Potential prophylactic efficacy of mast cell stabilizers against COVID-19 vaccine-induced anaphylaxis

Abstract

To fight against coronavirus disease 2019 (COVID-19), the vaccination is currently the most effective approach. However, in addition to common systemic side effects, the vaccines can cause serious allergic reactions or anaphylaxis. In anaphylaxis, the exposure to the allergen causes a sudden release of chemical mediators from mast cells, for which adrenaline is the drug of first choice. In our previous basic studies, in addition to adrenaline, anti-allergic drugs (olopatadine, loratadine, tranilast and ketotifen), antibiotics (clarithromycin), corticosteroids (hydrocortisone and dexamethasone) and certain food constituents (caffeine and catechin) inhibited the process of exocytosis and showed their effectiveness as highly potent mast cell stabilizers. In these studies, since mast cells were pre-incubated with these drugs or the food constituents before exocytosis was induced, the findings strongly indicated their prophylactic efficacy in stabilizing mast cells. Considering such pharmacological properties of these commonly prescribed medications or the food constituents, their prophylactic use may potentially be beneficial in preventing anaphylaxis caused by COVID-19 vaccination.

Adrenaline autoinjectors for Australian out‐of‐hospital anaphylaxis: where to from here?

“…3 Adrenaline also inhibits further mast cell degranulation, preventing additional deterioration. 4 Intramuscular adrenaline autoinjectors are prescribed for the immediate management and stabilisation of out-of-hospital anaphylaxis while medical attention is sought. Per Australian guidelines, such autoinjectors are recommended for patients with a clinical history of anaphylaxis, coexisting food allergy and unstable asthma or mast cell disorders, and are typically sold by the brand names EpiPen or Anapen.…”

“…Intramuscular adrenaline is the first‐line treatment for severe anaphylaxis because of its actions of peripheral vasoconstriction, decreased vascular permeability and bronchodilation, which act to prevent mortality from distributive shock or asphyxiation 3 . Adrenaline also inhibits further mast cell degranulation, preventing additional deterioration 4 . Intramuscular adrenaline autoinjectors are prescribed for the immediate management and stabilisation of out‐of‐hospital anaphylaxis while medical attention is sought.…”