{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T01:58:13Z","timestamp":1792029493876,"version":"4.4.0"},"reference-count":71,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T00:00:00Z","timestamp":1614902400000},"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>Vaccines constitute the most effective medications in public health as they control and prevent the spread of infectious diseases and reduce mortality. Similar to other medications, allergic reactions can occur during vaccination. While most reactions are neither frequent nor serious, anaphylactic reactions are potentially life-threatening allergic reactions that are encountered rarely, but can cause serious complications. The allergic responses caused by vaccines can stem from activation of mast cells via Fc\u03b5 receptor-1 type I reaction, mediated by the interaction between immunoglobulin E (IgE) antibodies against a particular vaccine, and occur within minutes or up to four hours. The type IV allergic reactions initiate 48 h after vaccination and demonstrate their peak between 72 and 96 h. Non-IgE-mediated mast cell degranulation via activation of the complement system and via activation of the Mas-related G protein-coupled receptor X2 can also induce allergic reactions. Reactions are more often caused by inert substances, called excipients, which are added to vaccines to improve stability and absorption, increase solubility, influence palatability, or create a distinctive appearance, and not by the active vaccine itself. Polyethylene glycol, also known as macrogol, in the currently available Pfizer-BioNTech and Moderna COVID-19 mRNA vaccines, and polysorbate 80, also known as Tween 80, in AstraZeneca and Johnson &amp; Johnson COVID-19 vaccines, are excipients mostly incriminated for allergic reactions. This review will summarize the current state of knowledge of immediate and delayed allergic reactions in the currently available vaccines against COVID-19, together with the general and specific therapeutic considerations. These considerations include: The incidence of allergic reactions and deaths under investigation with the available vaccines, application of vaccination in patients with mast cell disease, patients who developed an allergy during the first dose, vasovagal symptoms masquerading as allergic reactions, the COVID-19 vaccination in pregnancy, deaths associated with COVID-19 vaccination, and questions arising in managing of this current ordeal. Careful vaccine-safety surveillance over time, in conjunction with the elucidation of mechanisms of adverse events across different COVID-19 vaccine platforms, will contribute to the development of a safe vaccine strategy. Allergists\u2019 expertise in proper diagnosis and treatment of allergic reactions is vital for the screening of high-risk individuals.<\/jats:p>","DOI":"10.3390\/vaccines9030221","type":"journal-article","created":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T05:03:15Z","timestamp":1614920595000},"page":"221","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":156,"title":["Allergic Reactions to Current Available COVID-19 Vaccinations: Pathophysiology, Causality, and Therapeutic Considerations"],"prefix":"10.3390","volume":"9","author":[{"given":"Nicholas G.","family":"Kounis","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Cardiology, University of Patras Medical School, 26221 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioanna","family":"Koniari","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Cardiology, University Hospital of South Manchester NHS Foundation Trust, Manchester M23 9LT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3022-266X","authenticated-orcid":false,"given":"Cesare","family":"de Gregorio","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Messina Medical School, 98122 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitris","family":"Velissaris","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Patras, 26500 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1680-3062","authenticated-orcid":false,"given":"Konstantinos","family":"Petalas","sequence":"additional","affiliation":[{"name":"Department of Allergology, 251 General Air Force Hospital, 11525 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aikaterini","family":"Brinia","sequence":"additional","affiliation":[{"name":"Allergy Practice, 26221 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6901-3681","authenticated-orcid":false,"given":"Stelios F.","family":"Assimakopoulos","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Infectious Diseases, University of Patras Medical School, 26500 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9598-6954","authenticated-orcid":false,"given":"Christos","family":"Gogos","sequence":"additional","affiliation":[{"name":"Covid-19 Unit, Papageorgiou General Hospital, 56403 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia N.","family":"Kouni","sequence":"additional","affiliation":[{"name":"Speech Therapy Practice, 26221 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George N.","family":"Kounis","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, \u201cSaint Andrews\u201d State General Hospital, 26335 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"GianFranco","family":"Calogiuri","sequence":"additional","affiliation":[{"name":"Pneumonology Department, Civil Hospital \u201cNinettoMelli\u201d, Pietro Vernoti, 72027 Brindisi, Italy"},{"name":"Department of Internal Medicine, Immunology and Infectious Diseases, Section of Allergology and Clinical Immunology, University of Bari Medical School, 70121 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6912-7523","authenticated-orcid":false,"given":"Ming-Yow","family":"Hung","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Cardiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan"},{"name":"Department of Internal Medicine, Division of Cardiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan"},{"name":"Taipei Heart Institute, Taipei Medical University, Taipei 110, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,5]]},"reference":[{"key":"ref_1","first-page":"238","article-title":"Vaccine hypersensitivity\u2014Update and overview","volume":"140","author":"Fritsche","year":"2010","journal-title":"Swiss Med. Wkly."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"50","DOI":"10.7774\/cevr.2014.3.1.50","article-title":"Vaccine allergies","volume":"3","author":"Chung","year":"2014","journal-title":"Clin. Exp. Vaccine Res."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"134","DOI":"10.15585\/mmwr.mm6605e1","article-title":"Advisory Committee on Immunization Practices Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger\u2014United States, 2017","volume":"66","author":"Robinson","year":"2017","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1016\/j.jaci.2015.07.048","article-title":"Risk of anaphylaxis after vaccination in children and adults","volume":"137","author":"McNeil","year":"2016","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_5","unstructured":"(2021, February 01). Available online: http:\/\/www.fda.gov\/BiologicsBloodVaccines\/Vaccines\/ApprovedProducts\/ucm093833.htm."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/j.jaci.2018.01.034","article-title":"Mast cells signal their importance in health and disease","volume":"142","author":"Olivera","year":"2018","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3018","DOI":"10.1093\/eurheartj\/ehaa548","article-title":"Mast cell tryptase level should be checked in all patients with suspected Kounis syndrome","volume":"41","author":"Khan","year":"2020","journal-title":"Eur. Hear. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2694","DOI":"10.1111\/bcp.14112","article-title":"Immune-mediated adverse reactions to vaccines","volume":"85","author":"Stone","year":"2019","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2091","DOI":"10.1016\/j.jaip.2019.02.015","article-title":"Mastocytosis, Quinolones, MRGPRX2, and Anaphylaxis","volume":"7","author":"Weiler","year":"2019","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3027","DOI":"10.3389\/fimmu.2018.03027","article-title":"Mas-Related G Protein-Coupled Receptor-X2 (MRGPRX2) in Drug Hypersensitivity Reactions","volume":"9","author":"Porebski","year":"2018","journal-title":"Front. Immunol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"400","DOI":"10.18176\/jiaci.0562","article-title":"Delayed Hypersensitivity Reactions Caused by Drug Excipients: A Literature Review","volume":"30","author":"Caballero","year":"2020","journal-title":"J. Investig. Allergol. Clin. Immunol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/S1081-1206(10)61024-1","article-title":"Polysorbate 80 in medical products and nonimmunologic anaphylactoid reactions","volume":"95","author":"Coors","year":"2005","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Banerji, A., Wickner, P.G., Saff, R., Stone, C.A., Robinson, L.B., Long, A.A., Wolfson, A.R., Williams, P., Khan, D.A., and Phillips, E. (2020). mRNA Vaccines to Prevent COVID-19 Disease and Reported Allergic Reactions: Current Evidence and Suggested Approach. J. Allergy Clin. Immunol. Pract., 31.","DOI":"10.1016\/j.jaip.2020.12.047"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Neun, B.W., Barenholz, Y., Szebeni, J., and Dobrovolskaia, M.A. (2018). Understanding the Role of Anti-PEG Antibodies in the Complement Activation by Doxil in Vitro. Molecules, 23.","DOI":"10.3390\/molecules23071700"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2302","DOI":"10.1161\/01.CIR.99.17.2302","article-title":"Hemodynamic Changes Induced by Liposomes and Liposome-Encapsulated Hemoglobin in Pigs: A model for pseudoallergic cardiopulmonary reactions to liposomes. Role of complement and inhibition by soluble CR1 and anti-C5a antibody","volume":"99","author":"Szebeni","year":"1999","journal-title":"Circulation"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.jaci.2017.12.971","article-title":"Vaccine-associated hypersensitivity","volume":"141","author":"McNeil","year":"2018","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/j.iac.2014.04.004","article-title":"Vaccine Allergy","volume":"34","author":"Caubet","year":"2014","journal-title":"Immunol. Allergy Clin. N. Am."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2603","DOI":"10.1056\/NEJMoa2034577","article-title":"Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine","volume":"383","author":"Polack","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1038\/nrd.2017.243","article-title":"mRNA vaccines\u2014A new era in vaccinology","volume":"17","author":"Pardi","year":"2018","journal-title":"Nat. Rev. Drug Discov."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1016\/j.jaip.2018.12.003","article-title":"Immediate Hypersensitivity to Polyethylene Glycols and Polysorbates: More Common Than We Have Recognized","volume":"7","author":"Stone","year":"2019","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"9","DOI":"10.2174\/2212707004666161209161535","article-title":"Macrogols: A Misleading Cause of Drug Hypersensitivity Diagnosis","volume":"4","author":"Calogiuri","year":"2018","journal-title":"Clin. Immunol. Endocr. Metab. Drugs"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1007\/s11095-009-0020-2","article-title":"Fluorescent Molecular Rotors as Dyes to Characterize Polysorbate-Containing IgG Formulations","volume":"27","author":"Hawe","year":"2010","journal-title":"Pharm. Res."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Sokolowska, M., Eiwegger, T., Ollert, M., Torres, M.J., Barber, D., Del Giacco, S., Jutel, M., Nadeau, K.C., Palomares, O., and Rabin, R.L. (2021). EAACI statement on the diagnosis, management and prevention of severe allergic reactions to COVID-19 vaccines. Allergy.","DOI":"10.1111\/all.14739"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1016\/S0140-6736(20)31866-3","article-title":"Safety and immunogenicity of an rAd26 and rAd5 vector-based heterologous prime-boost COVID-19 vaccine in two formulations: Two open, non-randomised phase 1\/2 studies from Russia","volume":"396","author":"Logunov","year":"2020","journal-title":"Lancet"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/S1473-3099(20)30831-8","article-title":"Safety and immunogenicity of an inactivated SARS-CoV-2 vaccine, BBIBP-CorV: A randomised, double-blind, placebo-controlled, phase 1\/2 trial","volume":"21","author":"Xia","year":"2021","journal-title":"Lancet Infect Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1038\/s41418-020-00720-9","article-title":"COVID-19 Commission of Accademia Nazionale deiLincei, Rome. COVID-19 vaccines: Where we stand and challenges ahead","volume":"28","author":"Forni","year":"2021","journal-title":"Cell Death Differ."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"585354","DOI":"10.3389\/fimmu.2020.585354","article-title":"A Review of the Progress and Challenges of Developing a Vaccine for COVID-19","volume":"11","author":"Sharma","year":"2020","journal-title":"Front. Immunol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.addr.2020.12.008","article-title":"Non-viral COVID-19 vaccine delivery systems","volume":"169","author":"Park","year":"2021","journal-title":"Adv. Drug Deliv. Rev."},{"key":"ref_29","first-page":"1","article-title":"SARS-CoV-2 vaccines in development","volume":"586","author":"Krammer","year":"2020","journal-title":"Nat. Cell Biol."},{"key":"ref_30","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","volume":"14","author":"Turner","year":"2021","journal-title":"World Allergy Organ. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1159\/000494130","article-title":"Evaluation of the Potential Risk Factors for Drug-Induced Anaphylaxis in Adult Patients","volume":"178","author":"Demir","year":"2018","journal-title":"Int. Arch. Allergy Immunol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"S51","DOI":"10.1007\/s00011-005-0038-9","article-title":"H1- antihistamines and activated blood platelets","volume":"55","author":"Petrikova","year":"2006","journal-title":"Inflamm. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1053\/j.gastro.2020.05.053","article-title":"Famotidine Use Is Associated With Improved Clinical Outcomes in Hospitalized COVID-19 Patients: A Propensity Score Matched Retrospective Cohort Study","volume":"159","author":"Freedberg","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1007\/s40520-020-01570-8","article-title":"The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality","volume":"32","author":"Ilie","year":"2020","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_35","unstructured":"Center for Disease Control and Prevention (2020, July 01). Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine\u2014United States, Available online: https:\/\/www.cdc.gov\/mmwr\/volumes\/70\/wr\/mm7002e1.htm."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.anai.2020.11.003","article-title":"Potential association of mast cells with coronavirus disease 2019","volume":"126","author":"Theoharides","year":"2021","journal-title":"Ann. Allergy, Asthma Immunol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.jaci.2020.06.009","article-title":"Risk and management of patients with mastocytosis and MCAS in the SARS-CoV-2 (COVID-19) pandemic: Expert opinions","volume":"146","author":"Valent","year":"2020","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1016\/j.ijcard.2014.04.191","article-title":"Kounis syndrome following the performance of skin test to amoxicillin","volume":"174","author":"Matito","year":"2014","journal-title":"Int. J. Cardiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1111\/pai.12762","article-title":"Vaccination and allergy: EAACI position paper, practical aspects","volume":"28","author":"Schwarze","year":"2017","journal-title":"Pediatr. Allergy Immunol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"210","DOI":"10.14745\/ccdr.v46i06a10","article-title":"Managing immunization stress-related response: A contributor to sustaining trust in vaccines","volume":"4","author":"McMurtry","year":"2020","journal-title":"Can. Commun. Dis. Rep."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"384","DOI":"10.14745\/ccdr.v46i1112a04","article-title":"Canadian Immunization Guide: \u201cAnaphylaxis and other acute reactions following vaccination\u201d chapter update","volume":"46","author":"Dayneka","year":"2020","journal-title":"Can. Commun. Dis. Rep."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"498","DOI":"10.2105\/AJPH.2020.306045","article-title":"The Costs of Contradictory Messages about Live Vaccines in Pregnancy","volume":"111","author":"Jaffe","year":"2021","journal-title":"Am. J. Public Health"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Laris-Gonz\u00e1lez, A., Bernal-Serrano, D., Jarde, A., and Kampmann, B. (2020). Safety of Administering Live Vaccines during Pregnancy: A Systematic Review and Meta-Analysis of Pregnancy Outcomes. Vaccines, 8.","DOI":"10.3390\/vaccines8010124"},{"key":"ref_44","unstructured":"Centers for Disease Control and Prevention (CDC) (2021, January 25). Interim considerations: Preparing for the Potential Management of Anaphylaxis after COVID-19 Vaccination. Updated 31 December 2020, Available online: https:\/\/www.cdc.gov\/vaccines\/covid-19\/info-by-product\/pfizer\/anaphylaxis-management.html."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.15585\/mmwr.mm695152e2","article-title":"The Advisory Committee on Immunization Practices\u2019 Updated Interim Recommendation for Allocation of COVID-19 Vaccine\u2014United States, December 2020","volume":"69","author":"Dooling","year":"2021","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"26","DOI":"10.5414\/ALX02215E","article-title":"Severe allergic reactions to the COVID-19 vaccine\u2014statement and practical consequences","volume":"5","author":"Klimek","year":"2021","journal-title":"Allergol. Sel."},{"key":"ref_47","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_48","doi-asserted-by":"crossref","unstructured":"(2021). Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Moderna COVID-19 Vaccine\u2014United States, 21 December 2020\u201310 January 2021. MMWR. Morb. Mortal. Wkly. Rep., 70, 125\u2013129.","DOI":"10.15585\/mmwr.mm7004e1"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"805","DOI":"10.2217\/fca.11.63","article-title":"Kounis syndrome: A new twist on an old disease","volume":"7","author":"Kounis","year":"2011","journal-title":"Futur. Cardiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"14","DOI":"10.3325\/cmj.2017.58.14","article-title":"Vaccination and anaphylaxis: A forensic perspective","volume":"58","author":"Palmiere","year":"2017","journal-title":"Croat. Med. J."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"240","DOI":"10.4103\/0976-9668.136145","article-title":"The more allergens an atopic patient is exposed to, the easier and quicker anaphylactic shock and Kounis syndrome appear: Clinical and therapeutic paradoxes","volume":"5","author":"Kounis","year":"2014","journal-title":"J. Nat. Sci. Biol. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1366","DOI":"10.1111\/j.1398-9995.2006.01211.x","article-title":"Simultaneous exposure of several allergens has an additive effect on multisensitized basophils","volume":"61","author":"Nopp","year":"2006","journal-title":"Allergy"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1016\/j.ymthe.2021.01.030","article-title":"Allergic Reactions and Anaphylaxis to LNP-Based COVID-19 Vaccines","volume":"29","author":"Moghimi","year":"2021","journal-title":"Mol. Ther."},{"key":"ref_54","first-page":"1126","article-title":"Suspicions grow that nanoparticles in Pfizer\u2019s COVID-19 vaccine trigger rare allergic reactions","volume":"21","author":"Vrieze","year":"2020","journal-title":"Science"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"n149","DOI":"10.1136\/bmj.n149","article-title":"Covid-19: Norway investigates 23 deaths in frail elderly patients after vaccination","volume":"372","author":"Torjesen","year":"2021","journal-title":"BMJ"},{"key":"ref_56","unstructured":"Teraldsen, L.E. (2021, January 16). Norway Raises Concern over Vaccine Jabs for the Elderly. Bloomberg. Available online: https:\/\/www.bloombergquint.com\/politics\/norway-vaccine-fatalities-among-people-75-and-older-rise-to-29."},{"key":"ref_57","unstructured":"(2021, January 14). Zusammenhang Unwahrscheinlich: InstitutPr\u00fcftZehnTodesf\u00e4lleNachImpfung [German]. NTV. Available online: www.n-tv.de\/panorama\/Institut-prueft-zehn-Todesfaelle-nach-Impfung-article22292066.html."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.forsciint.2017.11.001","article-title":"Specific IgE levels in pericardial and cerebrospinal fluids in forensic casework: The presence of additional molecules for sudden cardiac death diagnosis","volume":"282","author":"Kounis","year":"2018","journal-title":"Forensic Sci. Int."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1007\/s00134-020-06059-6","article-title":"Facing COVID-19 in the ICU: Vascular dysfunction, thrombosis, and dysregulated inflammation","volume":"46","author":"Leisman","year":"2020","journal-title":"Intensiv. Care Med."},{"key":"ref_60","unstructured":"Aydin, S., and Aydin, S. (2020). Could Antihistamines Help in the Treatment and Spread of COVID-19 via re-Modulating Cytokines and by Reducing Sneezing?. Sci. Nutr. Health, 172\u2013173. Available online: https:\/\/actascientific.com\/ASNH\/ASNH-04-0684.php."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1159\/000053758","article-title":"Effect of the H1 receptor antagonist cetirizine on the stimulated expression of adhesion molecules and the activation of NF\u03baB in human endothelial cells","volume":"124","author":"Ambrosch","year":"2001","journal-title":"Int. Arch. Allergy Immunol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.antiviral.2017.06.015","article-title":"Identification of a coumarin-based antihistamine-like small molecule as an anti-filoviral entry inhibitor","volume":"145","author":"Cheng","year":"2017","journal-title":"Antivir. Res."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"282ra49","DOI":"10.1126\/scitranslmed.3010286","article-title":"Repurposing of the antihistamine chlorcyclizine and related compounds for treatment of hepatitis C virus infection","volume":"7","author":"He","year":"2015","journal-title":"Sci. Transl. Med."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"101989","DOI":"10.1016\/j.pupt.2021.101989","article-title":"Antihistamines and azithromycin as a treatment for COVID-19 on primary health care\u2014A retrospective observational study in elderly patients","volume":"67","author":"Alvarenga","year":"2021","journal-title":"Pulm. Pharmacol. Ther."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Palma, G., Pasqua, T., Silvestri, G., Rocca, C., Gualtieri, P., Barbieri, A., De Bartolo, A., De Lorenzo, A., Angelone, T., and Avolio, E. (2020). PI3K\u03b4 Inhibition as a Potential Therapeutic Target in COVID-19. Front. Immunol., 11.","DOI":"10.3389\/fimmu.2020.02094"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/j.atherosclerosis.2016.05.045","article-title":"Serum IgE levels in coronary artery disease","volume":"251","author":"Kounis","year":"2016","journal-title":"Atherosclerosis"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.atherosclerosis.2016.05.020","article-title":"Serum IgE levels are associated with coronary artery disease severity","volume":"251","author":"Guo","year":"2016","journal-title":"Atherosclerosis"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Min, K.-B., and Min, J.-Y. (2019). Risk of Cardiovascular Mortality in Relation to Increased Total Serum IgE Levels in Older Adults: A Population-Based Cohort Study. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16224350"},{"key":"ref_69","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_70","first-page":"337","article-title":"Is Vaccination Against IgE Possible?","volume":"409","author":"Hellman","year":"1996","journal-title":"Results Probl. Cell Differ."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"6107","DOI":"10.1016\/j.vaccine.2013.09.066","article-title":"Immediate hypersensitivity reactions following monovalent 2009 pandemic influenza A (H1N1) vaccines: Reports to VAERS","volume":"31","author":"Halsey","year":"2013","journal-title":"Vaccine"}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/9\/3\/221\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:33:13Z","timestamp":1760160793000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/9\/3\/221"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,5]]},"references-count":71,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["vaccines9030221"],"URL":"https:\/\/doi.org\/10.3390\/vaccines9030221","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,5]]}}}