Older adults, especially men and/or those with diabetes, hypertension, and/or obesity, are prone to severe COVID-19. In some countries, older adults, particularly those residing in nursing homes, have been prioritized to receive COVID-19 vaccines due to high risk of death. In very rare instances, the COVID-19 vaccines can induce anaphylaxis, and the management of anaphylaxis in older people should be considered carefully. An ARIA-EAACI-EuGMS (Allergic Rhinitis and its Impact on Asthma, European Academy of Allergy and Clinical Immunology, and European Geriatric Medicine Society) Working Group has proposed some recommendations for older adults receiving the COVID-19 vaccines. Anaphylaxis to COVID-19 vaccines is extremely rare (from 1 per 100,000 to 5 per million injections). Symptoms are similar in younger and older adults but they tend to be more severe in the older patients. Adrenaline is the mainstay treatment and should be readily available. A flowchart is proposed to manage anaphylaxis in the older patients.

Aix Marseille University IRD APHM MEPHI Marseille France

ALL MED Medical Research Institute Wroclaw Poland

ALL MED Medical Research Institute Wrocław Poland

Allergology and Clinical Immunology Carol Davila University of Medicine and Pharmacy Bucharest Romania

Allergy and Clinical Immunology Imperial College London London UK

Allergy and Clinical Immunology Unit Centro Hospitalar e Universitário de Coimbra Coimbra Portugal

Allergy and Respiratory Diseases Ospedale Policlino San Martino University of Genoa Genoa Italy

Allergy Center CUF Descobertas Hospital Lisbon Portugal

Allergy Department 2nd Pediatric Clinic Athens General Children's Hospital P and A Kyriakou University of Athens Athens Greece

Allergy Department Hospital Clínico San Carlos UCM IdISSC Madrid Spain

Allergy Research Group Instituto de Investigación Biomedica de Malaga IBIMA and ARADyAL Malaga Spain

Allergy Section Department of Internal Medicine Hospital Vall d'Hebron Barcelona Spain

Allergy Unit CUF Porto Porto Portugal

Allergy Unit Department of Clinical and Molecular Sciences Università Politecnica delle Marche Ancona Italy

Allergy Unit Hospital Regional Universitario de Malaga Malaga Spain

Allergy Unit Málaga Regional University Hospital IBIMA Málaga Spain

ARADyAL Research Network Barcelona Spain

Asian Hospital and Medical Center Manilla Philippines

Asthma Reference Center School of Medicine of Santa Casa de Misericórdia of Vitória Espírito Santo Brazil

Asthma UK Centre for Allergic Mechanisms in Asthma London UK

Austria Outpatient Allergy Clinic Reumannplatz Vienna Austria

Center for Rhinology and Allergology Wiesbaden Germany

Center of Allergy and Immunology Georgian Association of Allergology and Clinical Immunology Tbilisi Georgia

Children's Allergy Service Evelina London Children's Hospital Guy'sand St Thomas Hospital London UK

Children's Hospital Srebrnjak Zagreb Croatia

Christine Kühne Center for Allergy Research and Education CK CARE Davos Switzerland

Clinic for Pulmonary Diseases Clinical Center of Serbia Faculty of Medicine University of Belgrade Serbian Association for Asthma and COPD Belgrade Serbia

Clinical and Experimental Respiratory Immunoallergy IDIBAPS CIBERES University of Barcelona Barcelona Spain

Clinical Emergency Hospital for Children MS Curie Bucharest Romania

Clinical Research Center for Allergy and Rheumatology NHO Sagamihara National Hospital Sagamihara Japan

Department of Allergology Medical University of Gdańsk Gdańsk Poland

Department of Allergology Zhongnan Hospital of Wuhan University Wuhan China

Department of Allergy Al Rashed Allergy Center Kuwait City Kuwait

Department of Allergy Immunology and Respiratory Medicine Central Clinical School Monash University Alfred Health Melbourne Vic Australia

Department of Biochemistry and Molecular Biology School of Chemistry Complutense University of Madrid Madrid Spain

Department of Biomedical Sciences Humanitas University Milan Italy

Department of Clinical Immunology and Allergy Oncology Institute of St Elisabeth Bratislava Slovakia

Department of Clinical Immunology Wroclaw Medical University Wroclaw Poland

Department of Clinical Immunology Wrocław Medical University Wroclaw Poland

Department of Dermatology and Allergology University of Helsinki and Helsinki University Helsinki Finland

Department of Dermatology and Allergy Biederstein School of Medicine Technical University of Munich Munich Germany

Department of Dermatology and Allergy Center Odense Research Center for Anaphylaxis Odense University Hospital University of Southern Denmark Odense Denmark

Department of Dermatology and Allergy Centre Odense University Hospital Odense Research Center for Anaphylaxis Odense Denmark

Department of Dermatology and Allergy Comprehensive Allergy Center Charité Universitätsmedizin Berlin Humboldt Universität zu Berlin Berlin Institute of Health Berlin Germany

Department of Dermatology and Venerology Medical University of Graz Graz Austria

Department of ENT Diseases Karolinska University Hospital Stockholm Sweden

Department of Geriatrics CHRU de Nancy and Inserm DCAC Université de Lorraine Nancy France

Department of Geriatrics Montpellier University Hospital Montpellier France

Department of Health Services Research Department of Family Medicine Caphri Care and Public Health Research Institute Maastricht University Maastrich NL USA

Department of Immunology 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

Department of Immunology and Allergology Faculty of Medicine and Faculty Hospital in Pilsen Charles University Prague Pilsen Czech Republic

Department of Infectiology Montpellier University Hospital Montpellier France

Department of Infection and Immunity Luxembourg Institute of Health Esch sur Alzette Luxembourg

Department of Internal Medicine Allergy and Clin Immunology Silesian University of Medicine Katowice Poland

Department of Internal Medicine and Infectious Diseases St Joseph University Hotel Dieu de France Hospital Beirut Lebanon

Department of Internal Medicine and Paediatrics Section of Geriatrics Faculty of Medicine and Health Sciences Ghent University Ghent Belgium

Department of Internal Medicine University Hospital Ospedali Riuniti di Ancona Ancona Italy

Department of Medical Sciences Allergy and Clinical Immunology Unit University of Torino and Mauriziano Hospital Torino Italy

Department of Medical Sciences and Public Health Unit of Allergy and Clinical Immunology University Hospital Duilio Casula University of Cagliari Cagliari Italy

Department of Medicine and Health Research Methods Evidence and Impact McMaster University Hamilton ON Canada

Department of Occupational Diseases and Environmental Health Nofer Institute of Occupational Medicine Lodz Poland

Department of Otolaryngology Head and Neck Surgery Eye and Ear University Hospital Beirut Lebanon

Department of Otolaryngology Head and Neck Surgery Universitätsmedizin Mainz Mainz Germany

Department of Otolaryngology Yong Loo Lin School of Medicine National University of Singapore Singapore Singapore

Department of Otorhinolaryngology Academic Medical Centers AMC Amsterdam The Netherland

Department of Otorhinolaryngology Chiba University Hospital Chiba Japan

Department of Otorhinolaryngology Head and Neck Surgery Section of Rhinology and Allergy University Hospital Marburg Philipps Universität Marburg Marburg Germany

Department of Otorhinolaryngology Head and Neck Surgery Semmelweis University Budapest Hungary

Department of Pediatrics Allergy and Immunology Centre Pantai Hospital Universiti Putra Malaysia Teaching Hospital Kuala Lumpur Malaysia

Department of Pediatrics Medical School Federal University of Minas Gerais Belo Horizonte Brazil

Department of Prevention of Environmental Hazards Allergology and Immunology Medical University of Warsaw Warsaw Poland

Department of Public Health and Research and Development Unit Federico 2 University and Hospital Naples Italy

Department of Pulmonary Diseases Faculty of Medicine Celal Bayar University Manisa Turkey

Department of Pulmonary Diseases Istanbul University Cerrahpasa Cerrahpasa Faculty of Medicine Istanbul Turkey

Department of Pulmonary Medicine CHU Sart Tilman GIGA I3 Research Group Liege Belgium

Department of Respiratory Diseases and Allergy Aarhus University Hospital Aarhus Denmark

Department of Respiratory Medicine Copenhagen University Hospital Hvidovre Institute of Clinical Medicine University of Copenhagen Copenhagen Denmark

Department of Respiratory Medicine National Institute of Diseases of the Chest and Hospital Dhaka Bangladesh

Department of Respiratory Medicine University Hospital Olomouc Olomouc Czech Republic

Department of Women and Children's Health School of Life Course Sciences Faculty of Life Sciences and Medicine King's College London London UK

Departments of Immunology and Dermatology Allergology University Medical Center Utrecht The Netherlands

Director of Center of Allergy Immunology and Respiratory Diseases Santa Fe Argentina

Division of Allergy and Clinical Immunology Department of Medicine Agency of Health ASL Salerno Santa Maria della Speranza Hospital Salerno Italy

Division of Allergy Asthma and Clinical Immunology Emek Medical Center Afula Israel

Division of Allergy Immunology University of South Florida Tampa FL USA

Division of ENT Diseases CLINTEC Karolinska Institutet Stockholm Sweden

Division of Equipe PEPITES Sorbonne Université Institut Pierre Louis d'Epidémiologie et de Santé Publique Paris France

Division of Immunology and Allergic Diseases Department of Internal Medicine Istanbul Faculty of Medicine Istanbul University Istanbul Turkey

Division of Internal Medicine Asthma and Allergy Barlicki University Hospital Medical University of Lodz Lodz Poland

Division of Service de Dermatologie et Allergologie Hôpital Tenon Paris France

Division Paediatric Allergology University of Cape Town Cape Town South Africa

Ecole polytechnique Palaiseau IRBA Bretigny France

EFA European Federation of Allergy and Airways Diseases Patients' Associations Brussels Belgium

Emeritus Geriatrician and Professor of Medical Gerontology Population Health Sciences 1 King's College London London UK

EUFOREA Brussels Belgium

European Academy of Paediatrics (EAP UEMS SP Brussels Belgium

Faculdade de Ciências Médicas CEDOC Universidade Nova de Lisboa Lisbon Portugal

Faculdade de Medicina CINTESIS Center for Health Technology and Services Research Universidade do Porto Porto Portugal

Faculty of Health Sciences CICS UBI Health Sciences Research Centre University of Beira Interior Covilhã Portugal

Faculty of Medicine Fundacion Jimenez Diaz CIBERES Autonoma University of Madrid Madrid Spain

Faculty of Medicine ICBR Coimbra Institute for Clinical and Biomedical Research CIBB University of Coimbra Coimbra Portugal

Faculty of Medicine Transylvania University Brasov Romania

Faculty of Medicine University Children's Hospital University of Belgrade Belgrade Serbia

Faculty of Medicine Vilnius University Institute of Clinical Medicine and Institute of Health Sciences Vilnius Lithuania

Faculty of Public Health Medical University Sofia Bulgaria

Federal University of Pampa Uruguaiana Brazil

Fondazione Mediterranea GB Morgagni Catania Italy

Fundação ProAR Federal University of Bahia and GARD WHO Planning Group Salvador BA Brazil

Geriatria Accettazione Geriatrica e Centro di Ricerca per l'invecchiamento IRCCS INRCA Ancona Italy

Gérontopôle de Toulouse INSERM 1027 Toulouse France

Health Planning Unit Department of Social Medicine Faculty of Medicine University of Crete Crete Greece

Hospital of the Hospitaller Brothers in Buda Budapest Hungary

IHU Méditerranée Infection Marseille and IDESP INSERM University of Montpellier Montpellier France

Immunoallergology Unit Careggi University Hospital Florence Italy

Immunomodulation and Tolerance Group Imperial College London London UK

Imunoalergologia Centro Hospitalar Universitário de Coimbra and Faculty of Medicine University of Coimbra Coimbra Portugal

Institut Desbrest d'Epidémiologie et Santé Publique INSERM et Université de Montpellier Montpellier France

Institute of Biomedical Sciences Department of Pathology Faculty of Medicine Vilnius University Vilnius Lithuania

Institute of Clinical Medicine Aarhus University Aarhus Denmark

Institute of Clinical Medicine Clinic of Chest Diseases and Allergology Faculty of Medicine Vilnius University Vilnius Lithuania

Institute of Immunology Faculty of Medicine University of Coimbra Coimbra Portugal

Institute of Pathophysiology and Allergy Research Center of Pathophysiology Infectiology and Immunology Medical University of Vienna Vienna Austria

Institute of Translational Pharmacology Italian National Research Council Rome Italy

International Airway Research Center Sun Yat sen University 1st Affiliated Hospital Guangzou China

International Primary Care Respiratory Group IPCRG Aberdeen UK

IRCCS Humanitas Research Hospital Personalized Medicine Asthma and Allergy Milan Italy

LANUA International Healthcare Consultancy Down UK

MACVIA France Montpellier France

MEDCIDS Department of Community Medicine Information and Health Decision Sciences Faculty of Medicine University of Porto Porto Portugal

Medical Consulting Czarlewski Levallois France

Medical Faculty University Clinic of Pulmology and Allergy Skopje Republic of Macedonia

Medical University of Graz Graz Austria

Microbiology Department Faculty of Medicine Kuwait University Kuwait City Kuwait

National Research Center Institute of Immunology Federal Medicobiological Agency Laboratory of Molecular Immunology Moscow Russia

Nova Southeastern University Fort Lauderdale FL USA

Oasi Research Institute IRCCS Troina Italy

Paul Ehrlich Institut Langen Germany

Pediatric Allergy and Immunology Unit Children's Hospital Ain Shams University Cairo Egypt

Pediatric Allergy Unit Department of Child and Adolescent Geneva University Hospital Geneva Switzerland

Pediatrics and Child Health Research Institute Central Clinical Hospital of the Russian Academy of Sciences Russian National Research Medical University Moscow Russia

Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences Faculty of Life Sciences and Medicine King's College London London UK

President of Kazakhstan Association of Allergology and Clinical Immunology Department of Allergology and Clinical Immunology Kazakh National Medical University Almaty Kazakhstan

Primary Care and Population Sciences University of Southampton Southampton UK

PROMISE Department University of Palermo Palermo Italy

Pulmonary Division Heart Institute (InCor Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo Sao Paulo Brazil

Rappaport Faculty of Medicine Technion Israel Institute of Technology Haifa Israel

Regional Ministry of Health of Andalusia Seville Spain

Rhinology Unit and Smell Clinic ENT Department Hospital Clínic Barcelona Spain

Royal Brompton and Harefield NHS Foundation Trust London UK

School of Medicine University CEU San Pablo Madrid Spain

School of Medicine University J J Strossmayer Osijek Croatia

Service de Gériatrie CHRU Nice France

Service Gériatrie Clinique Centre Hospitalo Universitaire Grenoble Alpes GREPI (TIMC IMAG CNRS 5525 Université Grenoble Alpes Grenoble France

Servicio de Alergia e Immunologia Clinica Santa Isabel Buenos Aires Argentina

Serviço de Imunoalergologia Hospital de Dona Estefânia Centro Hospitalar de Lisboa Central Lisbon Portugal

Skin and Allergy Hospital Helsinki University Hospital University of Helsinki University Helsinki Finland

Société Française de Gériatrie et Gérontologie Paris France

SOS Allergology and Clinical Immunology USL Toscana Centro Prato Italy

Swiss Institute of Allergy and Asthma Research University of Zurich Davos Switzerland

Tartu University Institute of Clinical Medicine Children's Clinic Tartu Estonia

The Allergy and Asthma Institute Islamabad Pakistan

Ukrainina Medical Stomatological Academy Poltava Ukraine

Universidad Católica de Córdoba Universidad Nacional de Villa Maria Villa Maria Argentina

University Clinic of Respiratory and Allergic Diseases Golnik Slovenia

University Hospital Montpellier France

University Hospital Sv Ivan Rilski' Sofia Bulgaria

University of Bari Medical School Unit of Geriatric Immunoallergology Bari Italy

University of Medicine and Pharmacy Hochiminh City Vietnam

Upper Airways Research Laboratory ENT Department Ghent University Hospital Ghent Belgium

Usher Institute The University of Edinburgh Edinburgh UK

Woolcock Emphysema Centre Sydney Local Health District Glebe NSW Australia

Woolcock Institute of Medical Research University of Sydney Glebe NSW Australia

See more in PubMed

Esteve A, Permanyer I, Boertien D, Vaupel JW. National age and coresidence patterns shape COVID‐19 vulnerability. Proc Natl Acad Sci U S A. 2020;117(28):16118‐16120. PubMed PMC

Giangreco G. Case fatality rate analysis of Italian COVID‐19 outbreak. J Med Virol. 2020;92(7):919‐923. PubMed PMC

Mantovani A, Dalbeni A, Beatrice G. Coronavirus disease 2019 (COVID‐19): we don't leave women alone. Int J Public Health. 2020;65(3):235‐236. PubMed PMC

Iaccarino G, Grassi G, Borghi C, et al. Age and multimorbidity predict death among COVID‐19 patients: results of the SARS‐RAS study of the Italian Society of Hypertension. Hypertension 2020;76(2):366‐372. PubMed

Finucane FM, Davenport C. Coronavirus and obesity: could insulin resistance mediate the severity of COVID‐19 infection? Front Public Health. 2020;8:184. PubMed PMC

Klein SL, Dhakal S, Ursin RL, Deshpande S, Sandberg K, Mauvais‐Jarvis F. Biological sex impacts COVID‐19 outcomes. PLoS Pathog. 2020;16(6):e1008570. PubMed PMC

Gebhard C, Regitz‐Zagrosek V, Neuhauser HK, Morgan R, Klein SL. Impact of sex and gender on COVID‐19 outcomes in Europe. Biol Sex Differ. 2020;11(1):29. PubMed PMC

Barek MA, Aziz MA, Islam MS. Impact of age, sex, comorbidities and clinical symptoms on the severity of COVID‐19 cases: a meta‐analysis with 55 studies and 10014 cases. Heliyon. 2020;6(12):e05684. PubMed PMC

Scortichini M, Schneider Dos Santos R, De’ Donato F, et al. Excess mortality during the COVID‐19 outbreak in Italy: a two‐stage interrupted time‐series analysis. Int J Epidemiol. 2021;49(6):1909–1917. PubMed PMC

Pranata R, Henrina J, Lim MA, et al. Clinical frailty scale and mortality in COVID‐19: A systematic review and dose‐response meta‐analysis. Arch Gerontol Geriatr. 2020;93:104324. PubMed PMC

Hewitt J, Carter B, Vilches‐Moraga A, et al. The effect of frailty on survival in patients with COVID‐19 (COPE): a multicentre, European, observational cohort study. Lancet Public Health. 2020;5(8):e444‐e451. PubMed PMC

McMichael TM, Currie DW, Clark S, et al. Epidemiology of COVID‐19 in a long‐term care facility in King County, Washington. N Engl J Med. 2020;382(21):2005–2011. PubMed PMC

Blain H, Rolland Y, Tuaillon E, et al. Efficacy of a test‐retest strategy in residents and health care personnel of a nursing home facing a COVID‐19 outbreak. J Am Med Dir Assoc. 2020;21(7):933‐936. PubMed PMC

Telford CT, Onwubiko U, Holland D, et al. Mass screening for SARS‐CoV‐2 infection among residents and staff in twenty‐eight long‐term care facilities in Fulton County, Georgia. medRxiv 2020. 10.1101/2020.07.01.20144162 DOI

He M, Li Y, Fang F. Is there a link between nursing home reported quality and COVID‐19 cases? Evidence from California skilled nursing facilities. J Am Med Dir Assoc. 2020;21(7):905‐908. PubMed PMC

Grabowski DC, Mor V. Nursing home care in crisis in the wake of COVID‐19. JAMA 2020;324(1):23. PubMed

Gordon AL, Goodman C, Achterberg W, et al. Commentary: COVID in care homes‐challenges and dilemmas in healthcare delivery. Age Ageing 2020;49(5):701‐705. PubMed PMC

Blain H, Rolland Y, Schols J, et al. August 2020 interim EuGMS guidance to prepare European long‐term care facilities for COVID‐19. Eur Geriatr Med. 2020;11(6):899‐913. PubMed PMC

Banerji A, Wickner PG, Saff R, et al. mRNA vaccines to prevent COVID‐19 disease and reported allergic reactions: current evidence and approach. J Allergy Clin Immunol Pract 2021;9(4):1423–1437. PubMed PMC

Garvey LH, Nasser S. Anaphylaxis to the first COVID‐19 vaccine: is polyethylene glycol (PEG) the culprit? Br J Anaesth 2021;126(3). 10.1016/j.bja.2020.12.020. [Epub ahead of print]. PubMed DOI PMC

Klimek L, Jutel M, Akdis CA, et al. ARIA‐EAACI statement on severe allergic reactions to COVID‐19 vaccines ‐ an EAACI‐ARIA position paper. Allergy. 2021;76(6):1624‐1628. PubMed

Ventura MT, Boni E, Cecere R, et al. Importance of hypersensitivity in adverse reactions to drugs in the elderly. Clin Mol Allergy. 2018;16:7. PubMed PMC

Ruggeberg JU, Gold MS, Bayas JM, et al. Anaphylaxis: case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine. 2007;25(31):5675‐5684. PubMed

Su JR, Moro PL, Ng CS, Lewis PW, Said MA, Cano MV. Anaphylaxis after vaccination reported to the vaccine adverse event reporting system, 1990–2016. J Allergy Clin Immunol. 2019;143(4):1465‐1473. PubMed PMC

Shimabukuro T. COVID‐19 vaccine safety update. Advisory Committee on Immunization Practices (ACIP) January 27, 2021. National Center for Immunization and respiratory diseases CDC https://wwwcdcgov/vaccines/acip/meetings/downloads/slides‐2021‐01/06‐COVID‐Shimabukuropdf. 2021.

Cabanillas B, Akdis C, Novak N. Allergic reactions to the first COVID‐19 vaccine: a potential role of Polyethylene glycol? Allergy 2021;76(6):1617‐1618. PubMed

Shimabukuro T, Nair N. Allergic reactions including anaphylaxis after receipt of the first dose of Pfizer‐BioNTech COVID‐19 vaccine. JAMA 2021;325(8):780. PubMed PMC

Klimek L, Novak N, Cabanillas B, Jutel M, Bousquet J, Akdis CA. Allergenic components of the mRNA‐1273 vaccine for COVID‐19: Possible involvement of polyethlene glycol and IgG‐mediated complement activation. Allergy 2021. 10.1111/all.14794 PubMed DOI PMC

Sokolowska M, Eiwegger T, Ollert M, et al. EAACI statement on the diagnosis, management and prevention of severe allergic reactions to COVID‐19 vaccines. Allergy 2021;76(6):1629‐1639. PubMed PMC

Aurich S, Dolle‐Bierke S, Francuzik W, et al. Anaphylaxis in elderly patients‐data from the European anaphylaxis registry. Front Immunol. 2019;10:750. PubMed PMC

Campbell RL, Hagan JB, Li JT, et al. Anaphylaxis in emergency department patients 50 or 65 years or older. Ann Allergy Asthma Immunol. 2011;106(5):401‐406. PubMed

Ring J, Messmer K. Incidence and severity of anaphylactoid reactions to colloid volume substitutes. Lancet. 1977;1(8009):466‐469. PubMed

Jerschow E, Lin RY, Scaperotti MM, McGinn AP. Fatal anaphylaxis in the United States. 1999‐2010: temporal patterns and demographic associations. J Allergy Clin Immunol. 2014;134(6):1318‐1328.e7. PubMed PMC

Niggemann B, Beyer K. Time for a new grading system for allergic reactions? Allergy. 2016;71(2):135‐136. PubMed

Muraro A, Fernandez‐Rivas M, Beyer K, et al. The urgent need for a harmonized severity scoring system for acute allergic reactions. Allergy. 2018;73(9):1792‐1800. PubMed

Brockow K, Jofer C, Behrendt H, Ring J. Anaphylaxis in patients with mastocytosis: a study on history, clinical features and risk factors in 120 patients. Allergy. 2008;63(2):226‐232. PubMed

Dolle‐Bierke S, Siebenhaar F, Burmeister T, Worm M. Detection of KIT D816V mutation in patients with severe anaphylaxis and normal basal tryptase‐first data from the Anaphylaxis Registry (NORA). J Allergy Clin Immunol. 2019;144(5):1448‐1450.e1. PubMed

Worm M, Francuzik W, Renaudin JM, et al. Factors increasing the risk for a severe reaction in anaphylaxis: an analysis of data from The European Anaphylaxis Registry. Allergy. 2018;73(6):1322‐1330. PubMed

Bilo MB, Martini M, Tontini C, Corsi A, Antonicelli L. Anaphylaxis. Eur Ann Allergy Clin Immunol. 2020;53(01):4. PubMed

Lieberman P, Simons FE. Anaphylaxis and cardiovascular disease: therapeutic dilemmas. Clin Exp Allergy. 2015;45(8):1288‐1295. PubMed

Tejedor‐Alonso MA, Farias‐Aquino E, Perez‐Fernandez E, Grifol‐Clar E, Moro‐Moro M, Rosado‐Ingelmo A. Relationship between anaphylaxis and use of beta‐blockers and angiotensin‐converting enzyme inhibitors: a systematic review and meta‐analysis of observational studies. J Allergy Clin Immunol Pract. 2019;7(3):879‐897.e5. PubMed

Thim T, Krarup NH, Grove EL, Rohde CV, Lofgren B. Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. Int J Gen Med. 2012;5:117‐121. PubMed PMC

Muraro A, Roberts G, Worm M, et al. Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology. Allergy. 2014;69(8):1026‐1045. PubMed

Simons FE, Ebisawa M, Sanchez‐Borges M, et al. 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines. World Allergy Organ J. 2015;8(1):32. PubMed PMC

Simons KJ, Simons FE. Epinephrine and its use in anaphylaxis: current issues. Curr Opin Allergy Clin Immunol. 2010;10(4):354‐361. PubMed

Campbell RL, Bellolio MF, Knutson BD, et al. Epinephrine in anaphylaxis: higher risk of cardiovascular complications and overdose after administration of intravenous bolus epinephrine compared with intramuscular epinephrine. J Allergy Clin Immunol Pract. 2015;3(1):76‐80. PubMed

Bilo MB, Cichocka‐Jarosz E, Pumphrey R, et al. Self‐medication of anaphylactic reactions due to Hymenoptera stings‐an EAACI Task Force Consensus Statement. Allergy. 2016;71(7):931‐943. PubMed

O'Brien ME, Koehl JL, Raja AS, Erickson TB, Hayes BD. Age‐related cardiovascular outcomes in older adults receiving epinephrine for anaphylaxis in the emergency department. J Allergy Clin Immunol Pract. 2019;7(8):2888‐2890. PubMed

Rukma P. Glucagon for refractory anaphylaxis. Am J Ther. 2019;26(6):e755‐e756. PubMed

McLure M, Eastwood K, Parr M, Bray J. A Rapid review of advanced life support guidelines for cardiac arrest associated with anaphylaxis. Resuscitation 2021;159:137–149. PubMed

Lieberman PL. Recognition and first‐line treatment of anaphylaxis. Am J Med. 2014;127(1 Suppl):S6‐11. PubMed

Ring J, Beyer K, Biedermann T, et al. Guideline for acute therapy and management of anaphylaxis: S2 Guideline of the German Society for Allergology and Clinical Immunology (DGAKI), the Association of German Allergologists (AeDA), the Society of Pediatric Allergy and Environmental Medicine (GPA), the German Academy of Allergology and Environmental Medicine (DAAU), the German Professional Association of Pediatricians (BVKJ), the Austrian Society for Allergology and Immunology (OGAI), the Swiss Society for Allergy and Immunology (SGAI), the German Society of Anaesthesiology and Intensive Care Medicine (DGAI), the German Society of Pharmacology (DGP), the German Society for Psychosomatic Medicine (DGPM), the German Working Group of Anaphylaxis Training and Education (AGATE) and the patient organization German Allergy and Asthma Association (DAAB). Allergo J Int. 2014;23(3):96‐112. PubMed PMC