. 2021 Nov;76(11):3504-3516.

doi: 10.1111/all.14793. Epub 2021 Aug 25.

COVID-19 pandemic and allergen immunotherapy-an EAACI survey

Oliver Pfaar¹, Ioana Agache^{2

3}, Matteo Bonini^{4

5}, Helen Annaruth Brough^{6

7}, Tomás Chivato⁸, Stefano R Del Giacco⁹, Radoslaw Gawlik¹⁰, Aslı Gelincik¹¹, Karin Hoffmann-Sommergruber¹², Marek Jutel^{13

14}, Ludger Klimek¹⁵, Edward F Knol¹⁶, Antti Lauerma¹⁷, Markus Ollert^{18

19}, Liam O'Mahony²⁰, Charlotte G Mortz¹⁸, Oscar Palomares²¹, Carmen Riggioni^{22

23}, Jürgen Schwarze²⁴, Isabel Skypala^{5

25}, María José Torres²⁶, Eva Untersmayr¹², Jolanta Walusiak-Skorupa²⁷, Adam Chaker²⁸, Mattia Giovannini²⁹, Enrico Heffler^{30

31}, Erika Jensen-Jarolim^{12

32}, Cristina Quecchia³³, Mónica Sandoval-Ruballos^{23

34}, Umit Sahiner³⁵, Vesna Tomić Spirić^{36

37}, Montserrat Alvaro-Lozano^{23

34

38}

Affiliations

¹ Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
² Transylvania University, Brasov, Romania.
³ Theramed Medical Center, Brasov, Romania.
⁴ Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
⁵ National Heart and Lung Institute (NHLI), Imperial College London, London, UK.
⁶ Children's Allergy Service, Evelina Children's Hospital, Guy's and St, Thomas, Hospital NHS Foundation Trust, London, UK.
⁷ Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.
⁸ School of Medicine, University CEU San Pablo Madrid, Spain.
⁹ Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
¹⁰ Department of Internal Medicine, Allergology, Clinical Immunology, Medical University of Silesia, Katowice, Poland.
¹¹ Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
¹² Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
¹³ Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland.
¹⁴ ALL-MED Medical Research Institute, Wrocław, Poland.
¹⁵ Center for Rhinology and Allergology, Wiesbaden, Germany.
¹⁶ Departments of Immunology and Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
¹⁷ Department of Dermatology and Allergology, Helsinki University Hospital Inflammation Centre, University of Helsinki, Helsinki, Finland.
¹⁸ Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, University of Southern Denmark, Odense, Denmark.
¹⁹ Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.
²⁰ Departments of Medicine and Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland.
²¹ Department of Biochemistry and Molecular Biology, Chemistry School, Complutense University of Madrid, Madrid, Spain.
²² Allergy and Clinical Immunology, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
²³ Institut de Recerca Sant Joan de Déu, Barcelona, Spain.
²⁴ Centre for Inflammation Research and Child Life and Heath, the University of Edinburgh, Edinburgh, UK.
²⁵ Royal Brompton and Harefield NHS Foundation Trust, London, UK.
²⁶ Allergy Unit, Malaga Regional University Hospital-UMA-ARADyAL, Málaga, Spain.
²⁷ Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland.
²⁸ Department of Otolaryngology and Center of Allergy and Environment, TUM School of Medicine, Technical University of Munich, Munich, Germany.
²⁹ Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy.
³⁰ Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Hospital IRCCS, Rozzano, MI, Italy.
³¹ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
³² The Interuniversity Messerli Research Institute, University of Veterinary Medicine, Vienna, Medical University Vienna, Vienna, Austria.
³³ "Io e l'Asma" Center, Children's Hospital, ASST Spedali Civili, Brescia, Italy.
³⁴ Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain.
³⁵ Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey.
³⁶ Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
³⁷ Clinic of Allergology and Immunology, Clinical Centre of Serbia, Belgrade, Serbia.
³⁸ Universitat de Barcelona, Barcelona, Spain.

PMID: 33655519
PMCID: PMC8013670
DOI: 10.1111/all.14793

COVID-19 pandemic and allergen immunotherapy-an EAACI survey

Oliver Pfaar et al. Allergy. 2021 Nov.

. 2021 Nov;76(11):3504-3516.

doi: 10.1111/all.14793. Epub 2021 Aug 25.

Authors

Affiliations

¹ Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany.
² Transylvania University, Brasov, Romania.
³ Theramed Medical Center, Brasov, Romania.
⁴ Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
⁵ National Heart and Lung Institute (NHLI), Imperial College London, London, UK.
⁶ Children's Allergy Service, Evelina Children's Hospital, Guy's and St, Thomas, Hospital NHS Foundation Trust, London, UK.
⁷ Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK.
⁸ School of Medicine, University CEU San Pablo Madrid, Spain.
⁹ Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
¹⁰ Department of Internal Medicine, Allergology, Clinical Immunology, Medical University of Silesia, Katowice, Poland.
¹¹ Department of Internal Medicine, Division of Immunology and Allergic Diseases, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
¹² Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
¹³ Department of Clinical Immunology, Wrocław Medical University, Wroclaw, Poland.
¹⁴ ALL-MED Medical Research Institute, Wrocław, Poland.
¹⁵ Center for Rhinology and Allergology, Wiesbaden, Germany.
¹⁶ Departments of Immunology and Dermatology/Allergology, University Medical Center Utrecht, Utrecht, The Netherlands.
¹⁷ Department of Dermatology and Allergology, Helsinki University Hospital Inflammation Centre, University of Helsinki, Helsinki, Finland.
¹⁸ Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital, University of Southern Denmark, Odense, Denmark.
¹⁹ Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg.
²⁰ Departments of Medicine and Microbiology, APC Microbiome Ireland, University College Cork, Cork, Ireland.
²¹ Department of Biochemistry and Molecular Biology, Chemistry School, Complutense University of Madrid, Madrid, Spain.
²² Allergy and Clinical Immunology, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
²³ Institut de Recerca Sant Joan de Déu, Barcelona, Spain.
²⁴ Centre for Inflammation Research and Child Life and Heath, the University of Edinburgh, Edinburgh, UK.
²⁵ Royal Brompton and Harefield NHS Foundation Trust, London, UK.
²⁶ Allergy Unit, Malaga Regional University Hospital-UMA-ARADyAL, Málaga, Spain.
²⁷ Department of Occupational Diseases and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland.
²⁸ Department of Otolaryngology and Center of Allergy and Environment, TUM School of Medicine, Technical University of Munich, Munich, Germany.
²⁹ Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital, Florence, Italy.
³⁰ Personalized Medicine, Asthma and Allergy - Humanitas Clinical and Research Hospital IRCCS, Rozzano, MI, Italy.
³¹ Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
³² The Interuniversity Messerli Research Institute, University of Veterinary Medicine, Vienna, Medical University Vienna, Vienna, Austria.
³³ "Io e l'Asma" Center, Children's Hospital, ASST Spedali Civili, Brescia, Italy.
³⁴ Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain.
³⁵ Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey.
³⁶ Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
³⁷ Clinic of Allergology and Immunology, Clinical Centre of Serbia, Belgrade, Serbia.
³⁸ Universitat de Barcelona, Barcelona, Spain.

PMID: 33655519
PMCID: PMC8013670
DOI: 10.1111/all.14793

Abstract

Background: As in many fields of medical care, the coronavirus disease 2019 (COVID-19) resulted in an increased uncertainty regarding the safety of allergen immunotherapy (AIT). Therefore, the European Academy of Allergy and Clinical Immunology (EAACI) aimed to analyze the situation in different countries and to systematically collect all information available regarding tolerability and possible amendments in daily practice of sublingual AIT (SLIT), subcutaneous AIT (SCIT) for inhalant allergies and venom AIT.

Methods: Under the framework of the EAACI, a panel of experts in the field of AIT coordinated by the Immunotherapy Interest Group set-up a web-based retrospective survey (SurveyMonkey^® ) including 27 standardized questions on practical and safety aspects on AIT in worldwide clinical routine.

Results: 417 respondents providing AIT to their patients in daily routine answered the survey. For patients (without any current symptoms to suspect COVID-19), 60% of the respondents informed of not having initiated SCIT (40% venom AIT, 35% SLIT) whereas for the maintenance phase of AIT, SCIT was performed by 75% of the respondents (74% venom AIT, 89% SLIT). No tolerability concern arises from this preliminary analysis. 16 physicians reported having performed AIT despite (early) symptoms of COVID-19 and/or a positive test result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Conclusions: This first international retrospective survey in atopic diseases investigated practical aspects and tolerability of AIT during the COVID-19 pandemic and gave no concerns regarding reduced tolerability under real-life circumstances. However, the data indicate an undertreatment of AIT, which may be temporary, but could have a long-lasting negative impact on the clinical care of allergic patients.

Keywords: COVID-19; SARS-CoV-2; allergen immunotherapy (AIT); pandemic; survey.

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Conflict of interest statement

Dr. Pfaar reports grants and personal fees from ALK‐Abelló, grants and personal fees from Allergopharma, grants and personal fees from Stallergenes Greer, grants and personal fees from HAL Allergy Holding B.V./HAL Allergie GmbH, grants and personal fees from Bencard Allergie GmbH/Allergy Therapeutics, grants and personal fees from Lofarma, grants from Biomay, grants from Circassia, grants and personal fees from ASIT Biotech Tools S.A., grants and personal fees from Laboratorios LETI/LETI Pharma, personal fees from MEDA Pharma/MYLAN, grants and personal fees from Anergis S.A., personal fees from Mobile Chamber Experts (a GA2LEN Partner), personal fees from Indoor Biotechnologies, grants and personal fees from GlaxoSmithKline, personal fees from Astellas Pharma Global, personal fees from EUFOREA, personal fees from ROXALL Medizin, personal fees from Novartis, personal fees from Sanofi‐Aventis and Sanofi‐Genzyme, personal fees from Med Update Europe GmbH, personal fees from streamedup! GmbH, grants from Pohl‐Boskamp, grants from Inmunotek S.L., personal fees from John Wiley and Sons AS, personal fees from Paul‐Martini‐Stiftung (PMS), all outside the submitted work. Dr. Brough discloses personal speaker fees from DBV Technologies and Sanofi outside of the submitted work. Dr. Ollert reports personal fees from Hycor Biomedical, other from Tolerogenics SarL, outside the submitted work; In addition, Dr. Ollert has a patent WO2019/076478Al pending, and a patent WO2019/076477Al pending. Dr. Palomares reports research grants from Inmunotek S.L., Novartis and MINECO. Dr. Palomares has received fees for giving scientific lectures or participation in Advisory Boards from Allergy Therapeutics, Amgen, AstraZeneca, Diater, GlaxoSmithKline, S.A, Inmunotek S.L, Novartis, Sanofi‐Genzyme and Stallergenes. Dr. Schwarze reports personal fees from MYLAN, outside the submitted work; and as EAACI Secretary General involved in acquisition of industrial sponsorship as listed on EAACI website. Dr. Chaker reports grants for clinical studies and research and other from Allergopharma, ALK Abello, AstraZeneca, Bencard / Allergen Therapeutics, ASIT Biotech, Immunotek, Lofarma, GSK, Novartis, LETI, Roche, Sanofi Genzyme, Zeller and from the European Institute of Technology (EIT); has received travel support from the European Academy of Allergy and Clinical Immunology (EAACI) and DGAKI, all outside the submitted work. In addition, Dr. Chaker has a patent A ratio of immune cells as prognostic indicator of therapeutic success in allergen‐specific immunotherapy: 17 177 681.8 not licensed at present. Dr. Heffler reports personal fees from Sanofi, personal fees from AstraZeneca, personal fees from GSK, personal fees from Novartis, personal fees from Circassia, personal fees from Stallergenes Greer, personal fees from Nestlè Purina, outside the submitted work. Dr. Quecchia reports personal fees from Stallergenes Greer, outside the submitted work. Dr. Agache reports Associate Editor Allergy and PAI. Dr. Radoslaw reports and personal fees from Allergopharma, HAL Allergy, ALK‐Abello. Dr. Jensen‐Jarolim reports other from Biomedical Int. R + D, Vienna, grants, personal fees and other from Bencard Allergie, Germany, other from AllergyTherapeutics, UK, personal fees and other from Vifor Pharma, personal fees from Meda Pharma, personal fees from Sanofi, personal fees from Dr. Schär, outside the submitted work. Dr. Jutel reports personal fees from ALK‐Abello, personal fees from Allergopharma, personal fees from Stallergenes, personal fees from Anergis, personal fees from Allergy Therapeutics, personal fees from Circassia, personal fees from Leti, personal fees from Biomay, personal fees from HAL, during the conduct of the study; personal fees from Astra‐Zeneka, personal fees from GSK, personal fees from Novartis, personal fees from Teva, personal fees from Vectura, personal fees from UCB, personal fees from Takeda, personal fees from Roche, personal fees from Janssen, personal fees from Medimmune, personal fees from Chiesi, outside the submitted work. Dr. Klimek reports grants and personal fees from Allergopharma, grants and personal fees from MEDA/Mylan, personal fees from HAL Allergie, personal fees from ALK Abelló, grants and personal fees from LETI Pharma, grants and personal fees from Stallergenes, grants from Quintiles, grants and personal fees from Sanofi, grants from ASIT biotech, grants from Lofarma, personal fees from Allergy Therapeut., grants from AstraZeneca, grants and personal fees from GSK, grants from Inmunotek, personal fees from Cassella med, personal fees from Novartis, outside the submitted work; and Membership: AeDA, DGHNO, Deutsche Akademie für Allergologie und klinische Immunologie, HNO‐BV, GPA, EAACI. Dr. Torres reports personal fees from Diater, Aimmune Therapeutics and Leti laboratories, grants from European Commission, MINECO and ISCIII of Spanish Government and SEAIC, outside the submitted work. Dr. Bonini, Dr. Chivato, Dr. Del Giacco, Dr. Gawlik, Dr. Gelincik, Dr. Hoffmann‐Sommergruber, Dr. Knol, Dr. Lauerma, Dr. O’Mahony, Dr. Mortz, Dr. Riggioni, Dr. Skypala, Dr. Untersmayr, Dr. Walusiak‐Skorupa, Dr. Giovannini, Dr. Sandoval‐Ruballos, Dr. Sahiner, Dr. Tomić Spirić, Dr. Alvaro‐Lozano have nothing to disclose.

Figures

**FIGURE 1**
Continental distribution of respondents of survey

**FIGURE 2**
Continuation of AIT in patients without symptoms to suspect COVID‐19. Abbreviations: SCIT, subcutaneous immunotherapy; SLIT, sublingual immunotherapy

**FIGURE 3**
Consequences for AIT practical considerations in second half of 2020 (if the risk for SARS‐CoV‐2 transmission persists). Abbreviations: AIT, allergen immunotherapy; HCPs, healthcare providers, SARS‐CoV‐2, severe acute respiratory syndrome coronavirus 2; SCIT, subcutaneous immunotherapy; SLIT, sublingual immunotherapy

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COVID-19 pandemic and allergen immunotherapy-an EAACI survey

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COVID-19 pandemic and allergen immunotherapy-an EAACI survey

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Conflict of interest statement

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