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Kayode OS, Nakonechna A, Siew LQC, Dziadzio M, Kennard L, Rutkowski K, Mirakian R, Wagner A. Polyethylene glycol hypersensitivity, patient outcomes in a 7-year retrospective study. Ann Allergy Asthma Immunol 2024:S1081-1206(24)00206-0. [PMID: 38561050 DOI: 10.1016/j.anai.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/17/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Immediate IgE-mediated hypersensitivity reactions to polyethylene glycol (PEG) are rare. Our understanding of PEG hypersensitivity is limited. OBJECTIVE To evaluate the clinical characteristics and investigation outcomes of the largest cohort of patients with PEG allergy reported. METHODS A total of 44 patients investigated for suspected PEG allergy across 4 United Kingdom tertiary allergy centers between October 2013 and December 2020 were studied. Clinical characteristics, index reaction, and approaches to and outcomes of allergy investigations were analyzed. RESULTS PEG hypersensitivity was confirmed in 42 of 44 cases. Macrogol laxatives were the most common index drugs reported (23%), followed by depo-medroxyprogesterone (19%), oral penicillin V (10%), and depo-methylprednisolone (10%). In general, 61% experienced grade III anaphylaxis. Intradermal testing (IDT) increased the diagnostic sensitivity from 51% to 85%. Five patients experienced systemic reactions during IDT. Of the 5 patients, 2 were skin prick test positive to a high molecular weight PEG. Three patients with negative skin test results had positive drug provocation test results. Seven patients with PEG allergy reported tolerance to H1-antihistamines containing PEG. Administration of messenger RNA COVID-19 or Oxford/AstraZeneca COVID-19 vaccines was tolerated in all 16 patients to whom they were administered. CONCLUSION PEG hypersensitivity is an uncommon cause of drug-induced anaphylaxis. Four index drugs accounted for two-thirds of the cases, and reactions to these drugs should prompt PEG hypersensitivity investigations. PEG IDT increases diagnostic yield. The role of skin prick test with higher molecular weight PEGs requires further attention. Further studies are required to understand PEG thresholds and PEG equivalent doses of various administration routes. COVID-19 vaccines were tolerated by all exposed.
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Affiliation(s)
- Oyindamola Stephanie Kayode
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, United Kingdom.
| | - Alla Nakonechna
- Department of Pharmacology and Therapeutics, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom; Allergy and Immunology Department, Hull University Hospitals, NHS Foundation Trust, Hull, United Kingdom
| | - Leonard Quok Chean Siew
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, United Kingdom; Peter Gorer Department of Immunobiology, Guy's Hospital, King's College London, London, United Kingdom
| | - Magdalena Dziadzio
- Specialist Allergy and Clinical Immunology, Royal National ENT and Eastman Dental Hospitals, UCLH NHS Foundation Trust, London, United Kingdom; UCL Ear Institute, UCL, London, United Kingdom
| | - Lucinda Kennard
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, United Kingdom
| | - Krzysztof Rutkowski
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, United Kingdom
| | - Rita Mirakian
- Department of Allergy, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Annette Wagner
- Department of Adult Allergy, Guy's and St Thomas' NHS Foundation Trust, Guy's Hospital, London, United Kingdom
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2
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Wolfset N, Azar ARP, Phillips CA, Stein M, Rheingold SR, Heimall J, Elgarten CW. Coronavirus Disease 2019 mRNA Vaccination Appears Safe in Pediatric Patients With Hypersensitivity to Polyethylene Glycolated Escherichia coli L-asparaginase. J Pediatr Hematol Oncol 2024; 46:e202-e204. [PMID: 38181327 PMCID: PMC11046694 DOI: 10.1097/mph.0000000000002805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 11/05/2023] [Indexed: 01/07/2024]
Abstract
Polyethylene glycol-asparaginase (PEGAsp) is an established component of acute leukemia therapy. Hypersensitivity reactions to PEGAsp occur in 10% to 15% of patients, with polyethylene glycol suggested as the antigenic culprit. As coronavirus disease 2019 (COVID-19) mRNA vaccines contain polyethylene glycol, the safety of administration of these vaccines to patients with prior PEGAsp hypersensitivity has been questioned. Between December 21, 2020 and March 3, 2022, 66 patients with acute leukemia and PEGAsp allergy received COVID-19 vaccination. No patients (0/66 0%, 95% CI: 0%-5.4%) experienced an allergic reaction to the vaccine. COVID-19 mRNA vaccination appears to be safe in pediatric and young adult patients with acute lymphoblastic leukemia with PEGAsp allergy.
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Affiliation(s)
- Nicole Wolfset
- Children’s Hospital of Philadelphia, Division of Allergy and Immunology
| | | | - Charles A. Phillips
- Children’s Hospital of Philadelphia, Division of Oncology
- Children’s Hospital of Philadelphia, Department of Biomedical and Health Informatics
| | - Madison Stein
- Children’s Hospital of Philadelphia, Division of Oncology
| | | | - Jennifer Heimall
- Children’s Hospital of Philadelphia, Division of Allergy and Immunology
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3
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Li Z, Shen L, Ma A, Talkington A, Li Z, Nyborg AC, Bowers MS, LaMoreaux B, Livingston EW, Frank JE, Yuan H, Lai SK. Pegloticase co-administered with high MW polyethylene glycol effectively reduces PEG-immunogenicity and restores prolonged circulation in mouse. Acta Biomater 2023; 170:250-259. [PMID: 37659730 PMCID: PMC10619887 DOI: 10.1016/j.actbio.2023.08.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/04/2023]
Abstract
The interactions between polymers and the immune system remains poorly controlled. In some instances, the immune system can produce antibodies specific to polymer constituents. Indeed, roughly half of pegloticase patients without immunomodulation develop high titers of anti-PEG antibodies (APA) to the PEG polymers on pegloticase, which then quickly clear the drug from circulation and render the gout treatment ineffective. Here, using pegloticase as a model drug, we show that addition of high molecular weight (MW) free (unconjugated) PEG to pegloticase allows us to control the immunogenicity and mitigates APA induction in mice. Compared to pegloticase mixed with saline, mice repeatedly dosed with pegloticase containing different MW or amount of free PEG possessed 4- to 12- fold lower anti-PEG IgG, and 6- to 10- fold lower anti-PEG IgM, after 3 rounds of pegloticase dosed every 2 weeks. The markedly reduced APA levels, together with competitive inhibition by free PEG, restored the prolonged circulation of pegloticase to levels observed in APA-naïve animals. In contrast, mice with pegloticase-induced APA eliminated nearly all pegloticase from the circulation within just four hours post-injection. These results support the growing literature demonstrating free PEG may effectively suppress drug-induced APA, which in turn may offer sustained therapeutic benefits without requiring broad immunomodulation. We also showed free PEG effectively blocked the PEGylated protein from binding with cells expressing PEG-specific B cell receptors. It provides a template of how we may be able to tune the interactions and immunogenicity of other polymer-modified therapeutics. STATEMENT OF SIGNIFICANCE: A major challenge with engineering materials for drug delivery is their interactions with the immune system. For instance, our body can produce high levels of anti-PEG antibodies (APA). Unfortunately, the field currently lack tools to limit immunostimulation or overcome pre-existing anti-PEG antibodies, without using broad immunosuppression. Here, we showed that simply introducing free PEG into a clinical formulation of PEG-uricase can effectively limit induction of anti-PEG antibodies, and restore their prolonged circulation upon repeated dosing. Our work offers a readily translatable method to safely and effectively restore the use PEG-drugs in patients with PEG-immunity, and provides a template to use unconjugated polymers with low immunogenicity to regulate interactions with the immune system for other polymer-modified therapeutics.
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Affiliation(s)
- Zhongbo Li
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Limei Shen
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Alice Ma
- Department of Biomedical Engineering, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Anne Talkington
- Program in Bioinformatics and Computational Biology, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Zibo Li
- Department of Radiology, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | - Eric W Livingston
- Biomedical Research Imaging Center, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Jonathan E Frank
- Biomedical Research Imaging Center, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Hong Yuan
- Biomedical Research Imaging Center, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
| | - Samuel K Lai
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA; Department of Biomedical Engineering, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA; Program in Bioinformatics and Computational Biology, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA.; Department of Immunology and Microbiology, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA.
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4
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Greenhawt M, Dribin TE, Abrams EM, Shaker M, Chu DK, Golden DBK, Akin C, Anagnostou A, ALMuhizi F, Alqurashi W, Arkwright P, Baldwin JL, Banerji A, Bégin P, Ben-Shoshan M, Bernstein J, Bingemann TA, Bindslev-Jensen C, Blumenthal K, Byrne A, Cahill J, Cameron S, Campbell D, Campbell R, Cavender M, Chan ES, Chinthrajah S, Comberiati P, Eastman JJ, Ellis AK, Fleischer DM, Fox A, Frischmeyer-Guerrerio PA, Gagnon R, Garvey LH, Grayson MH, Isabwe GAC, Hartog N, Hendron D, Horner CC, Hourihane JO, Iglesia E, Kan M, Kaplan B, Katelaris CH, Kim H, Kelso JM, Khan DA, Lang D, Ledford D, Levin M, Lieberman JA, Loh R, Mack DP, Mazer B, Mody K, Mosnaim G, Munblit D, Mustafa SS, Nanda A, Nathan R, Oppenheimer J, Otani IM, Park M, Pawankar R, Perrett KP, Peter J, Phillips EJ, Picard M, Pitlick M, Ramsey A, Rasmussen TH, Rathkopf MM, Reddy H, Robertson K, Rodriguez Del Rio P, Sample S, Sheshadri A, Sheik J, Sindher SB, Spergel JM, Stone CA, Stukus D, Tang MLK, Tracy JM, Turner PJ, Vander Leek TK, Wallace DV, Wang J, Wasserman S, Weldon D, Wolfson AR, Worm M, Yacoub MR. Updated guidance regarding the risk of allergic reactions to COVID-19 vaccines and recommended evaluation and management: A GRADE assessment and international consensus approach. J Allergy Clin Immunol 2023; 152:309-325. [PMID: 37295474 PMCID: PMC10247143 DOI: 10.1016/j.jaci.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
| | - Timothy E Dribin
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Immunology, The University of Manitoba, Winnipeg, Canada
| | - Marcus Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, NH; Dartmouth Geisel School of Medicine, Hanover, NH
| | - Derek K Chu
- Faculty of Medicine, and the Department of McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada; The Research Institute of St. Joe's Hamilton, Hamilton, Canada; Evidence in Allergy Group, McMaster University Medical Centre, Hamilton, Canada
| | - David B K Golden
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Bethesda
| | - Cem Akin
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan School, Ann Arbor, Mich
| | - Akterini Anagnostou
- Section of Immunology, Allergy, and Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, Tex; Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Tex
| | - Faisal ALMuhizi
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Security Forces Hospital Program, Riyadh, Arabia
| | - Waleed Alqurashi
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Arkwright
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, United Kingdom
| | - James L Baldwin
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan School, Ann Arbor, Mich
| | - Aleena Banerji
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Philippe Bégin
- Centre Hospital Universitaire Sainte-Justine, Montreal, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Center-Montreal Children's Hospital, Montreal, Canada
| | - Jonathan Bernstein
- Division of Immunology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Theresa A Bingemann
- Division of Allergy, Immunology, and Rheumatology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Center, Odense Research Centre for Anaphylaxis, Odense, Denmark
| | - Kim Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Aideen Byrne
- Department of Paediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Julia Cahill
- University of Alberta, Faculty of Medicine, Calgary, Canada
| | - Scott Cameron
- Allergy Victoria, Victoria, British Columbia, Canada
| | | | - Ronna Campbell
- Department of Emergency Medicine, Mayo Clinic, Rochester
| | | | - Edmond S Chan
- Division of Allergy and Immunology, BC Children's Hospital, The University of British Columbia, Vancouver, Canada
| | - Sharon Chinthrajah
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, Calif
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Jacqueline J Eastman
- Corewell Health Allergy and Immunology, Grand Rapids, Mich; Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Canada
| | - David M Fleischer
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Adam Fox
- Guys's and St Tomas's Hospital National Health Service Foundation Trust, London, Mass
| | - Pamela A Frischmeyer-Guerrerio
- Laboratory of Allergic Diseases, Food Allergy Research Section, National Institutes of Allergy and Infectious Diseases, the National Institutes of Health, Bethesda, Md
| | - Remi Gagnon
- Clinique Spécialisée en Allergie de la Capitale, Québec, Canada
| | - Lene H Garvey
- Allergy Clinic, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mitchell H Grayson
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Ghislaine Annie Clarisse Isabwe
- Division of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Center-Montreal Children's Hospital, Montreal, Canada
| | - Nicholas Hartog
- Corewell Health Allergy and Immunology, Grand Rapids, Mich; Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - David Hendron
- Access Health Care Physicians LLC, New Port Richey, Fla
| | - Caroline C Horner
- Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Mo
| | | | - Edward Iglesia
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | | | - Blanka Kaplan
- Division of Allergy and Immunology, Northwell Health, New York, NY
| | | | - Harold Kim
- Faculty of Medicine, and the Department of McMaster University, Hamilton, Canada; Division of Clinical Immunology and Allergy, Department of Medicine, Western University, St Joseph's Health Care, London (Canada), Mass
| | - John M Kelso
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif
| | - David A Khan
- Division of Allergy and Immunology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
| | - David Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dennis Ledford
- Division of Allergy and Immunology, Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Michael Levin
- Division of Paediatric Allergology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jay A Lieberman
- Division of Allergy and Immunology, The University of Tennessee, Memphis, Tenn
| | - Richard Loh
- Immunology Department, Perth Children's Hospital, Perth, Australia
| | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, Canada; Halton Pediatric Allergy, Burlington, Canada
| | - Bruce Mazer
- Division of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Center-Montreal Children's Hospital, Montreal, Canada
| | - Ketan Mody
- Elite Sports Medicine Institute Ltd, Westmont, Ill
| | - Gisele Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill
| | - Daniel Munblit
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, Mass
| | - S Shahzad Mustafa
- Rochester Regional Health, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Anil Nanda
- Division of Allergy and Immunology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Tex; Asthma and Allergy Center, Lewisville and Flower Mound, Dallas, Tex
| | | | - John Oppenheimer
- University of Medicine and Dentistry of New Jersey, Rutgers University School of Medicine, New Brunswick, NJ
| | - Iris M Otani
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco, Calif
| | - Miguel Park
- Division of Allergic Diseases, Mayo Clinic, Rochester
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Kirsten P Perrett
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill; Population Allergy Group and the Centre for Food and Allergy Research, Murdoch Children's Research Institute, University of Melbourne, University of Melbourne, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Jonny Peter
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town and the Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town
| | - Elizabeth J Phillips
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Matthieu Picard
- Hôspital Maisonneuve-Rosemont, Université de Montréal, Montreal, Canada
| | | | - Allison Ramsey
- Rochester Regional Health, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Trine Holm Rasmussen
- Department of Dermatology and Allergy Center, Odense Research Centre for Anaphylaxis, Odense, Denmark
| | | | - Hari Reddy
- Allergy, Asthma and Immunology Center of Alaska, Anchorage, Alaska; Department of Pediatrics, University of Washington School of Medicine, Seattle, Wash
| | - Kara Robertson
- Division of Clinical Immunology and Allergy, St Joseph's Health Care, London (Canada), Mass; Schulich School of Medicine and Dentistry, Western University, St Joseph's Health Care, London (Canada), Mass
| | | | | | - Ajay Sheshadri
- Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Javed Sheik
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, Calif
| | - Sayantani B Sindher
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, Calif
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa
| | - Cosby A Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - David Stukus
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Mimi L K Tang
- Department of Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Parkville, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - James M Tracy
- Allergy, Asthma, and Immunology Associates PC, Omaha, Neb; Department of Pediatrics, University of Nebraska School of Medicine, Omaha, Neb
| | - Paul J Turner
- Imperial College Healthcare National Health Service Trust, London, Mass; Royal Brompton and Harefield National Health Service Foundation Trust, London, Mass
| | - Timothy K Vander Leek
- Pediatric Allergy and Immunology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Dana V Wallace
- Nova Southeastern University College of Allopathic Medicine, Fort Lauderdale, Fla
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY; Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Susan Wasserman
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Canada
| | - David Weldon
- Baylor Scott and White Clinic, College Station, Tex
| | - Anna R Wolfson
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Margitta Worm
- Division of Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mona-Rita Yacoub
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Segrate, Milan, Italy
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5
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Walter G, Jeimy S, Liddy C, Guglani S, Ellis AK, Blair A, Kobayaa H, Chad Z, Keely E. Utility of eConsults for COVID-19 vaccine-related concerns in Ontario: a cross-sectional analysis. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:38. [PMID: 37143148 PMCID: PMC10158700 DOI: 10.1186/s13223-023-00789-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/06/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND The Champlain BASE™ and Ontario eConsult services are virtual platforms that serve to facilitate contact between primary care providers and specialists across Ontario, relaying patient-specific questions to relevant specialists via a secure web-based platform. Despite ample evidence regarding the general effectiveness of these platforms, their utility as it pertains to clinical concerns regarding COVID-19 vaccines has not yet been explored. METHODS We performed a cross-sectional descriptive analysis of COVID-19 vaccine related eConsults on Ontario patients completed by five allergy specialists between February and October of 2021. 4318 COVID-19 vaccine-related eConsults were completed in total during this time; with 1857 completed by the five allergists participating in this analysis. Question types/content were categorized using a taxonomy developed through consensus on a weighted monthly sample of 499 total cases. Data regarding whether external resources were required to answer each eConsult, impact on primary care provider referral decisions, and allergy consultant response times were collected. A 2-question survey was completed by primary care providers following eConsultation and results were collected. RESULTS 41.08% of eConsults received involved safety concerns regarding COVID-19 vaccine administration in the setting of prior allergic disease and another 36.1% involved a potential reaction the first dose of a COVID-19 vaccine. 72.1% of eConsults were answered by specialist without needing external resources, and only 9.8% of all eConsults received resulted in a recommendation for formal in-person referral to Clinical Immunology & Allergy specialist or another subspecialty. Average time to complete eConsult was 16.4 min, and 79.7% of PCP eConsult queries which would have traditionally resulted in formal consultation were resolved based on advice provided in the eConsult without need for in-person assessment. CONCLUSIONS Our study demonstrates the utility of the eConsult service as it pertains to COVID-19 vaccine-related concerns. The eConsult platform proved an effective tool in diverting the need for in-person assessment by an Allergist or other medical specialty. This is significant given the large volume of eConsults completed by Allergists, and demonstrates the impact of an effective electronic delivery of care model during a time of strained resources and public health efforts directed at mass vaccination.
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Affiliation(s)
- Graham Walter
- Department of Medicine, University of Western Ontario, London, ON, Canada.
- Divison of Clinical Immunology & Allergy, University of Western Ontario, London, ON, Canada.
| | - Samira Jeimy
- Department of Medicine, University of Western Ontario, London, ON, Canada
- Divison of Clinical Immunology & Allergy, University of Western Ontario, London, ON, Canada
| | - Clare Liddy
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sheena Guglani
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Anne K Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Amy Blair
- Division of Pediatric Clinical Immunology & Allergy, University of Toronto, Toronto, ON, Canada
| | | | - Zave Chad
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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6
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Doyle R, Melo M, Teoh C, Wen S, Willcocks S. Safety of mRNA vaccination for COVID-19 in children with polyethylene glycol (PEG)-asparaginase allergy. Pediatr Allergy Immunol 2023; 34:e13939. [PMID: 36974643 DOI: 10.1111/pai.13939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/02/2023] [Accepted: 03/05/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Rebecca Doyle
- Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
- University of Queensland, School of Nursing, Midwifery and Social Work, St Lucia, Australia
| | - Mariana Melo
- Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
| | - Cindy Teoh
- Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
| | - Sophie Wen
- Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
- University of Queensland, Centre for Clinical Research, Herston, Australia
| | - Sophie Willcocks
- Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
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7
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Riggioni C, Phang KF, Tay SH, Van Bever H, Xu S, Oh S, Bueno A, Chua R, Goh SH, Chong KW, Tham EH, Santosa A. National assessment strategy for adults and children with a history of vaccine allergy shows low utility of COVID-19 vaccine skin testing. Pediatr Allergy Immunol 2023; 34:e13923. [PMID: 36825742 DOI: 10.1111/pai.13923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Carmen Riggioni
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kee Fong Phang
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Sen Hee Tay
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hugo Van Bever
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Serene Xu
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Sylvia Oh
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Angela Bueno
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Ruth Chua
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
| | - Si Hui Goh
- Allergy Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kok Wee Chong
- Allergy Service, Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore.,Human Potential Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Amelia Santosa
- Division of Rheumatology, Department of Medicine, National University Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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8
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Khalid MB, Frischmeyer-Guerrerio PA. The conundrum of COVID-19 mRNA vaccine-induced anaphylaxis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:1-13. [PMID: 36532656 PMCID: PMC9746073 DOI: 10.1016/j.jacig.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 12/14/2022]
Abstract
Novel messenger RNA (mRNA) vaccines have proven to be effective tools against coronavirus disease 2019, and they have changed the course of the pandemic. However, early reports of mRNA vaccine-induced anaphylaxis resulted in public alarm, contributing toward vaccine hesitancy. Although initial reports were concerning for an unusually high rate of anaphylaxis to the mRNA vaccines, the true incidence is likely comparable with other vaccines. These reactions occurred predominantly in young to middle-aged females, and many had a history of allergies. Although initially thought to be triggered by polyethylene glycol (PEG), lack of reproducibility of these reactions with subsequent dosing and absent PEG sensitization point away from an IgE-mediated PEG allergy in most. PEG skin testing has poor posttest probability and should be reserved for evaluating non-vaccine-related PEG allergy without influencing decisions for subsequent mRNA vaccination. Immunization stress-related response can closely mimic vaccine-induced anaphylaxis and warrants consideration as a potential etiology. Current evidence suggests that many individuals who developed anaphylaxis to the first dose of an mRNA vaccine can likely receive a subsequent dose after careful evaluation. The need to understand these reactions mechanistically remains critical because the mRNA platform is rapidly finding its way into other vaccinations and therapeutics.
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Key Words
- AE, Adverse event
- BAT, Basophil activation test
- CARPA, Complement activation–related pseudoallergy
- COVID-19
- COVID-19, Coronavirus disease 2019
- ISRR
- ISRR, Immunization stress–related response
- LNP, Lipid nanoparticle
- PAF, Platelet-activating factor
- PEG
- PEG, Polyethylene glycol
- SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2
- VAERS, Vaccine adverse event reporting system
- allergic reaction
- allergy
- anaphylaxis
- immunization stress–related response
- mRNA
- mRNA, Messenger RNA
- polyethylene glycol
- vaccine
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Affiliation(s)
| | - Pamela A. Frischmeyer-Guerrerio
- Corresponding author: Pamela A. Frischmeyer-Guerrerio, MD, PhD, Laboratory of Allergic Diseases, Food Allergy Research Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, MSC 1881, 10 Center Dr, Bethesda, MD 20892
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9
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Kelso JM. Literature Review: Update in pediatric allergy. Ann Allergy Asthma Immunol 2023; 130:134-135. [PMID: 36464595 DOI: 10.1016/j.anai.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 12/03/2022]
Affiliation(s)
- John M Kelso
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, California.
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10
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Greenhawt M, Shaker M, Golden DBK, Abrams EM, Blumenthal KG, Wolfson AR, Stone CA, Krantz MS, Chu DK, Dwamena BA. Diagnostic accuracy of vaccine and vaccine excipient testing in the setting of allergic reactions to COVID-19 vaccines: A systematic review and meta-analysis. Allergy 2023; 78:71-83. [PMID: 36321821 PMCID: PMC9878056 DOI: 10.1111/all.15571] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/14/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022]
Abstract
For persons with immediate allergic reactions to mRNA COVID-19 vaccines, skin testing (ST) to the vaccine/excipients (polyethylene glycol[PEG] and polysorbate 80 [PS]) has been recommended, but has unknown accuracy. To assess vaccine/excipient ST accuracy in predicting all-severity immediate allergic reactions upon re-vaccination, systematic review was performed searching Medline, EMBASE, Web of Science, and the WHO global coronavirus database (inception-Oct 4, 2021) for studies addressing immediate (≤4 h post-vaccination) all-severity allergic reactions to 2nd mRNA COVID-19 vaccination in persons with 1st dose immediate allergic reactions. Cases evaluating delayed reactions, change of vaccine platform, or revaccination without vaccine/excipient ST were excluded. Meta-analysis of diagnostic testing accuracy was performed using Bayesian methods. The GRADE approach evaluated certainty of the evidence, and QUADAS-2 assessed risk of bias. Among 20 studies of mRNA COVID-19 first dose vaccine reactions, 317 individuals underwent 578 ST to any one or combination of vaccine, PEG, or PS, and were re-vaccinated with the same vaccine. Test sensitivity for either mRNA vaccine was 0.2 (95%CrI 0.01-0.52) and specificity 0.97 (95%CrI 0.9-1). PEG test sensitivity was 0.02 (95%CrI 0.00-0.07) and specificity 0.99 (95%CrI 0.96-1). PS test sensitivity was 0.03 (95%CrI 0.00-0.0.11) and specificity 0.97 (95%CrI 0.91-1). Combined for use of any of the 3 testing agents, sensitivity was 0.03 (95%CrI 0.00-0.08) and specificity was 0.98 (95%CrI 0.95-1.00). Certainty of evidence was moderate. ST has low sensitivity but high specificity in predicting all-severity repeat immediate allergic reactions to the same agent, among persons with 1st dose immediate allergic reactions to mRNA COVID-19 vaccines. mRNA COVID-19 vaccine or excipient ST has limited risk assessment utility.
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Affiliation(s)
- Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital ColoradoUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Marcus Shaker
- Dartmouth‐Hitchcock Medical Center, Section of Allergy and ImmunologyLebanonNew HampshireUSA,Dartmouth Geisel School of MedicineHanoverNew HampshireUSA
| | - David B. K. Golden
- Division of Allergy and Clinical ImmunologyJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Elissa M. Abrams
- Department of Pediatrics and Child Health, Section of Allergy and ImmunologyThe University of ManitobaWinnipegManitobaCanada
| | - Kimberly G. Blumenthal
- Division of Rheumatology, Allergy, and ImmunologyDepartment of Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Anna R. Wolfson
- Division of Rheumatology, Allergy, and ImmunologyDepartment of Medicine, Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Cosby A. Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of MedicineVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Matthew S. Krantz
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of MedicineVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Derek K. Chu
- Department of MedicineMcMaster UniversityHamiltonOntarioCanada,Department of Health Research Methods, Evidence & ImpactMcMaster UniversityHamiltonOntarioCanada,The Research Institute of St. Joe's HamiltonHamiltonOntarioCanada,Evidence in Allergy GroupHamiltonOntarioCanada
| | - Ben A. Dwamena
- Division of Nuclear Medicine, Department of Radiology, Michigan MedicineUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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11
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Swanson HD, Hakim H, Hijano DR, Morton T, Cross S, Inaba H, Jeha S, Pui C, Karol SE. Vaccines against SARS-CoV-2 are safe to administer in patients with antibodies to pegaspargase. Cancer Med 2023; 12:1552-1555. [PMID: 35837830 PMCID: PMC9349948 DOI: 10.1002/cam4.5011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 06/30/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Allergic reactions to pegaspargase during ALL therapy are typically due to antibodies against polyethylene glycol (PEG), which is also used as a stabilizing agent in mRNA-based SARS-CoV-2 vaccines. To evaluate the safety of these vaccines in patients with anti-pegaspargase antibodies. METHODS We retrospectively reviewed the records of patients treated for ALL who had received SARS-CoV-2 vaccinations. All patients had antibodies against pegaspargase assayed during ALL therapy prospectively and in response to clinical allergies. Symptoms of intolerance to vaccination were gathered retrospectively from chart abstraction. RESULTS SARS-CoV-2 vaccination was well tolerated in all 78 patients with prior exposure to pegaspargase as part of their leukemia therapy. No reactions were observed in the 54 patients without a history of anti-pegaspargase antibodies or in 19 patients with antibodies who received mRNA vaccination. 1 patient who received the polysorbate containing Janssen vaccine experienced mild symptoms after vaccination not meeting the criteria of clinical allergy which spontaneously resolved within 25 minutes. CONCLUSION SARS-CoV-2 vaccination is safe in this population.
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Affiliation(s)
- Hope D. Swanson
- Department of Pharmacy and Pharmaceutical SciencesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Hana Hakim
- Department of Infectious DiseasesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Diego R. Hijano
- Department of Infectious DiseasesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Ted Morton
- Department of Infectious DiseasesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Shane Cross
- Department of Pharmacy and Pharmaceutical SciencesSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Hiroto Inaba
- Department of OncologySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Sima Jeha
- Department of OncologySt. Jude Children's Research HospitalMemphisTennesseeUSA
- Department of Global Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Ching‐Hon Pui
- Department of OncologySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Seth E. Karol
- Department of OncologySt. Jude Children's Research HospitalMemphisTennesseeUSA
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12
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Keshavarz S, Keshavarz S, Ziamajidi N, Daei S. Immune Response to COVID-19 Vaccination in Hematologic Malignancies: A Mini-Review. Chonnam Med J 2023; 59:24-30. [PMID: 36794237 PMCID: PMC9900228 DOI: 10.4068/cmj.2023.59.1.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 02/01/2023] Open
Abstract
The outbreak of the COVID-19 infection has led to the rapidity of vaccine usage in recent years. Emerging data indicate that the efficacy of vaccination against COVID-19 was about 95% in the general population, though its impact is impaired in patients with hematologic malignancies. As such, we decided to research the publications in which the authors reported the impacts of COVID-19 vaccination in patients suffering from hematologic malignancies. We concluded that patients with hematologic malignancies have lower responses, antibody titers as well as an impaired humoral response following vaccination, notably in patients with chronic lymphocytic leukemia (CLL) and lymphoma. Furthermore, it seems that the status of treatment can significantly affect the responses to the COVID-19 vaccination.
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Affiliation(s)
- Samaneh Keshavarz
- School of Paramedicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Somayeh Keshavarz
- School of Paramedicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Nasrin Ziamajidi
- Department of Clinical Biochemistry, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Sajedeh Daei
- School of Paramedicine, Guilan University of Medical Sciences, Rasht, Iran.,Department of Clinical Biochemistry, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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13
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Broos N, Brigitha LJ, Schuurhof A, Röckmann-Helmbach H, Tissing WJE, Pieters R, van der Sluis IM, Stadermann MB. Safety of mRNA-based COVID-19 vaccination in paediatric patients with a PEG-asparaginase allergy. EJC PAEDIATRIC ONCOLOGY 2022; 1:100002. [PMID: 38013843 PMCID: PMC9788842 DOI: 10.1016/j.ejcped.2022.100002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/12/2022] [Accepted: 12/23/2022] [Indexed: 11/29/2023]
Abstract
Background Children treated for a malignancy are at risk to develop serious illness from a COVID-19 infection. Pegylated E. coli asparaginase (PEG-asparaginase) is used in the treatment of acute lymphoblastic leukemia. Allergy to this drug is common and both asparaginase and polyethylene glycol (PEG) are identified as possible antigens. The mRNA-based vaccines against COVID-19 contain PEG as a stabilizing component. Methods We developed a protocol to be able to safely vaccinate children with a PEG-asparaginase allergy. All patients with a history of allergy to PEG-asparaginase have been included and skin prick testing for various PEGs was performed before vaccination with the mRNA Pfizer-BioNTech COVID-19 vaccine. Results Twelve children between six and 16 years old were vaccinated, without allergic reaction. None of them got a positive skin prick test for PEG. Ten patients had pre-existing IgG or IgM antibodies against PEG. Conclusion Children with a PEG-asparaginase allergy can be safely vaccinated against COVID-19 with mRNA vaccines containing PEG irrespective of IgG/IgM antibodies to PEG-asparaginase. Routine skin prick testing in patients with PEG-asparaginase allergy does not seem to be of added value.
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Affiliation(s)
- Nancy Broos
- Paediatric Allergology, Wilhelmina Children's Hospital Utrecht, the Netherlands
| | - Leiah J Brigitha
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Annemieke Schuurhof
- Paediatric Allergology, Wilhelmina Children's Hospital Utrecht, the Netherlands
| | | | - Wim J E Tissing
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Rob Pieters
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Marike B Stadermann
- Paediatric Allergology, Wilhelmina Children's Hospital Utrecht, the Netherlands
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14
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Ma Y, Liu N, Zhong G, Wang D, Cao L, Bai S, Zhu P, Zhang A, Wang X. Parent Acceptance toward Inactivated COVID-19 Vaccination in Children with Acute Lymphoblastic Leukemia: The Power of Oncologist and Alliance. Vaccines (Basel) 2022; 10:vaccines10122016. [PMID: 36560428 PMCID: PMC9785446 DOI: 10.3390/vaccines10122016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: The current study aims to survey the willingness of parents to vaccinate their children, who are childhood acute lymphoblastic leukemia survivors (CALLS), and identify factors associated with vaccine acceptance. Methods: Parents of CALLS on/off treatment, with the general condition of being amendable to vaccination, were recruited for interviews with attending oncologists about COVID-19 vaccination acceptance from July to November 2021 in China. After controlling for socioeconomic factors, the Association of Oncologists’ recommendations and parent−oncologist alliance with acceptance status were investigated. For validation, propensity score-matched (PSM) analysis was used. Results: A total of 424 families were included in the study, with CALLS mean remission age of 5.99 ± 3.40 years. Among them, 91 (21.4%) agreed, 168 (39.6%) hesitated, and 165 (38.9%) parents disagreed with the vaccination. The most common reason that kept parents from vaccinating their children was lack of recommendations from professional personnel (84/165, 50.9%), and massive amounts of internet information (78/175, 44.6%) was the main nonhealthcare resource against vaccination. Logistic regression analysis showed that only the recommendation from the oncologist was associated with parents’ vaccine acceptance (OR = 3.17, 95% CI = 1.93−5.20), as demonstrated by PSM comparison (42 in recommendation group vs. 18 in nonrecommendation group among 114 pairs, p < 0.001). An exploratory analysis revealed that parents with a better patient−oncologist alliance had a significantly higher level of acceptance (65.6% in alliance group vs. 15.6% in nonalliance group among 32 pairs, p < 0.001). Conclusions: Due to a lack of professional recommendation resources and the potential for serious consequences, parents were generally reluctant to vaccinate their CALLS. The recommendation of oncologists, which was influenced by the parent−oncologist alliance, significantly increased acceptance. This study emphasizes the critical role of oncologists in vaccinating cancer survivors and can be used to promote COVID-19 vaccines among vulnerable populations.
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Affiliation(s)
- Yifei Ma
- Department of Orthopedics and Spine Surgery, The Second Affiliated Hospital of Shantou University Medical College, 69 Dongsha North Road, Shantou 515000, China
- Department of Bone and Soft Tissue Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou 515041, China
| | - Nianqi Liu
- Faculty of Psychology, Institute of Educational Science, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Guanqing Zhong
- Department of Clinical Laboratory, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Dao Wang
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Lu Cao
- Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Shenrui Bai
- Department of Hematological Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Pengfei Zhu
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - Ao Zhang
- Department of Clinical Laboratory, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
| | - Xinjia Wang
- Department of Orthopedics and Spine Surgery, The Second Affiliated Hospital of Shantou University Medical College, 69 Dongsha North Road, Shantou 515000, China
- Department of Bone and Soft Tissue Oncology, Cancer Hospital of Shantou University Medical College, 7 Raoping Road, Shantou 515041, China
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15
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Munblit D, Greenhawt M, Brough HA, Pushkareva A, Karimova D, Demidova A, Warner JO, Kalayci O, Sediva A, Untersmayr E, Rodriguez Del Rio P, Vazquez-Ortiz M, Arasi S, Alvaro-Lozano M, Tsabouri S, Galli E, Beken B, Eigenmann PA. Allergic diseases and immunodeficiencies in children, lessons learnt from COVID-19 pandemic by 2022: A statement from the EAACI-section on pediatrics. Pediatr Allergy Immunol 2022; 33:e13851. [PMID: 36282136 PMCID: PMC9538373 DOI: 10.1111/pai.13851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022]
Abstract
By the April 12, 2022, the COVID-19 pandemic had resulted in over half a billion people being infected worldwide. There have been 6.1 million deaths directly due to the infection, but the pandemic has had many more short- and long-term pervasive effects on the physical and mental health of the population. Allergic diseases are among the most prevalent noncommunicable chronic diseases in the pediatric population, and health-care professionals and researchers were seeking answers since the beginning of pandemic. Children are at lower risk of developing severe COVID-19 or dying from infection. Allergic diseases are not associated with a higher COVID-19 severity and mortality, apart from severe/poorly controlled asthma. The pandemic disrupted routine health care, but many mitigation strategies, including but not limited to telemedicine, were successfully implemented to continue delivery of high-standard care. Although children faced a multitude of pandemic-related issues, allergic conditions were effectively treated remotely while reduction in air pollution and lack of contact with outdoor allergens resulted in improvement, particularly respiratory allergies. There is no evidence to recommend substantial changes to usual management modalities of allergic conditions in children, including allergen immunotherapy and use of biologicals. Allergic children are not at greater risk of multisystem inflammatory syndrome development, but some associations with Long COVID were reported, although the data are limited, and further research is needed. This statement of the EAACI Section on Pediatrics provides recommendations based on the lessons learnt from the pandemic, as available evidence.
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Affiliation(s)
- Daniel Munblit
- Inflammation, Repair and Development Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Helen A Brough
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital, London, UK.,Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Anna Pushkareva
- European Academy of Allergy and Clinical Immunology (EAACI), Zurich, Switzerland
| | - Diana Karimova
- European Academy of Allergy and Clinical Immunology (EAACI), Zurich, Switzerland
| | - Anastasia Demidova
- European Academy of Allergy and Clinical Immunology (EAACI), Zurich, Switzerland
| | - John O Warner
- Inflammation, Repair and Development Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Omer Kalayci
- Pediatric Allergy and Asthma, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Anna Sediva
- Department of Immunology, 2nd Medical Faculty, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Eva Untersmayr
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | | | - Marta Vazquez-Ortiz
- Inflammation, Repair and Development Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Stefania Arasi
- Translational Research in Pediatric Specialities Area, Division of Allergy, IRCCS, Bambino Gesù Children's Hospital, Rome, Italy
| | - Montserrat Alvaro-Lozano
- Allergology and Clinical Immunology Department, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Sophia Tsabouri
- Child Health Department, University of Ioannina School of Medicine, Ioannina, Greece
| | - Elena Galli
- Pediatric Allergology Unit, Department of Pediatric Medicine, S.Pietro Hospital Fatebenefratelli, Rome, Italy
| | - Burcin Beken
- Department of Pediatric Allergy and Immunology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Philippe A Eigenmann
- Pediatric Allergy Unit, Department of Woman, Child and Adolescent, University Hospitals of Geneva, Geneva, Switzerland
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16
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Corey KB, Koo G, Phillips EJ. Adverse Events and Safety of SARS-CoV-2 Vaccines: What's New and What's Next. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2254-2266. [PMID: 35550878 PMCID: PMC9085443 DOI: 10.1016/j.jaip.2022.04.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 12/29/2022]
Abstract
Just over 1 year following rollout of the first vaccines for coronavirus disease 2019, 572 million doses have been administered in the United States. Compared with the number of vaccines administered, adverse effects such as anaphylaxis have been rare, and seemingly, the more serious the effect, the rarer the occurrence. Despite these adverse effects, there are few, if any, true contraindications to coronavirus disease 2019 vaccination and most individuals recover without further sequelae. This review provides guidance for the allergist/immunologist regarding appropriate next steps based on patient's known allergy history or adverse reaction after receipt of coronavirus disease 2019 vaccine to assist in safe global immunization.
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Affiliation(s)
- Kristen B Corey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Grace Koo
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Elizabeth J Phillips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, WA, Australia.
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17
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Safety outcomes of SARS-CoV-2 vaccination in pediatric patients with a first dose reaction history or allergy to polyethylene glycol or polysorbate. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:2172-2175.e1. [PMID: 35842413 PMCID: PMC9277098 DOI: 10.1016/j.jaip.2022.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/22/2022] [Accepted: 05/24/2022] [Indexed: 12/02/2022]
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Sadeghi S, Kalantari Y, Shokri S, Fallahpour M, Nafissi N, Goodarzi A, Valizadeh R. Immunologic response, Efficacy, and Safety of Vaccines against COVID-19 Infection in Healthy and immunosuppressed Children and Adolescents Aged 2 - 21 years old: A Systematic Review and Meta-analysis. J Clin Virol 2022; 153:105196. [PMID: 35716417 PMCID: PMC9162782 DOI: 10.1016/j.jcv.2022.105196] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/29/2022] [Accepted: 06/01/2022] [Indexed: 12/13/2022]
Abstract
Children and adolescents form a large proportion of societies and play an important role in the transmission of COVID-19. On the other hand, their education, mental and physical wellness, and safety are compromised which makes vaccination a crucial step to return to normal life. In the current systematic review, the COVID-19 vaccination was evaluated in a total of 50,148 children and adolescents in 22 published studies and 5,279 participants in two ongoing clinical trials. The study was registered in the PROSPERO with the ID# CRD42022303615. Data were collected about multiple vaccines including BNT162b2 (Pfizer), mRNA-1273 (Moderna), JNJ-78436735 (Johnson and Johnson), CoronaVac (Sinovac), BBIBP-CorV (Sinopharm), adenovirus type-5-vectored vaccine, ZyCov-D, and BBV152 (COVAXIN). The immune response and efficacy of such vaccines were 96% - 100% in healthy children and adolescents and were also acceptable in those with underlying diseases and suppressed immune systems. The current systematic review revealed favorable safety profiles of employed vaccines in children and adolescents; however, adverse reactions such as myocarditis and myopericarditis were reported which were transient and resolved entirely. Consequently, vaccinating children and adolescents aged 2 - 21 years old is beneficial to abort the COVID-19 pandemic. Moreover, the risk-benefit assessments revealed favorable results for vaccinating children and adolescents, especially those with underlying diseases and immunosuppressed conditions, alongside adults to prevent transmission, severe infection, negative outcomes, and new variants formation. Also, according to the meta-analysis, the efficacy and immune response of vaccines after the first and second doses were 91% and 92%, respectively. Meanwhile, overall immune response for all vaccines was 95% and 91% for Pfizer vaccine.
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Affiliation(s)
- Sara Sadeghi
- Department of Pediatrics, Division of Dermatology, University of Calgary, Alberta Children's Hospital, Calgary, AB, Canada; Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Yasamin Kalantari
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sima Shokri
- Department of Pediatrics, Allergy and Clinical Immunology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Morteza Fallahpour
- Department of Pediatrics, Allergy and Clinical Immunology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Nahid Nafissi
- Department of General Surgery, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran; Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Iran Jordan Dermatology and Hair Transplantation Center, Tehran, Iran.
| | - Rohollah Valizadeh
- Department of Epidemiology, Student Research Committee, School of Public Health, Iran University of Medical science, Tehran, Iran and Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
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19
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Copaescu AM, Rosa Duque JS, Phillips EJ. What have we learned about the allergenicity and adverse reactions associated with the severe acute respiratory syndrome coronavirus 2 vaccines: One year later. Ann Allergy Asthma Immunol 2022; 129:40-51. [PMID: 35390476 PMCID: PMC8979618 DOI: 10.1016/j.anai.2022.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to the most rapid response and scale-up in vaccine and therapeutic development in history. We highlight the history of these amazing achievements with a focus on the description of the classification and mechanisms of allergic reactions and adverse events relevant to the allergist and immunologist that have been associated with the SARS-CoV-2 vaccines. Finally, we offer a detailed management approach in the context of a possible allergic reaction. DATA SOURCES Using defined search strategy, we identified peer-reviewed articles within PubMed that were published between January 1, 2019, and December 4, 2021. STUDY SELECTIONS All recent articles on COVID-19 published in English were reviewed with focus on the immunogenicity and allergenicity of the current existing COVID-19 vaccines. RESULTS Following a detailed literature review, we discuss the evolution and development of the new vaccines for SARS-CoV-2. Furthermore, we provide evidence regarding the significance and mechanisms of allergic reactions associated with the vaccines and offer a management approach for those with an increased risk of presenting an allergic or other relevant vaccine reaction. CONCLUSION The international rollout of COVID-19 vaccination started with reports of immediate allergic reactions. Although we still need to understand the mechanisms of these reactions, we can be reassured that patients with underlying allergic disease will not need to avoid SARS-CoV-2 vaccination. In addition, the vast majority of those with a first-dose reaction will tolerate subsequent doses.
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Affiliation(s)
- Ana M Copaescu
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Jaime S Rosa Duque
- Li Ka Shing Faculty of Medicine, Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Elizabeth Jane Phillips
- Center for Drug Safety and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee; Institute for Immunology & Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia.
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20
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Banerji A, Norton AE, Blumenthal KG, Stone CA, Phillips E. Rapid progress in our understanding of COVID-19 vaccine allergy: A cause for optimism, not hesitancy. J Allergy Clin Immunol 2022; 150:12-16. [PMID: 35398412 PMCID: PMC8988439 DOI: 10.1016/j.jaci.2022.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 01/31/2023]
Abstract
Anaphylaxis is a life-threatening condition and when associated with vaccination, leads to vaccine hesitancy. The concerns around vaccine-related anaphylaxis have become even more important during the coronavirus disease 2019 (COVID-19) pandemic where the COVID-19 vaccines remain one of our most important tools. Although rates of anaphylaxis to COVID-19 vaccines are not significantly different from those to other vaccines, Centers for Disease Control and Prevention guidance recommends avoidance of the same COVID-19 vaccine in individuals who had an allergic reaction or are allergic to a COVID-19 vaccine component. Fortunately, our understanding of COVID-19 vaccine allergic reactions has improved dramatically in the past year in large part due to important research efforts from individuals in the allergy community. Initially, researchers published algorithmic approaches using risk stratification and excipient skin testing. However, as our experience and knowledge improved with ongoing research, we have better data showing safety of repeat vaccination despite an initial reaction. We review our progress starting in December 2020 when the Food and Drug Administration approved the first COVID-19 vaccine in the United States through early 2022, highlighting our success in understanding COVID-19 vaccine reactions.
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Affiliation(s)
- Aleena Banerji
- Division of Rheumatology Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Allison E Norton
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, Tenn
| | - Kimberly G Blumenthal
- Division of Rheumatology Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, Mass
| | - Cosby A Stone
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Elizabeth Phillips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
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21
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Zarnegar‐Lumley S, Stone CA, Smith CM, Hall LL, Luck KE, Koo G, Plager JH, Phillips EJ, Friedman DL. Oncologist counseling practice and COVID-19 vaccination outcomes for patients with history of PEG-asparaginase hypersensitivity. Pediatr Blood Cancer 2022; 69:e29686. [PMID: 35353440 PMCID: PMC9088539 DOI: 10.1002/pbc.29686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/16/2022] [Accepted: 03/07/2022] [Indexed: 11/07/2022]
Abstract
Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an effective strategy to prevent serious coronavirus disease 2019 (COVID-19) and is important for oncology patients. mRNA-based COVID-19 vaccines are contraindicated in those with a history of severe or immediate allergy to any vaccine component, including polyethylene glycol (PEG)2000. Patients with acute lymphoblastic leukemia/lymphoma receive asparaginase conjugated to PEG5000 (PEG-ASNase) and those with PEG-ASNase-associated hypersensitivity may be unnecessarily excluded from receiving mRNA COVID-19 vaccines. We, therefore, surveyed oncologists on COVID-19 vaccine counseling practice and vaccination outcomes in COVID-19 vaccination-eligible patients and show safe receipt of mRNA vaccines despite PEG-ASNase hypersensitivity.
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Affiliation(s)
- Sara Zarnegar‐Lumley
- Division of Hematology and Oncology, Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA,Vanderbilt‐Ingram Cancer CenterVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Cosby A. Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Christine M. Smith
- Division of Hematology and Oncology, Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA,Vanderbilt‐Ingram Cancer CenterVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Laura L. Hall
- Department of Pediatric PharmacyPharmacology, Monroe Carell, Jr. Children's Hospital at VanderbiltNashvilleTennesseeUSA
| | - Kate E. Luck
- Division of Hematology and Oncology, Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Grace Koo
- Department of Pediatric PharmacyPharmacology, Monroe Carell, Jr. Children's Hospital at VanderbiltNashvilleTennesseeUSA
| | - Jessica H. Plager
- Department of Pediatric PharmacyPharmacology, Monroe Carell, Jr. Children's Hospital at VanderbiltNashvilleTennesseeUSA
| | - Elizabeth J. Phillips
- Division of Infectious Diseases, Department of MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA,Department of Pathology, Microbiology and ImmunologyVanderbilt University School of MedicineNashvilleTennesseeUSA,Institute for Immunology & Infectious DiseasesMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Debra L. Friedman
- Division of Hematology and Oncology, Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA,Vanderbilt‐Ingram Cancer CenterVanderbilt University Medical CenterNashvilleTennesseeUSA
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22
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Otani IM, Tsao LR, Tang M. Coronavirus disease 2019 vaccine administration in patients with reported reactions to polyethylene glycol- and polysorbate-containing therapeutics. Ann Allergy Asthma Immunol 2022; 129:88-94.e1. [PMID: 35288274 PMCID: PMC8916834 DOI: 10.1016/j.anai.2022.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/24/2022] [Accepted: 03/06/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Polyethylene glycol (PEG) and polysorbate reactions were initially implicated as a likely risk factor for reacting to coronavirus disease 2019 (COVID-19) vaccines and remain a source of vaccine hesitancy despite increasing evidence that they do not pose an increased risk for COVID-19 vaccine reactions. OBJECTIVE To investigate COVID-19 vaccine safety outcomes in patients with reported reactions to PEG- and polysorbate-containing medications and vaccines. METHODS COVID-19 vaccine safety was reviewed in patients with PEG or polysorbate reactions documented in their electronic medical records at a tertiary academic medical center (cohort 1) and patients referred to Allergy and Immunology with reported PEG or polysorbate reactions (cohort 2). COVID-19 vaccine safety was also reviewed following reported symptoms (onset ≤ 12 hours) to first-dose PEG-containing messenger RNA (mRNA) COVID-19 vaccine (cohort 3). RESULTS Of 252 patients in cohort 1 (n = 202) and cohort 2 (n = 50), 236 (94%) received mRNA COVID-19 vaccines (106 Pfizer, 130 Moderna); 235 received both doses. Only 3 patients from cohort 2 developed mild rash following vaccination. None of the 44 patients in cohort 3 with acute symptoms following first-dose mRNA COVID-19 vaccine (27 Pfizer, 17 Moderna) had previously reported PEG or polysorbate reactions. Of these 44 patients, 43 received the second dose and all 3 who developed symptoms following the second dose (1 required epinephrine) had negative PEG skin testing. CONCLUSION Patients with reported reactions to PEG and polysorbate safely received COVID-19 vaccines. PEG and polysorbate skin testing did not identify patients at risk for first dose or recurrent reactions to COVID-19 vaccines. Screening for PEG and polysorbate allergy may only increase vaccine hesitancy without identifying patients at risk for COVID-19 vaccine reactions.
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Affiliation(s)
- Iris M. Otani
- Reprints: Iris M. Otani, MD, Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, Department of Medicine, University of California San Francisco Medical Center, 400 Parnassus Avenue, Box 0336, San Francisco, CA 94143
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23
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Consensus on COVID-19 Vaccination in Pediatric Oncohematological Patients, on Behalf of Infectious Working Group of Italian Association of Pediatric Hematology Oncology. J Clin Med 2022; 11:jcm11051235. [PMID: 35268326 PMCID: PMC8911119 DOI: 10.3390/jcm11051235] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/05/2022] [Accepted: 02/22/2022] [Indexed: 02/07/2023] Open
Abstract
Vaccines represent the best tool to prevent the severity course and fatal consequences of the pandemic by the new Coronavirus 2019 infection (SARS-CoV-2). Considering the limited data on vaccination of pediatric oncohematological patients, we developed a Consensus document to support the Italian pediatric hematological oncological (AIEOP) centers in a scientifically correct communication with families and patients and to promote vaccination. The topics of the Consensus were: SARS-CoV-2 infection and disease (COVID-19) in the pediatric subjects; COVID-19 vaccines (type, schedule); who and when to vaccinate; contraindications and risk of serious adverse events; rare adverse events; third dose and vaccination after COVID-19; and other general prevention measures. Using the Delphi methodology for Consensus, 21 statements and their corresponding rationale were elaborated and discussed with the representatives of 31 centers, followed by voting. A high grade of Consensus was obtained on topics such as the potential risk of severe COVID-19 outcome in pediatric oncohematological patients, the need for vaccination as a preventative measure, the type, schedule and booster dose of vaccine, the eligibility of the patients for vaccination, and the timing, definition, and management of contraindications and serious adverse events, and other general prevention measures. All 21 of the statements were approved. This consensus document highlights that children and adolescents affected by hematological and oncological diseases are a fragile category. Vaccination plays an important role to prevent COVID-19, to permit the regular administration of chemotherapy or other treatments, to perform control visits and hospital admissions, and to prevent treatment delays.
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24
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Rush C, Faulk KE, Bradley ZK, Turner A, Krumins M, Greenhawt M. The safety of SARS-CoV-2 vaccines in persons with a known history of pegaspargase allergy: A single institution experience. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:630-632. [PMID: 34883262 PMCID: PMC8648374 DOI: 10.1016/j.jaip.2021.11.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/09/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Cassandra Rush
- Pharmacy Department, Children's Hospital Colorado, Aurora, Colo
| | - Kelly E Faulk
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo
| | | | - Aubree Turner
- Pharmacy Department, Children's Hospital Colorado, Aurora, Colo
| | - Maija Krumins
- Pharmacy Department, Children's Hospital Colorado, Aurora, Colo
| | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
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25
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Rudan I, Adeloye D, Katikireddi V, Murray J, Simpson C, Shah SA, Robertson C, Sheikh A. The COVID-19 pandemic in children and young people during 2020-2021: A complex discussion on vaccination. J Glob Health 2021; 11:01011. [PMID: 35047183 PMCID: PMC8763337 DOI: 10.7189/jogh.11.01011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Igor Rudan
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Davies Adeloye
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Josie Murray
- COVID-19 Surveillance Lead, Public Health Scotland, Fife, UK
| | - Colin Simpson
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, New Zealand
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Chris Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK and Public Health Scotland, Glasgow, UK
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - EAVE II collaboration
- Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
- MRC/CSO Social & Public Health Sciences Unit, Glasgow, UK
- COVID-19 Surveillance Lead, Public Health Scotland, Fife, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, New Zealand
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK and Public Health Scotland, Glasgow, UK
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26
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Elkrief A, Wu JT, Jani C, Enriquez KT, Glover M, Shah MR, Shaikh HG, Beeghly-Fadiel A, French B, Jhawar SR, Johnson DB, McKay RR, Rivera DR, Reuben DY, Shah S, Tinianov SL, Vinh DC, Mishra S, Warner JL. Learning through a Pandemic: The Current State of Knowledge on COVID-19 and Cancer. Cancer Discov 2021; 12:303-330. [PMID: 34893494 DOI: 10.1158/2159-8290.cd-21-1368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/26/2021] [Accepted: 12/09/2021] [Indexed: 12/15/2022]
Abstract
The ongoing COVID-19 pandemic has left patients with current or past history of cancer facing disparate consequences at every stage of the cancer trajectory. This comprehensive review offers a landscape analysis of the current state of the literature on COVID-19 and cancer including the immune response to COVID-19, risk factors for severe disease, and impact of anticancer therapies. We also review the latest data on treatment of COVID-19 and vaccination safety and efficacy in patients with cancer, as well as impact of the pandemic on cancer care, including the urgent need for rapid evidence generation and real-world study designs.
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Affiliation(s)
- Arielle Elkrief
- Hemato-Oncology, University of Montreal Research Center (CRCHUM)
| | | | | | - Kyle T Enriquez
- Medical Scientist Training Program, Vanderbilt University School of Medicine
| | | | - Mansi R Shah
- Division of Blood Disorders, Rutgers Cancer Institute of New Jersey
| | | | | | | | - Sachin R Jhawar
- Radiation Oncology, The Ohio State University Comprehensive Cancer Center
| | | | | | | | - Daniel Y Reuben
- Hematology and Oncology, Medical University of South Carolina
| | | | | | | | - Sanjay Mishra
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center
| | - Jeremy L Warner
- Medicine and Biomedical Informatics, Vanderbilt University Medical Center
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27
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Affiliation(s)
- Samira Jeimy
- Division of Clinical Immunology and Allergy (Jeimy), Department of Medicine, Western University, London, Ont.; Division of Allergy and Immunology (Wong), Department of Pediatrics, The University of British Columbia, Vancouver, BC; Division of Clinical Immunology and Allergy (Song), Department of Medicine, University of Toronto, Toronto, Ont.
| | - Tiffany Wong
- Division of Clinical Immunology and Allergy (Jeimy), Department of Medicine, Western University, London, Ont.; Division of Allergy and Immunology (Wong), Department of Pediatrics, The University of British Columbia, Vancouver, BC; Division of Clinical Immunology and Allergy (Song), Department of Medicine, University of Toronto, Toronto, Ont
| | - Christine Song
- Division of Clinical Immunology and Allergy (Jeimy), Department of Medicine, Western University, London, Ont.; Division of Allergy and Immunology (Wong), Department of Pediatrics, The University of British Columbia, Vancouver, BC; Division of Clinical Immunology and Allergy (Song), Department of Medicine, University of Toronto, Toronto, Ont
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28
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Khandker SS, Godman B, Jawad MI, Meghla BA, Tisha TA, Khondoker MU, Haq MA, Charan J, Talukder AA, Azmuda N, Sharmin S, Jamiruddin MR, Haque M, Adnan N. A Systematic Review on COVID-19 Vaccine Strategies, Their Effectiveness, and Issues. Vaccines (Basel) 2021; 9:1387. [PMID: 34960133 PMCID: PMC8708628 DOI: 10.3390/vaccines9121387] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 12/13/2022] Open
Abstract
COVID-19 vaccines are indispensable, with the number of cases and mortality still rising, and currently no medicines are routinely available for reducing morbidity and mortality, apart from dexamethasone, although others are being trialed and launched. To date, only a limited number of vaccines have been given emergency use authorization by the US Food and Drug Administration and the European Medicines Agency. There is a need to systematically review the existing vaccine candidates and investigate their safety, efficacy, immunogenicity, unwanted events, and limitations. The review was undertaken by searching online databases, i.e., Google Scholar, PubMed, and ScienceDirect, with finally 59 studies selected. Our findings showed several types of vaccine candidates with different strategies against SARS-CoV-2, including inactivated, mRNA-based, recombinant, and nanoparticle-based vaccines, are being developed and launched. We have compared these vaccines in terms of their efficacy, side effects, and seroconversion based on data reported in the literature. We found mRNA vaccines appeared to have better efficacy, and inactivated ones had fewer side effects and similar seroconversion in all types of vaccines. Overall, global variant surveillance and systematic tweaking of vaccines, coupled with the evaluation and administering vaccines with the same or different technology in successive doses along with homologous and heterologous prime-booster strategy, have become essential to impede the pandemic. Their effectiveness appreciably outweighs any concerns with any adverse events.
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Affiliation(s)
- Shahad Saif Khandker
- Gonoshasthaya-RNA Molecular Diagnostic & Research Center, Dhanmondi, Dhaka 1205, Bangladesh; (S.S.K.); (M.U.K.); (M.A.H.); (M.R.J.)
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G1 1XQ, UK;
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman P.O. Box 346, United Arab Emirates
| | - Md. Irfan Jawad
- Department of Microbiology, Jahangirnagar University, Savar 1342, Bangladesh; (M.I.J.); (B.A.M.); (T.A.T.); (A.A.T.); (N.A.)
| | - Bushra Ayat Meghla
- Department of Microbiology, Jahangirnagar University, Savar 1342, Bangladesh; (M.I.J.); (B.A.M.); (T.A.T.); (A.A.T.); (N.A.)
| | - Taslima Akter Tisha
- Department of Microbiology, Jahangirnagar University, Savar 1342, Bangladesh; (M.I.J.); (B.A.M.); (T.A.T.); (A.A.T.); (N.A.)
| | - Mohib Ullah Khondoker
- Gonoshasthaya-RNA Molecular Diagnostic & Research Center, Dhanmondi, Dhaka 1205, Bangladesh; (S.S.K.); (M.U.K.); (M.A.H.); (M.R.J.)
- Department of Community Medicine, Gonoshasthaya Samaj Vittik Medical College, Savar 1344, Bangladesh
| | - Md. Ahsanul Haq
- Gonoshasthaya-RNA Molecular Diagnostic & Research Center, Dhanmondi, Dhaka 1205, Bangladesh; (S.S.K.); (M.U.K.); (M.A.H.); (M.R.J.)
| | - Jaykaran Charan
- Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur 342005, India;
| | - Ali Azam Talukder
- Department of Microbiology, Jahangirnagar University, Savar 1342, Bangladesh; (M.I.J.); (B.A.M.); (T.A.T.); (A.A.T.); (N.A.)
| | - Nafisa Azmuda
- Department of Microbiology, Jahangirnagar University, Savar 1342, Bangladesh; (M.I.J.); (B.A.M.); (T.A.T.); (A.A.T.); (N.A.)
| | - Shahana Sharmin
- Department of Pharmacy, BRAC University, Dhaka 1212, Bangladesh;
| | - Mohd. Raeed Jamiruddin
- Gonoshasthaya-RNA Molecular Diagnostic & Research Center, Dhanmondi, Dhaka 1205, Bangladesh; (S.S.K.); (M.U.K.); (M.A.H.); (M.R.J.)
- Department of Pharmacy, BRAC University, Dhaka 1212, Bangladesh;
| | - Mainul Haque
- The Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sugai Besi, Kuala Lumpur 57000, Malaysia
| | - Nihad Adnan
- Gonoshasthaya-RNA Molecular Diagnostic & Research Center, Dhanmondi, Dhaka 1205, Bangladesh; (S.S.K.); (M.U.K.); (M.A.H.); (M.R.J.)
- Department of Microbiology, Jahangirnagar University, Savar 1342, Bangladesh; (M.I.J.); (B.A.M.); (T.A.T.); (A.A.T.); (N.A.)
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