astra Zeneca, MedImmune, Boehringer Ingelheim, Chiesi, Faes, Genentech, Guidotti, Malesci, GlaxoSmithKline, HAL Allergy, Novartis, OM Pharma, Sanofi-Aventis, Sanofi-Genzyme, Regeneron, Stallergenes, Greer, Thermo Fisher and Valeas. PK reports having receinved honoraria for lecture from Adamed, Astra Zeneca, Berlin Chemie Menarini, Boehringer Ingelheim, Celon Pharma, Faes, Glenmark, GSK, Novartis, Polpharma, Sandoz, Sanofi and Teva: PK also reports having received support for attending meetings and/or travel from Berlin Chemie Menarini and AstraZeneca. MM is or recently was a speaker and/or advisor for and/or has received research funding from Allakos, Alvotech, Amgen, Aquestive, Aralez, AstraZeneca, Astria, Bayer, BioCryst, Blueprint, Celldex, Celltrion, Centogene, CSL Behring, Evoemmune, GSK, Ipsen, Kalvista, Kyowa Kirin, Leo Pharma, Lilly, Menarini, Mitsubishi Tanabe Pharma, Moxie, Noucor, Novartis, Orion Biotechnoloy, Pharvaris, Resonance Medicine, Sanofi/Regeneron, Septerna, Takeda, Teva, Trial Form Support International AB, Third HarmonicBio, Valenza Bio, Yuhan Corporation and Zurabio. RM reports personal fees from Menarini, during the conduct of the study, as well as personal fees from ALK, Allergopharma, Allergy Therapeutics, Angelini Pharma, Bayer, Bencard, Bitop, Faes, Friulchem, GSK, HAL BV, Hexal, Klosterfrau, Johnson&Johnson, Laboratoire de la Mer, Lek, Lofarma, Meda, MSD, Mundipharma, Novartis, Nuvo, Pohl-Boskamp, PRO-AdWise, Servier, Sidroga, Stada, Stallergenes, UCB and Ursapharm; grants from ASIT biotech, Bencard, Bitop, Cassella-med GmbH & Co. KG, HAL BV, Hulka, Inmunotek, JGL, Leti, Lofarma, Optima, Sanofi, Stallergenes and Ursapharm; non-financial support from Atmos, Bionorica, Ferrero, JGL, Lofarma, Novartis, Otonomy and Roxall, all outside the submitted work. ZN reports having received consulting fees, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, educational events from AbbVi Pharma, AstraZeneca, Berlin-Chemie/A. Menarini, Boehringer, Chiesi, GlaxoSmithKline, Novartis, Orion Pharma and Sandoz, as well as support for attending meetings and/or travel from Berlin-Chemie/A. Menarini; ZN also reports participation on a Data Safety Monitoring Board or Advisory Board for AbbVi Pharma, AstraZeneca, Berlin-Chemie/A. Menarini, GlaxoSmithKline, Novartis and Orion Pharma. NGP reports having received grants from Capricare, Nestle, Numil, REG and Vianex; NGP also reports having received consulting fees from Abbott, Abbvie, AstraZeneca, GSK, HAL, Medscape, Menarini/Faes Farma, Mylan, Novartis, Nutricia, OM Pharma and Regeneron/Sanofi. PRdR has been a speaker for Aimmune Therapeutics, Allergy Group, ALK-Abelló, DBV, Faes, GSK, HAL, Leti, Merck and Novartis. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2024/04/dic.2024-2-3-COI.pdf, (Copyright © 2024 Canonica GW, Kuna P, Maurer M, Mösges R, Novak Z, Papadopoulos N, Rodriguez del Rio P, the Delphi Study Group.)

While the world is facing an unprecedented pandemic with COVID-19, patients with chronic diseases need special attention and if warranted adaptation of their regular treatment plan. In children, allergy and asthma are among the most prevalent non-communicable chronic diseases, and healthcare providers taking care of these patients need guidance. At the current stage of knowledge, children have less severe symptoms of COVID-19, and severe asthma and immunodeficiency are classified as risk factors. In addition, there is no evidence that currently available asthma and allergy treatments, including antihistamines, corticosteroids, and bronchodilators, increase the risk of severe disease from COVID-19. Most countries affected by COVID-19 have opted for nationwide confinement, which means that communication with the primary clinician is often performed by telemedicine. Optimal disease control of allergic, asthmatic, and immunodeficient children should be sought according to usual treatment guidelines. This statement of the EAACI Section on Pediatrics puts forward six recommendations for the management of childhood allergies and immunodeficiencies based on six underlying facts and existing evidence., (© 2020 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.)