Management of anaphylaxis due to COVID-19 vaccines in the elderly

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.Peer reviewe

Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Histamine Intolerance—The More We Know the Less We Know. A Review

The intake of food may be an initiator of adverse reactions. Food intolerance is an abnormal non-immunological response of the organism to the ingestion of food or its components in a dosage normally tolerated. Despite the fact that food intolerance is spread throughout the world, its diagnosing is still difficult. Histamine intolerance (HIT) is the term for that type of food intolerance which includes a set of undesirable reactions as a result of accumulated or ingested histamine. Manifestations may be caused by various pathophysiological mechanisms or a combination of them. The problem with a “diagnosis” of HIT is precisely the inconstancy and variety of the manifestations in the same individual following similar stimuli. The diagnosing of HIT therefore requires a complex time-demanding multidisciplinary approach, including the systematic elimination of disorders with a similar manifestation of symptoms. Among therapeutic approaches, the gold standard is a low-histamine diet. A good response to such a diet is considered to be confirmation of HIT. Alongside the dietary measures, DAO supplementation supporting the degradation of ingested histamine may be considered as subsidiary treatment for individuals with intestinal DAO deficiency. If antihistamines are indicated, the treatment should be conscious and time-limited, while 2nd or 3rd generation of H1 antihistamines should take precedence

Management of anaphylaxis due to COVID-19 vaccines in the elderly

10.1111/all.14838Allergy: European Journal of Allergy and Clinical Immunology76102952-296

Management of anaphylaxis due to COVID-19 vaccines in the elderly

none149siOlder 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.noneBousquet J.; Agache I.; Blain H.; Jutel M.; Ventura M.T.; Worm M.; Del Giacco S.; Benetos A.; Bilo B.M.; Czarlewski W.; Abdul Latiff A.H.; Al-Ahmad M.; Angier E.; Annesi-Maesano I.; Atanaskovic-Markovic M.; Bachert C.; Barbaud A.; Bedbrook A.; Bennoor K.S.; Berghea E.C.; Bindslev-Jensen C.; Bonini S.; Bosnic-Anticevich S.; Brockow K.; Brussino L.; Camargos P.; Canonica G.W.; Cardona V.; Carreiro-Martins P.; Carriazo A.; Casale T.; Caubet J.-C.; Cecchi L.; Cherubini A.; Christoff G.; Chu D.K.; Cruz A.A.; Dokic D.; El-Gamal Y.; Ebisawa M.; Eberlein B.; Farrell J.; Fernandez-Rivas M.; Fokkens W.J.; Fonseca J.A.; Gao Y.; Gavazzi G.; Gawlik R.; Gelincik A.; Gemicioglu B.; Gotua M.; Guerin O.; Haahtela T.; Hoffmann-Sommergruber K.; Hoffmann H.J.; Hofmann M.; Hrubisko M.; Illario M.; Irani C.; Ispayeva Z.; Ivancevich J.C.; Julge K.; Kaidashev I.; Khaitov M.; Knol E.; Kraxner H.; Kuna P.; Kvedariene V.; Lauerma A.; Le L.T.T.; Le Moing V.; Levin M.; Louis R.; Lourenco O.; Mahler V.; Martin F.C.; Matucci A.; Milenkovic B.; Miot S.; Montella E.; Morais-Almeida M.; Mortz C.G.; Mullol J.; Namazova-Baranova L.; Neffen H.; Nekam K.; Niedoszytko M.; Odemyr M.; O'Hehir R.E.; Okamoto Y.; Ollert M.; Palomares O.; Papadopoulos N.G.; Panzner P.; Passalacqua G.; Patella V.; Petrovic M.; Pfaar O.; Pham-Thi N.; Plavec D.; Popov T.A.; Recto M.T.; Regateiro F.S.; Reynes J.; Roller-Winsberger R.E.; Rolland Y.; Romano A.; Rondon C.; Rottem M.; Rouadi P.W.; Salles N.; Samolinski B.; Santos A.F.; S Sarquis F.; Sastre J.; M. G. A. Schols J.; Scichilone N.; Sediva A.; Shamji M.H.; Sheikh A.; Skypala I.; Smolinska S.; Sokolowska M.; Sousa-Pinto B.; Sova M.; Stelmach R.; Sturm G.; Suppli Ulrik C.; Todo-Bom A.M.; Toppila-Salmi S.; Tsiligianni I.; Torres M.; Untersmayr E.; Urrutia Pereira M.; Valiulis A.; Vitte J.; Vultaggio A.; Wallace D.; Walusiak-Skorupa J.; Wang D.-Y.; Waserman S.; Yorgancioglu A.; Yusuf O.M.; Zernotti M.; Zidarn M.; Chivato T.; Akdis C.A.; Zuberbier T.; Klimek L.Bousquet, J.; Agache, I.; Blain, H.; Jutel, M.; Ventura, M. T.; Worm, M.; Del Giacco, S.; Benetos, A.; Bilo, B. M.; Czarlewski, W.; Abdul Latiff, A. H.; Al-Ahmad, M.; Angier, E.; Annesi-Maesano, I.; Atanaskovic-Markovic, M.; Bachert, C.; Barbaud, A.; Bedbrook, A.; Bennoor, K. S.; Berghea, E. C.; Bindslev-Jensen, C.; Bonini, S.; Bosnic-Anticevich, S.; Brockow, K.; Brussino, L.; Camargos, P.; Canonica, G. W.; Cardona, V.; Carreiro-Martins, P.; Carriazo, A.; Casale, T.; Caubet, J. -C.; Cecchi, L.; Cherubini, A.; Christoff, G.; Chu, D. K.; Cruz, A. A.; Dokic, D.; El-Gamal, Y.; Ebisawa, M.; Eberlein, B.; Farrell, J.; Fernandez-Rivas, M.; Fokkens, W. J.; Fonseca, J. A.; Gao, Y.; Gavazzi, G.; Gawlik, R.; Gelincik, A.; Gemicioglu, B.; Gotua, M.; Guerin, O.; Haahtela, T.; Hoffmann-Sommergruber, K.; Hoffmann, H. J.; Hofmann, M.; Hrubisko, M.; Illario, M.; Irani, C.; Ispayeva, Z.; Ivancevich, J. C.; Julge, K.; Kaidashev, I.; Khaitov, M.; Knol, E.; Kraxner, H.; Kuna, P.; Kvedariene, V.; Lauerma, A.; L. T. T., Le; Le Moing, V.; Levin, M.; Louis, R.; Lourenco, O.; Mahler, V.; Martin, F. C.; Matucci, A.; Milenkovic, B.; Miot, S.; Montella, E.; Morais-Almeida, M.; Mortz, C. G.; Mullol, J.; Namazova-Baranova, L.; Neffen, H.; Nekam, K.; Niedoszytko, M.; Odemyr, M.; O'Hehir, R. E.; Okamoto, Y.; Ollert, M.; Palomares, O.; Papadopoulos, N. G.; Panzner, P.; Passalacqua, G.; Patella, V.; Petrovic, M.; Pfaar, O.; Pham-Thi, N.; Plavec, D.; Popov, T. A.; Recto, M. T.; Regateiro, F. S.; Reynes, J.; Roller-Winsberger, R. E.; Rolland, Y.; Romano, A.; Rondon, C.; Rottem, M.; Rouadi, P. W.; Salles, N.; Samolinski, B.; Santos, A. F.; S Sarquis, F.; Sastre, J.; M. G. A. Schols J., ; Scichilone, N.; Sediva, A.; Shamji, M. H.; Sheikh, A.; Skypala, I.; Smolinska, S.; Sokolowska, M.; Sousa-Pinto, B.; Sova, M.; Stelmach, R.; Sturm, G.; Suppli Ulrik, C.; Todo-Bom, A. M.; Toppila-Salmi, S.; Tsiligianni, I.; Torres, M.; Untersmayr, E.; Urrutia Pereira, M.; Valiulis, A.; Vitte, J.; Vultaggio, A.; Wallace, D.; Walusiak-Skorupa, J.; Wang, D. -Y.; Waserman, S.; Yorgancioglu, A.; Yusuf, O. M.; Zernotti, M.; Zidarn, M.; Chivato, T.; Akdis, C. A.; Zuberbier, T.; Klimek, L

Management of anaphylaxis due to COVID-19 vaccines in the elderly

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. © 2021 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd