COVID-19 vaccination and allergen immunotherapy (AIT) - A position paper of the German Society for Applied Allergology (AeDA) and the German Society for Allergology and Clinical Immunology (DGAKI)

Ludger Klimek; Oliver Pfaar; Eckard Hamelmann; Jörg Kleine-Tebbe; Christian Taube; Martin Wagenmann; Thomas Werfel; Randolf Brehler; Natalija Novak; Norbert Mülleneisen; Sven Becker; Margitta Worm

doi:10.5414/ALX02245E

COVID-19 vaccination and allergen immunotherapy (AIT) - A position paper of the German Society for Applied Allergology (AeDA) and the German Society for Allergology and Clinical Immunology (DGAKI)

Allergol Select. 2021 Aug 24:5:251-259. doi: 10.5414/ALX02245E. eCollection 2021.

Authors

Ludger Klimek¹, Oliver Pfaar², Eckard Hamelmann³, Jörg Kleine-Tebbe⁴, Christian Taube⁵, Martin Wagenmann⁶, Thomas Werfel⁷, Randolf Brehler^{1

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12}, Natalija Novak⁹, Norbert Mülleneisen¹⁰, Sven Becker¹¹, Margitta Worm¹²

Affiliations

¹ Center for Rhinology and Allergology, Wiesbaden.
² Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg.
³ University Hospital for Pediatrics and Adolescent Medicine, Children's Center Bethel, University of Bielefeld.
⁴ Allergy Center Westend, Berlin.
⁵ Department of Pneumology, University Hospital Essen - Ruhrlandklinik, Essen.
⁶ Department of Otorhinolaryngology, University Hospital Düsseldorf, Düsseldorf.
⁷ Department of Dermatology, Allergology and Venerology, Hanover Medical School.
⁸ Department of Dermatology, University Hospital Münster, Division of Allergology, Occupational Dermatology and Environmental Medicine, Münster.
⁹ Department of Dermatology and Allergy, Polyclinic for Dermatology and Allergology, Bonn.
¹⁰ Asthma and Allergy Center, Leverkusen.
¹¹ Clinic for Otorhinolaryngology, University Hospital, Tübingen, and.
¹² Allergology and Immunology, Clinic for Dermatotology, Venerology and Allergology, Charité Universitätsmedizin Berlin, Germany.

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.

Keywords: COVID-19; SARS-CoV-2; allergen immunotherapy; allergic rhinitis; asthma.