Abstract
Background: Vaccinations against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) are intended to induce an immune response to protect against infection/disease. Allergen immunotherapy (AIT) is thought to induce a (different) immune response, e.g., to induce tolerance to allergens. In this position paper we clarify how to use AIT in temporal relation to COVID-19 vaccination. Four SARS-CoV-2 vaccines are currently approved in the EU, and their possible immunological interactions with AIT are described together with practical recommendations for use. Materials and methods: Based on the internationally published literature, this position paper provides specific recommendations for the use of AIT in temporal relation to a SARS-CoV-2 vaccination. Results: AIT is used in 1) allergic rhinitis, 2) allergic bronchial asthma, 3) insect venom allergy, 4) food allergy (peanut). Conclusion: For the continuation of an ongoing AIT, we recommend an interval of 1 week before and after vaccination for subcutaneous immunotherapy (SCIT). For sublingual immunotherapy (SLIT) and oral immunotherapy (OIT), we recommend taking them up to the day before vaccination and a break of 2 – 7 days after vaccination. Initiation of a new SCIT, SLIT, or OIT should be delayed until 1 week after the day of the second vaccination. For SCIT, we generally recommend an interval of ~ 1 week to COVID-19 vaccination.
Highlights
Allergen immunotherapyAllergen immunotherapy (AIT) is the only causally effective therapy for which long-term clinical benefit has been demonstrated in allergic respiratory diseases, for example, allergic bronchial asthma or allergic rhinoconjunctivitis and other allergic diseases [1]
For the continuation of an ongoing Allergen immunotherapyAllergen immunotherapy (AIT), we recommend an interval of 1 week before and after vaccination for subcutaneous immunotherapy (SCIT)
Systematic meta-analyses have confirmed that AIT significantly reduces symptoms of allergic disease and the amount of necessary antisymptomatic medication in patients with allergic asthma [4] and allergic rhinoconjunctivitis [5]
Summary
Allergen immunotherapy (AIT) is the only causally effective therapy for which long-term clinical benefit has been demonstrated in allergic respiratory diseases, for example, allergic bronchial asthma or allergic rhinoconjunctivitis and other allergic diseases [1]. Based on the technical and directions for use of the four approved COVID-19 vaccines, AIT is not a contraindication [27, 28, 29, 30] On this basis, scientific societies have published recommendations for COVID-19 vaccinations for patients undergoing biologic therapy [25, 26, 64]. Vaccines against viral infectious diseases are designed to induce humoral and cellular immune responses against the vaccinated antigen. BNT162b2 and mRNA-1273 are mRNA-based vaccines that do not introduce the antigen against which an immune response is to be induced (surface protein of the SARS-CoV-2 virus) but the blueprint (the mRNA) to produce the target protein in human cells. There is no evidence that they are increased under AIT [25, 40]
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