{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T22:00:44Z","timestamp":1763071244991,"version":"build-2065373602"},"reference-count":39,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,9,27]],"date-time":"2022-09-27T00:00:00Z","timestamp":1664236800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background. Allergic patients may develop reactions following COVID-19 vaccination more frequently than non-allergic individuals. The aim of our study was to assess the risk of reactions in high-risk allergic patients vaccinated for COVID-19 at the University Health Agency Giuliano-Isontina (ASUGI) of Trieste (northeastern Italy). Methods. Patients were considered at high risk for allergic reactions in case of: prior anaphylactic reaction to any drug\/vaccine; multiple drug allergy; intolerance to polyethylene glycol (PEG) or polysorbate 80 (PS80) containing drugs; and mast cell disorders. High-risk allergic patients were immunized in hospital by a dedicated allergy team supported by resuscitation staff. Patients were interviewed over the phone one month after vaccination to complete a structured questionnaire investigating signs and symptoms developed after immunization. Results. From March 2021 to February 2022, 269 patients with a history of severe allergic reactions were assessed, of whom 208 (77.3%) eventually received COVID-19 vaccination, 50 (18.6%) refused to be immunized, 10 (3.7%) were deferred for medical reasons and one was declared exempted due to testing positive for PS80. Mild reactions (urticaria, angioedema, rhinitis, erythema) to COVID-19 vaccines were reported by 30.3% of patients, 8.7% within 4 h and 21.6% &gt; 4 h after immunization. No anaphylactic events were observed. Although they were 80 times (3.8%) more prevalent than in COVID-19 vaccinees from the general population (0.047%), vaccine allergic reactions in high-risk patients were mainly mild and late, more likely affecting women (OR = 3.05; 95% CI 1.22\u20137.65). Conclusions. High-risk allergic patients with urticaria and angioedema may experience mild flare-ups of mast cell activation-like symptoms following COVID-19 vaccination, supporting antihistamine premedication before vaccination and to be continued for one week afterwards.<\/jats:p>","DOI":"10.3390\/vaccines10101616","type":"journal-article","created":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T01:23:16Z","timestamp":1664414596000},"page":"1616","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Allergic Reactions to COVID-19 Vaccination in High-Risk Allergic Patients: The Experience of Trieste University Hospital (North-Eastern Italy)"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7717-0417","authenticated-orcid":false,"given":"Francesca Larese","family":"Filon","sequence":"first","affiliation":[{"name":"Unit of Occupational Medicine, Department of Medical Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy"},{"name":"Unit of Occupational Medicine, University Health Agency Giuliano-Isontina (ASUGI), 34129 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ilaria","family":"Lazzarato","sequence":"additional","affiliation":[{"name":"Unit of Occupational Medicine, University Health Agency Giuliano-Isontina (ASUGI), 34129 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilia","family":"Patriarca","sequence":"additional","affiliation":[{"name":"Unit of Occupational Medicine, Department of Medical Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Iavernig","sequence":"additional","affiliation":[{"name":"Unit of Occupational Medicine, Department of Medical Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Peratoner","sequence":"additional","affiliation":[{"name":"Accident & Emergency, University Health Agency Giuliano-Isontina (ASUGI), 34129 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2142-0816","authenticated-orcid":false,"given":"Giuseppe","family":"Perri","sequence":"additional","affiliation":[{"name":"Directorate Office, Cattinara Hospital, University Health Agency Giuliano-Isontina (ASUGI), 34149 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuliano","family":"Ponis","sequence":"additional","affiliation":[{"name":"Hospital Pharmacy, Giuliano Area, University Health Agency Giuliano-Isontina (ASUGI), 34128 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulio","family":"Rocco","sequence":"additional","affiliation":[{"name":"Public Health Department, University Health Agency Giuliano-Isontina (ASUGI), 34128 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6285-7355","authenticated-orcid":false,"given":"Luca","family":"Cegolon","sequence":"additional","affiliation":[{"name":"Unit of Occupational Medicine, Department of Medical Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy"},{"name":"Public Health Department, University Health Agency Giuliano-Isontina (ASUGI), 34128 Trieste, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1056\/NEJMoa2035389","article-title":"Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine","volume":"384","author":"Baden","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2603","DOI":"10.1056\/NEJMoa2034577","article-title":"C4591001 Clinical Trial Group. Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine","volume":"383","author":"Polack","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1920","DOI":"10.1056\/NEJMoa2022483","article-title":"An mRNA vaccine against SARS-CoV-2\u2014preliminary report","volume":"383","author":"Jackson","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"CDC COVID-19 Response Team, and Food and Drug Administration (2021). Allergic reactions including anaphylaxis after receipt of the first dose of Pfizer-BioNTech COVID-19 vaccine\u2014United States, December 14\u201323, 2020. MMWR Morb Mortal Wkly Rep., 70, 46\u201351.","DOI":"10.15585\/mmwr.mm7002e1"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1001\/jama.2021.0600","article-title":"Allergic reactions including anaphylaxis after receipt of the first dose of Pfizer-BioNTech COVID-19 vaccine","volume":"325","author":"Shimabukuro","year":"2021","journal-title":"JAMA"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1056\/NEJMra2035343","article-title":"Maintaining safety with SARS-CoV-2 vaccines","volume":"384","author":"Castells","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1016\/j.jaip.2020.12.047","article-title":"mRNA Vaccines to Prevent COVID-19 Disease and Reported Allergic Reactions: Current Evidence and Suggested Approach","volume":"9","author":"Banerji","year":"2021","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1629","DOI":"10.1111\/all.14739","article-title":"EAACI statement on the diagnosis, management and prevention of severe allergic reactions to COVID-19 vaccines","volume":"76","author":"Sokolowska","year":"2021","journal-title":"Allergy"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.1111\/all.14726","article-title":"ARIA-EAACI statement on severe allergic reactions to COVID-19 vaccines\u2014An EAACI-ARIA Position Paper","volume":"76","author":"Klimek","year":"2021","journal-title":"Allergy"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s40629-021-00165-7","article-title":"Practical handling of allergic reactions to COVID-19 vaccines: A position paper from German and Austrian Allergy Societies AeDA, DGAKI, GPA and \u00d6GAI","volume":"30","author":"Klimek","year":"2021","journal-title":"Allergo J. Int."},{"key":"ref_11","unstructured":"AAITO\u2014Associazione degli Allergologi Italiani Territoriali e Ospedalieri (2022, July 12). Linee di Indirizzo Per la Gestione da Parte Degli Allergologi dei Pazienti a Rischio di Reazioni Allergiche ai Vaccini Per COVID-19. Available online: https:\/\/www.aaiito.it\/go\/chisiamo\/351\/Emergenza%20COVID-19."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1016\/j.jaad.2021.03.092","article-title":"Cutaneous reactions reported after Moderna and Pfizer COVID-19 vaccination: A registry-based study of 414 cases","volume":"85","author":"McMahon","year":"2021","journal-title":"J. Am. Acad Dermatol."},{"key":"ref_13","unstructured":"Stokes, J., and Casale, T.B. (2022, September 06). The Relationship between IgE and Allergic Disease. Uptodate. Available online: https:\/\/www.uptodate.com\/contents\/the-relationship-between-ige-and-allergic-disease?search=atopy&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1."},{"key":"ref_14","unstructured":"Pichler, W.J. (2022, September 06). Drug Hypersensitivity: Classification and Clinical Features. Uptodate. Available online: https:\/\/www.uptodate.com\/contents\/drug-hypersensitivity-classification-and-clinical-features?search=hypersensitivity&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1186\/1710-1492-7-S1-I1","article-title":"Practical guide for allergy and immunology in Canada","volume":"7","author":"Kim","year":"2011","journal-title":"Allergy Asthma Clin. Immunol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1136\/oem.2003.011460","article-title":"Latex allergy: A follow up study of 1040 healthcare workers","volume":"63","author":"Filon","year":"2006","journal-title":"Occup. Environ. Med."},{"key":"ref_17","unstructured":"Kemp, S.F. (2022, September 06). Pathophysiology of Anaphylaxis. Uptodate. Available online: https:\/\/www.uptodate.com\/contents\/pathophysiology-of-anaphylaxis?search=Anaphylactoid%20reaction&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"878081","DOI":"10.3389\/fpubh.2022.878081","article-title":"Allergic Reactions After the Administration of COVID-19 Vaccine","volume":"10","author":"Bian","year":"2022","journal-title":"Front Public Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1111\/j.1398-9995.2008.01880.x","article-title":"Gender difference, sex hormones, and immediate type hypersensitivity reactions","volume":"63","author":"Chen","year":"2008","journal-title":"Allergy"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e2122255","DOI":"10.1001\/jamanetworkopen.2021.22255","article-title":"Prevalence of Allergic Reactions After Pfizer-BioNTech COVID-19 Vaccination Among Adults With High Allergy Risk","volume":"4","author":"Shavit","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1111\/j.1398-9995.2006.01303.x","article-title":"A framework for measuring the social impact of food allergy across Europe: A EuroPrevall state of the art paper","volume":"62","author":"Duiverman","year":"2007","journal-title":"Allergy"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1136\/thoraxjnl-2011-201249","article-title":"Gender differences in prevalence, diagnosis and incidence of allergic and non-allergic asthma: A population-based cohort","volume":"67","author":"Leynaert","year":"2012","journal-title":"Thorax"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"28","DOI":"10.3390\/vaccines10020286","article-title":"COVID-19 Vaccination Safety and Tolerability in Patients Allegedly at High Risk for Immediate Hypersensitivity Reactions","volume":"10","author":"Ieven","year":"2022","journal-title":"Vaccines"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1136\/thx.2004.038844","article-title":"Time trends in allergic disorders in the UK","volume":"62","author":"Gupta","year":"2007","journal-title":"Thorax"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e185630","DOI":"10.1001\/jamanetworkopen.2018.5630","article-title":"Prevalence and severity of food allergies among US adults","volume":"2","author":"Gupta","year":"2019","journal-title":"JAMA Netw. Open"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/j.jaip.2018.06.010","article-title":"Drug-induced anaphylaxis documented in electronic health records","volume":"7","author":"Dhopeshwarkar","year":"2019","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"4407","DOI":"10.1016\/j.vaccine.2021.06.058","article-title":"Relationship between pre-existing allergies and anaphylactic reactions post mRNA COVID-19 vaccine administration","volume":"39","author":"Desai","year":"2021","journal-title":"Vaccine"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Nittner-Marszalska, M., Rosiek-Biegus, M., Kope\u0107, A., Paw\u0142owicz, R., Kosi\u0144ska, M., \u0141ata, A., and Szenborn, L. (2021). Pfizer-BioNTech COVID-19 Vaccine Tolerance in Allergic versus Non-Allergic Individuals. Vaccines, 9.","DOI":"10.3390\/vaccines9060553"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3307","DOI":"10.1111\/all.14794","article-title":"Allergenic components of the mRNA-1273 vaccine for COVID-19: Possible involvement of polyethylene glycol and IgG-mediated complement activation","volume":"76","author":"Klimek","year":"2021","journal-title":"Allergy"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1097\/ACI.0000000000000762","article-title":"Vaccine allergy: Evidence to consider for COVID-19 vaccines","volume":"21","author":"Nilsson","year":"2021","journal-title":"Curr. Opin. Allergy Clin. Immunol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"3308","DOI":"10.1016\/j.jaip.2021.06.010","article-title":"First-Dose mRNA COVID-19 Vaccine Allergic Reactions: Limited Role for Excipient Skin Testing","volume":"9","author":"Wolfson","year":"2021","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2292","DOI":"10.1111\/all.15241","article-title":"Allergies and COVID-19 vaccines: An ENDA\/EAACI Position paper","volume":"77","author":"Barbaud","year":"2022","journal-title":"Allergy"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Kounis, N.G., Koniari, I., Mplani, V., Plotas, P., and Velissaris, D. (Cardiology, 2022). Hypersensitivity myocarditis and the pathogenetic conundrum of COVID 19 Vaccine Related Myocarditis, Cardiology, online ahead of print.","DOI":"10.1159\/000524224"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"100517","DOI":"10.1016\/j.waojou.2021.100517","article-title":"COVID-19 vaccine-associated anaphylaxis: A statement of the World Allergy Organization Anaphylaxis Committee WAO Anaphylaxis Committee","volume":"14","author":"Turner","year":"2021","journal-title":"World Allergy Organ. J."},{"key":"ref_35","unstructured":"Kelso, J.M. (2022, September 05). COVID-19: Allergic reactions to SARS-CoV-2 vaccines. Uptodate. Available online: https:\/\/www.uptodate.com\/contents\/covid-19-allergic-reactions-to-sars-cov-2-vaccines#:~:text=Delayed%20reactions%20(%3E2%20hours%20after,after%20vaccination%20(picture%201)."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e15461","DOI":"10.1111\/dth.15461","article-title":"A systematic review on mucocutaneous presentations after COVID-19 vaccination and expert recommendations about vaccination of important immune-mediated dermatologic disorders","volume":"35","author":"Seirafianpour","year":"2022","journal-title":"Dermatol. Ther."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1111\/jdv.17744","article-title":"Cutaneous findings following COVID-19 vaccination: Review of world literature and own experience","volume":"36","author":"Gambichler","year":"2022","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1390","DOI":"10.1001\/jama.2021.15072","article-title":"Surveillance for Adverse Events After COVID-19 mRNA Vaccination","volume":"326","author":"Klein","year":"2021","journal-title":"JAMA"},{"key":"ref_39","first-page":"S2213-2198(22)00814-5","article-title":"Assessment of immediate allergic reactions after immunization with the Pfizer BNT162b2 vaccine using intradermal skin testing with the COVID-19 vaccines","volume":"13","author":"Shavit","year":"2022","journal-title":"J. Allergy Clin. Immunol. Pract."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/10\/10\/1616\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:40:29Z","timestamp":1760143229000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/10\/10\/1616"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,27]]},"references-count":39,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["vaccines10101616"],"URL":"https:\/\/doi.org\/10.3390\/vaccines10101616","relation":{},"ISSN":["2076-393X"],"issn-type":[{"type":"electronic","value":"2076-393X"}],"subject":[],"published":{"date-parts":[[2022,9,27]]}}}