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

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2952 | Allergy. 2021;76:2952–2964. wileyonlinelibrary.com/journal/all !;1;b;7Ĺ Ɩ ;0u-u ƑƏƑƐ | !;bv;7Ĺ ƐƖ -u1_ ƑƏƑƐ | 11;r|;7Ĺ ƑƖ -u1_ ƑƏƑƐ DOI: 10.1111/all.14838 EAACI POSITION PAPER Management of anaphylaxis due to COVID-19 vaccines in the elderly Jean Bousquet 1,2,3 | Ioana Agache 4 | Hubert Blain 5 | Marek Jutel 6,7 | Maria Teresa Ventura 8 | Margitta Worm 1 | Stefano Del Giacco 9 | Athanasios Benetos 10 | Beatrice Maria Bilo 11,12 | Wienczyslawa Czarlewski 13 | Amir Hamzah Abdul Latiff 14 | Mona Al-Ahmad 15,16 | Elizabeth Angier 17 | Isabella Annesi-Maesano 18 | Marina Atanaskovic-Markovic 19 | Claus Bachert 20,21,22,23 | Annick Barbaud 24,25 | Anna Bedbrook 14 | Kazi S. Bennoor 26 | Elena Camelia Berghea 27,28 | Carsten Bindslev-Jensen 29 | Sergio Bonini 30 | Sinthia Bosnic-Anticevich 31,32 | Knut Brockow 33 | Luisa Brussino 34 | Paulo Camargos 35 | G. Walter Canonica 36,37 | Victoria Cardona 38,39 | Pedro Carreiro-Martins 40,41 | Ana Carriazo 42 | Thomas Casale 43 | Jean-Christoph Caubet 44 | Lorenzo Cecchi 45 | Antonio Cherubini 46 | George Christoff 47 | Derek K. Chu 48 | Alvaro A. Cruz 49 | Dejan Dokic 50 | Yehia El-Gamal† 51 | Motohiro Ebisawa 52 | Bernadette Eberlein 33 | John Farrell 53 | Montserrat Fernandez-Rivas 54 | Wytske J. Fokkens 55,56 | Joao A. Fonseca 57,58 | Yadong Gao 59 | Gaëtan Gavazzi 60 | Radoslaw Gawlik 61 | Asli Gelincik 62 | bѴm ;lb1boѴ 63 | Maia Gotua 64 | Olivier Guérin 65 | Tari Haahtela 66 | Karin Hoffmann-Sommergruber 67 | Hans Jürgen Hoffmann 68,69 | Maja Hofmann 1 | Martin Hrubisko 70 | Maddalena Illario 71 | Carla Irani 72 | Zhanat Ispayeva 73 | Juan Carlos Ivancevich 74 | Kaja Julge 75 | Igor Kaidashev 76 | Musa Khaitov 77 | Edward Knol 78 | Helga Kraxner 79 | Piotr Kuna 80 | Violeta Kvedariene 81,82 | Antti Lauerma 83 | Lan T. T. Le 84 | Vincent Le Moing 85 | Michael Levin 86 | Renaud Louis 87 | Olga Lourenco 88 | Vera Mahler 89 | Finbarr C. Martin 90 | Andrea Matucci 91 | Branislava Milenkovic 92 | Stéphanie Miot 5 | Emma Montella 71 | Mario Morais-Almeida 93 | Charlotte G. Mortz 29 | Joaquim Mullol 94,95 | Leyla Namazova-Baranova 96 | Hugo Neffen 97 | Kristof Nekam 98 | Marek Niedoszytko 99 | Mikaëla Odemyr 100 | Robyn E. O’Hehir 101 | Yoshitaka Okamoto 102 | Markus Ollert 103,104 | Oscar Palomares 105 | Nikolaos G. Papadopoulos 106 | Petr Panzner 107 | Giovanni Passalacqua 108 | š ƑƏƑƐ -m7 o_m )bѴ; -m7 "omv ņ"ĺ 0Ѵbv_;7 0 o_m )bѴ; -m7 "omv |7ĺ Abbreviations: bm_b0b|ouvķ -m]bo|;mvbm 1om;u|bm] ;ml; bm_b0b|ouĸ ķ bu-ķ u;-|_bm]ķ bu1Ѵ-|bomķ bv-0bѴb|ķ rovu;ĸ !ķ ѴѴ;u]b1 !_bmb|bv -m7 b|v lr-1| om v|_l-ĸ $ŊƑŊ-m|-]ombv|vķ m]bo|;mvbm u;1;r|ou |r; Ƒĸ ķ uor;-m 1-7;l o= ѴѴ;u] -m7 Ѵbmb1-Ѵ llmoѴo]ĸ "ķ uor;-m ;ub-|ub1 ;7b1bm; "o1b;|ĸ &ķ bm|;mvb; 1-u; mb|ĸ ķ bm|u-lv1Ѵ-uĸ (ķ m|u-;movĺ

Transcript of Management of anaphylaxis due to COVID- 19 vaccines in the ...

2952Պ |Պ Allergy. 2021;76:2952–2964.wileyonlinelibrary.com/journal/all

!;1;b�;7Ĺ�Ɩ� ;0u�-u��ƑƏƑƐՊ |Պ!;�bv;7Ĺ�ƐƖ��-u1_�ƑƏƑƐՊ |Պ�11;r|;7Ĺ�ƑƖ��-u1_�ƑƏƑƐDOI: 10.1111/all.14838

E A A C I P O S I T I O N P A P E R

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

Jean Bousquet1,2,3 Պ| Ioana Agache4 Պ| Hubert Blain5Պ| Marek Jutel6,7Պ| Maria Teresa Ventura8Պ| Margitta Worm1 Պ| Stefano Del Giacco9Պ| Athanasios Benetos10Պ| Beatrice Maria Bilo11,12Պ| Wienczyslawa Czarlewski13Պ| Amir Hamzah Abdul Latiff14Պ| Mona Al- Ahmad15,16 Պ| Elizabeth Angier17Պ| Isabella Annesi- Maesano18 Պ| Marina Atanaskovic- Markovic19 Պ| Claus Bachert20,21,22,23 Պ| Annick Barbaud24,25Պ| Anna Bedbrook14Պ| Kazi S. Bennoor26Պ| Elena Camelia Berghea27,28Պ| Carsten Bindslev- Jensen29Պ| Sergio Bonini30 Պ| Sinthia Bosnic- Anticevich31,32Պ| Knut Brockow33 Պ| Luisa Brussino34Պ| Paulo Camargos35Պ| G. Walter Canonica36,37 Պ| Victoria Cardona38,39 Պ| Pedro Carreiro- Martins40,41 Պ| Ana Carriazo42Պ| Thomas Casale43Պ| Jean- Christoph Caubet44 Պ| Lorenzo Cecchi45 Պ| Antonio Cherubini46Պ| George Christoff47Պ| Derek K. Chu48Պ| Alvaro A. Cruz49 Պ| Dejan Dokic50Պ| Yehia El- Gamal†51Պ| Motohiro Ebisawa52 Պ| Bernadette Eberlein33Պ| John Farrell53Պ| Montserrat Fernandez- Rivas54Պ| Wytske J. Fokkens55,56Պ| Joao A. Fonseca57,58Պ| Yadong Gao59Պ| Gaëtan Gavazzi60Պ| Radoslaw Gawlik61Պ| Asli Gelincik62 Պ| �bѴ�m��;lb1boऀѴ�63Պ| Maia Gotua64 Պ| Olivier Guérin65Պ| Tari Haahtela66 Պ| Karin Hoffmann- Sommergruber67Պ| Hans Jürgen Hoffmann68,69Պ| Maja Hofmann1Պ| Martin Hrubisko70Պ| Maddalena Illario71Պ| Carla Irani72Պ| Zhanat Ispayeva73Պ| Juan Carlos Ivancevich74Պ| Kaja Julge75Պ| Igor Kaidashev76Պ| Musa Khaitov77 Պ| Edward Knol78Պ| Helga Kraxner79Պ| Piotr Kuna80Պ| Violeta Kvedariene81,82Պ| Antti Lauerma83Պ| Lan T. T. Le84Պ| Vincent Le Moing85Պ| Michael Levin86 Պ| Renaud Louis87Պ| Olga Lourenco88 Պ| Vera Mahler89Պ| Finbarr C. Martin90Պ| Andrea Matucci91Պ| Branislava Milenkovic92Պ| Stéphanie Miot5Պ| Emma Montella71Պ| Mario Morais- Almeida93 Պ| Charlotte G. Mortz29 Պ| Joaquim Mullol94,95Պ| Leyla Namazova- Baranova96Պ| Hugo Neffen97Պ| Kristof Nekam98Պ| Marek Niedoszytko99 Պ| Mikaëla Odemyr100Պ| Robyn E. O’Hehir101 Պ| Yoshitaka Okamoto102Պ| Markus Ollert103,104Պ| Oscar Palomares105 Պ| Nikolaos G. Papadopoulos106 Պ| Petr Panzner107 Պ| Giovanni Passalacqua108 Պ|

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ՊՍՊ |ՊƑƖƔƒBOUSQUET ET al.

Vincenzo Patella109 Պ| Mirko Petrovic110Պ| Oliver Pfaar111 Պ| Nhân Pham- Thi112Պ| Davor Plavec113,114Պ| Todor A. Popov115Պ| Marysia T. Recto116Պ| Frederico S. Regateiro117,118,119Պ| Jacques Reynes85Պ| Regina E. Roller- Winsberger120Պ| Yves Rolland121Պ| Antonino Romano122,123Պ| Carmen Rondon124,125 Պ| Menachem Rottem126,127Պ| Philip W. Rouadi128 Պ| Nathalie Salles129Պ| Boleslaw Samolinski130Պ| Alexandra F. Santos131,132,133,134 Պ| Faradiba S Sarquis135Պ| Joaquin Sastre136 Պ| Jos M. G. A. Schols137Պ| Nicola Scichilone138Պ| Anna Sediva139Պ| Mohamed H. Shamji140,141 Պ| Aziz Sheikh142Պ| Isabel Skypala143 Պ| Sylwia Smolinska144,145Պ| Milena Sokolowska146Պ| Bernardo Sousa- Pinto57,58,147Պ| Milan Sova148Պ| Rafael Stelmach149Պ| Gunter Sturm150,151Պ| Charlotte Suppli Ulrik152Պ| Ana Maria Todo- Bom153 Պ| Sanna Toppila- Salmi66Պ| Ioanna Tsiligianni154,155 Պ| Maria Torres156 Պ| Eva Untersmayr157Պ| Marilyn Urrutia Pereira158Պ| Arunas Valiulis159,160 Պ| Joana Vitte161,162 Պ| Alessandra Vultaggio91Պ| Dana Wallace163Պ| Jolanta Walusiak- Skorupa164Պ| De- Yun Wang165Պ| Susan Waserman48Պ| Arzu Yorgancioglu166Պ| Osman M. Yusuf167Պ| Mario Zernotti168Պ| Mihaela Zidarn169Պ| Tomas Chivato170 Պ| Cezmi A. Akdis171 Պ| Torsten Zuberbier1Պ| Ludger Klimek172,173

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F I G U R E 3Պb-]movbv�-m7�l-m-];l;m|�o=�v;�;u;�-ѴѴ;u]b1�u;-1|bomv�-=|;u���(�Ŋ�ƐƖ��-11bm-|bom�bm�|_;��-11bm-|bom�1;m|;u�Ő=uol29ő�

Swollen tongue-uvula,Cramping abdominal pain,

vomiting,diarrhea

ORShortness of breath,

wheezestridor

ORSyncope,incontinence

blood pressure drop

ORobserve at least 15 minutesVACCINATION

Bronchospasm

Salbutamol4-10 puffs

via large volumespacer

No improvementin 5-10 min:

REPEATEPINEPHRINE(ADRENALINE)intramuscularly

Blood pressure drop

2000-3000 ml of 0.9% NaClintravenouslyin 10-20 min

Put the patient in the reclining position with legs up

intramuscularly in the mid-outer thigh quadriceps muscle

Administer EPINEPHRINE (ADRENALINE)0.3 mg in auto-injector

OR0.5 mg per dose (of 1:1000 (1 mg/ml) of aqueous solution)

URGENTLY

Secure intravenous accessesand start infusion with 0.9% NaCl (10-20 ml/min)

Clear the airwaysAdminister Oxygen via facial mask (at least 10 liters/min)

AND

if

Discharge after 24 hrsRefer to the allergy center for the urgent workup Transfer to ICU

if patient develops the following symptoms

if if

(monitor vital signs and observe at least 30 minutes in patients at high risk)

Monitor vital signs

CALL emergency assistancedepending on your location(911, 112, ICU team)

if symptoms are fully resolved if symptoms continue

Generalized hives,generalized pruritus,generalized flushing,face angioedema

Antihistaminesoral/parenteralGlucocorticoidsoral/parenteralobservation 4 hr

ANDif

progressin minutes

Discharge 4-8 hrs after full resolutionof the symptoms

Refer to the allergy center for the workup

resolvednot

resolved

ONLYif isolatedand not

progressing

Advise against second planned SARS-CoV-2vaccination until clarified by the allergy centre

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ORCIDJean Bousquet _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƑŊƓƏѵƐŊƓƕѵѵ Ioana Agache _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƐŊƕƖƖƓŊƒѵƓ* Margitta Worm _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƑŊƒƓƓƖŊƐƑƓƔ Mona Al- Ahmad _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƒŊƒƕƑƏŊƕƏƒƑ Isabella Annesi- Maesano _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƑŊѵƒƓƏŊƖƒƏƏ Marina Atanaskovic- Markovic _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƒŊƐƒƔƓŊѵƏƕƑ Claus Bachert _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƒŊƓƕƓƑŊƐѵѵƔ Sergio Bonini _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƒŊƏƏƕƖŊƒƏƒƐ Knut Brockow _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƑŊƑƕƕƔŊƒѵѶƐ G. Walter Canonica _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƐŊѶƓѵƕŊƑƔƔƕ Victoria Cardona _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƒŊƑƐƖƕŊƖƕѵƕ Pedro Carreiro- Martins _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƑŊƓƐƑƖŊƐƒƒ* Jean- Christoph Caubet _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƐŊƔƏƏѵŊƔƕƑƓ Lorenzo Cecchi _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƑŊƏѵƔѶŊƑƓƓƖ Alvaro A. Cruz _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƑŊƕƓƏƒŊƒѶƕƐ Motohiro Ebisawa _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƒŊƓƐƐƕŊƔƔѶ* Asli Gelincik _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƑŊƒƔƑƓŊƖƖƔƑ Maia Gotua _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƒŊƑƓƖƕŊƓƐƑѶ Tari Haahtela _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƒŊƓƕƔƕŊƑƐƔѵ Musa Khaitov _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƒŊƓƖѵƐŊƖѵƓƏ Michael Levin _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƒŊƑƓƒƖŊƕƖѶƐ Olga Lourenco _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƑŊѶƓƏƐŊƔƖƕѵ Mario Morais- Almeida _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƒŊƐѶƒƕŊƑƖѶƏ Charlotte G. Mortz _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƐŊѶƕƐƏŊƏѶƑƖ Marek Niedoszytko _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƒŊƐƏѶƖŊƐƖƐƐ Robyn E. O’Hehir _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƑŊƒƓѶƖŊƕƔƖƔ Oscar Palomares _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƒŊƓƔƐѵŊƏƒѵƖ Nikolaos G. Papadopoulos _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƑŊƓƓƓѶŊƒƓѵѶ Petr Panzner _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƑŊƐƑƖƐŊƓƔƏ* Giovanni Passalacqua _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƑŊƔƐƒƖŊƒѵƏƓ Vincenzo Patella _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƐŊƔѵƓƏŊѵƓƓѵ Oliver Pfaar _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƒŊƓƒƕƓŊƖѵƒƖ Carmen Rondon _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƒŊƏƖƕѵŊƒƓƏƑ Philip W. Rouadi _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƑŊƔƒѵƔŊƖƔѵѶ Alexandra F. Santos _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƑŊƕѶƏƔŊƐƓƒѵ Joaquin Sastre _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƒŊƓѵѶƖŊѵѶƒƕ Mohamed H. Shamji _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƒŊƒƓƑƔŊƒƓѵƒ Isabel Skypala _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƒŊƒѵƑƖŊƓƑƖƒ Ana Maria Todo- Bom _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƑŊƐѶƔƏŊѵѵѶƖ Ioanna Tsiligianni _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƐŊƕƖƑƑŊƕƓƖƐ Maria Torres _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƐŊƔƑƑѶŊƓƕƐ* Arunas Valiulis _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƑŊƏƑѶƕŊƖƖƐƔ

Joana Vitte _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƑŊƒƒƓƓŊƖƓƏѶ Tomas Chivato _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƑŊƔƓƏƒŊƏƖѵƓ Cezmi A. Akdis _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƐŊѶƏƑƏŊƏƐƖ* Ludger Klimek _||rvĹņņou1b7ĺou]ņƏƏƏƏŊƏƏƏƑŊƑƓƔƔŊƏƐƖƑ

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