BACKGROUND: Anaphylaxis, which is rare, has been reported after COVID-19 vaccination, but its management is not standardized. METHOD: Members of the European Network for Drug Allergy and the European Academy of Allergy and Clinical Immunology interested in drug allergy participated in an online questionnaire on pre-vaccination screening and management of allergic reactions to COVID-19 vaccines, and literature was analysed. RESULTS: No death due to anaphylaxis to COVID-19 vaccines has been confirmed in scientific literature. Potential allergens, polyethylene glycol (PEG), polysorbate and tromethamine are excipients. The authors propose allergy evaluation of persons with the following histories: 1-anaphylaxis to injectable drug or vaccine containing PEG or derivatives; 2-anaphylaxis to oral/topical PEG containing products; 3-recurrent anaphylaxis of unknown cause; 4-suspected or confirmed allergy to any mRNA vaccine; and 5-confirmed allergy to PEG or derivatives. We recommend a prick-to-prick skin test with the left-over solution in the suspected vaccine vial to avoid waste. Prick test panel should include PEG 4000 or 3500, PEG 2000 and polysorbate 80. The value of in vitro test is arguable. CONCLUSIONS: These recommendations will lead to a better knowledge of the management and mechanisms involved in anaphylaxis to COVID-19 vaccines and enable more people with history of allergy to be vaccinated.

Allergology and Clinical Immunology Department Centre Hospitalier Lyon Sud Pierre Bénite France

Allergy and Clinical Immunology Department Centro Hospitalar Universitário de S João Porto and Allergy Unit Hospital Lusíadas Porto Portugal

Allergy and Clinical Immunology Department University of Liverpool Royal Preston Hospital Lancashire Teaching Hospitals NHS Foundation Trust UK

Allergy and Clinical Immunology Unit Centro Hospitalar de Trás os Montes e Alto Douro Vila Real and Allergy and Clinical Immunology Unit Centro Hospitalar do Baixo Vouga Aveiro Portugal

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

Allergy Centre Wythenshawe Hospital Manchester University NHS Foundation Trust and University of Manchester Manchester UK

Allergy Clinic Copenhagen University Hospital at Gentofte Copenhagen Denmark

Allergy Clinical Unit Hospital Regional Universitario de Málaga Instituto de Investigación Biomédica de Málaga IBIMA ARADyAL Málaga Spain

Allergy Department Centro Hospitalar Universitário do Porto Porto Portugal

Allergy Department Fundación Jiménez Diaz Universidad Autonoma de Madrid CIBERES Instituto de Salud Carlos 3 Spain

Allergy Department Hospital General Universitario Gregorio Marañón Madrid Spain

Allergy Research Group Allergy Unit Hospital Regional Universitario de Málaga Instituto de Investigación Biomédica de Málaga IBIMA Plaza del Hospital Civil s n Málaga Spain

Allergy Research Group Instituto de Investigación Biomédica de Málaga IBIMA and Allergy Unit Hospital Regional Universitario de Málaga HRUM Málaga Spain

Allergy Unit Allergo Anaesthesia Unit Faculty of Medicine Hospital Central de la Cruz Roja Alfonso 10 El Sabio University Madrid Spain

Allergy Unit Angers University Hospital Angers France

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

Allergy Unit Department of Pediatrics Meyer Children's University Hospital

Allergy Unit Departments of Internal Medicine Azienda Sanitaria della Romagna Rimini Hospital Rimini Italy

Allergy Unit Fondazione Policlinico Gemelli IRCCS Largo Gemelli Rome Italy

Allergy Unit Regional University Hospital of Malaga IBIMA UMA ARADyAL Malaga Spain

Allergy Unit S S Filippo and Nicola Avezzano Italy

Allergy Unit Trento Italy

Allergy Unit Verona University Hospital Verona Italy

Barts Health NHS Trust St Bartholomew's Hospital London UK

C Villarroel Barcelona Spain

Center for Rhinology and Allergology Wiesbaden Germany

Charité Universitätsmedizin Berlin Klinik für Dermatologie Berlin Germany

Clinical Immunology and Allergy Unit Northern General Hospital Sheffield Teaching Hospitals NHS Foundation Trust Sheffield UK

Department of Adult Allergy Memorial Ankara Hospital Ankara Turkey

Department of Allergology Carol Davila University of Medicine and Pharmacy Nicolae Malaxa Clinical Hospital Bucharest Romania

Department of Chest Diseases Division of Allergy and Immunology Chest Diseases and Surgery Training and Research Hospital Izmir Turkey

Department of Chest Diseases Division of Immunology and allergy Ankara University School of Medicine cebeci Hospital Ankara Turkey

Department of Clinical and Environmental Allergology Jagiellonian University Medical College Krakow Poland

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

Department of Clinical Immunology King's College Hospital London UK

Department of Clinical Medicine University of Copenhagen Denmark

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

Department of Dermatology and Allergy Cantonal Hospital Aarau Aarau Switzerland

Department of Dermatology and Allergy OE6600 Comprehensive Allergy Center Hannover Medical School Hannover Germany

Department of Dermatology Universitair Ziekenhuis Vrije Universiteit Brussel Brussel Belgium

Department of Dermatology University Medical Centre Utrecht Heidelberglaan 100 Utrecht The Netherlands

Department of Dermatology Venerology and Allergology Universitätsmedizin Leipzig Leipzig Germany

Department of ENT AUMC Amsterdam The Netherlands

Department of Immunology and Allergy Medical University of Lodz Poland

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

Department of Internal Diseases Allergology and Clinical Immunology Medical University of Silesia Katowice Poland

Department of Medical Sciences Uppsala university Sweden

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

Department of Respiratory Medicine and Allergy Department of Medicine Karolinska University Hospital Huddinge Karolinska Institutet Stockholm Sweden

Department of Women Children Teenagers University Hospital of Geneva Geneva Switzerland

Division of Allergology and Clinical Immunology Department of Pneumology Inselspital Bern University Hospital University of Bern Bern Switzerland

Division of Internal Medicine Hepatobiliary and Immunoallergic Disease IRCCS Azienda Ospedaliero Universitaria di Bologna Italy

Dohlenfeld Muelheim Germany

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

Faculty of Medicine Dpt of Pediatric Allergy and Immunology Mersin University Mersin Turkey

Faculty of Medicine Transylvania University Brasov Romania

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

Floridsdorf Allergy Center Vienna Austria

Gennet s r o Allergy and Clinical Immunology Czech Republic

Giovanna Zanoni Immunology Unit Policlinico G B Rossi Azienda Ospedaliera Universitaria Integrata Verona Italy

Hospital Quironsalud Cordoba Cordoba Spain

Hospital Vito Fazzi Lecce Italy

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

Immunology Department Manchester University NHS Foundation Trust Manchester UK

Immunology Unit University Hospital of Verona Policlinico G B Rossi Verona Italy

Infanta Leonor University Hospital Madrid Spain

Institute of Biomedical Sciences Department of Pathology Faculty of Medicine Vilnius University Institute of Clinical Medicine Clinic of Chest diseases Immunology and Allergology Faculty of Medicine Vilnius Lithuania

Institute of Immunology Faculty of Medicine University of Coimbra Coimbra Portugal

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

Medicine Department Medicine Ward Mantova Hospital ASST di Mantova Italy

Microbiology Department Faculty of Medicine Kuwait University Kuwait

Moral Luis Pediatric Allergy and Respiratory Unit Alicante University General Hospital Alicante Institute for Health and Biomedical Research Alicante Spain

National Heart and Lung Institute Imperial College London London UK

Oasi Research Institute IRCCS Troina Italy

School of Medicine Department of Pulmonary Diseases Division of Allergy FAAAI Ankara University Ankara Turkey

Service transversal d'allergologie et immunologie clinique CHR de Tours Tours France

Sorbonne Université INSERM 1135 Cimi Paris Hôpital Tenon Assistance Publique Hôpitaux de Paris Departement de dermatologie et d'allergologie Paris France

Sorbonne Université INSERM Institut Pierre Louis d'Epidémiologie et de Santé Publique AP HP Sorbonne Université Hôpital Tenon Département de dermatologie et allergologie Paris France

SOS Allergologia e Immunologia Azienda USL Toscana Centro Ospedale S Stefano Prato Italy

SOS Allergologia ed Immunologia clinica Azienda USL Toscana Centro Ospedale San Giovanni di Dio Firenze Italy

University Clinic Golnik Slovenia

University Clinic of Respiratory and Allergic Diseases Golnik Golnik and Internal Medicine Faculty of Medicine University of Ljubljana Ljubljana Slovenia

University Clinic of Respiratory and Allergic Diseases Golnik Golnik Slovenia

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