Abstract

Background: After the beginning and during the worldwide pandemic caused by the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), patients with allergic and atopic diseases have felt and still feel insecure. Currently, four vaccines against SARS-CoV-2 have been approved by the Paul Ehrlich Institute in Germany, and vaccination campaigns have been started nationwide. In this respect, it is of utmost importance to give recommendations on possible immunological interactions and potential risks of immunomodulatory substances (monoclonal antibodies, biologicals) during concurrent vaccination with the approved vaccines. Materials and methods: This position paper provides specific recommendations on the use of immunomodulatory drugs in the context of concurrent SARS-CoV-2 vaccinations based on current literature. Results: The recommendations are covering the following conditions in which biologicals are indicated and approved: 1) chronic inflammatory skin diseases (atopic dermatitis, chronic spontaneous urticaria), 2) bronchial asthma, and 3) chronic rhinosinusitis with nasal polyps (CRSwNP). Patients with atopic dermatitis or chronic spontaneous urticaria are not at increased risk for allergic reactions after COVID-19 vaccination. Nevertheless, vaccination may result in transient eczema exacerbation due to general immune stimulation. Vaccination in patients receiving systemic therapy with biologicals can be performed. Patients with severe asthma and concomitant treatment with biologicals also do not have an increased risk of allergic reaction following COVID-19 vaccination which is recommended in these patients. Patients with CRSwNP are also not known to be at increased risk for allergic vaccine reactions, and continuation or initiation of a treatment with biologicals is also recommended with concurrent COVID-19 vaccination. In general, COVID-19 vaccination should be given within the interval between two applications of the respective biological, that is, with a time-lag of at least 1 week after the previous or at least 1 week before the next biological treatment planned. Conclusion: Biologicals for the treatment of atopic dermatitis, chronic spontaneous urticaria, bronchial asthma, and CRSwNP should be continued during the current COVID-19 vaccination campaigns. However, the intervals of biological treatment may need to be slightly adjusted (DGAKI/AeDA recommendations as of March 22, 2021).

Author Details

Authors

• Oliver Pfaar¹
• Ludger Klimek²
• Eckard Hamelmann³
• Jörg Kleine-Tebbe⁴
• Christian Taube⁵
• Martin Wagenmann⁶
• Thomas Werfel⁷
• Randolf Brehler⁸
• Natalija Novak⁹
• Norbert Mülleneisen¹⁰
• Sven Becker¹¹
• Margitta Worm¹²

Departments

• ¹ Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg,
• ² Center for Rhinology and Allergology, Wiesbaden,
• ³ University Hospital for Pediatrics and Adolescent Medicine, Children’s Center Bethel, University of Bielefeld,
• ⁴ Allergy Center Westend, Berlin,
• ⁵ Clinic of Pneumology University Hospital Essen – Ruhrlandklinik, Essen,
• ⁶ Clinic of Otolaryngology, University Hospital Düsseldorf, Düsseldorf,
• ⁷ Department of Dermatology, Allergology and Venerology, Hannover Medical School, Hannover,
• ⁸ Department of Dermatology, Wilhelm University of Münster, Münster,
• ⁹ Department of Dermatology and Allergology, Bonn,
• ¹ 
• ⁰ Allergy and Asthma Center, Leverkusen,
• ¹ 
• ¹ Department of Otorhinolaryngology, University Hospital, Tübingen, and
• ¹ 
• ² Allergology and Immunology, Department of Dermatotology, Venereology and Allergology, Charité Universitätsmedizin Berlin, Germany

Address

Prof. Dr. med. Oliver Pfaar, Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Baldingerstraße, 35043 Marburg, Germany
Email: [email protected]

Citation