Safety of COVID-19 Vaccination in Patients with Clonal Mast Cell Disorders.

Clinical ImplicationsIn our series, COVID-19 vaccination in patients with clonal mast cell disease who received antihistamine before vaccination turned out to be safe, and the rate of adverse reactions was comparable to that of the general population.Mast cell activation syndromes (MCAS) encompass a heterogeneous group of pathologies characterized by the presence of symptoms resulting from the release of mast cell (MC) mediators. The presenting symptomatology may vary from mild to severe symptoms, including anaphylaxis.1Akin C. Mast cell activation syndromes.J Allergy Clin Immunol. 2017; 140: 349-355Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar Mast cell activation syndromes are classified as secondary (to allergy or owing to other underlying diseases), idiopathic, and primary. The latter may be also divided into (1) clonal or monoclonal MCAS, is a condition that courses with systemic symptoms owing to the release of MC mediators and the presence of clonal MCs (the expression of CD25 and/or KIT mutation) although complete diagnostic criteria for systemic mastocytosis (SM) are not met; and (2) SM, a disease characterized by the proliferation and accumulation of neoplastic MCs in extracutaneous organs, with well-defined diagnostic criteria.1Akin C. Mast cell activation syndromes.J Allergy Clin Immunol. 2017; 140: 349-355Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar It is widely known that patients with clonal MC diseases (MCDs) have a permanent risk for several MC-release symptoms evoked by different triggers, such as viral infections or vaccine administration.During the coronavirus pandemic (COVID-19) and subsequent severe acute respiratory syndrome (SARS-CoV-2), many questions have arisen about how infection with this virus could affect patients with SM. Some of these questions have already been answered by experts in the field.2Valent P. Akin C. Bonadonna P. Brockow N. Niedoszytko M. Butterfield J. et al.Risk and management of patients with mastocytosis and MCAS in the SARS-CoV-2 (COVID-19) pandemic: expert opinions.J Allergy Clin Immunol. 2020; 146: 300-306Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar It was reported that in SM patients infected with SARS-CoV-2, symptoms, severity, and mortality rates were comparable to those in the general population.2Valent P. Akin C. Bonadonna P. Brockow N. Niedoszytko M. Butterfield J. et al.Risk and management of patients with mastocytosis and MCAS in the SARS-CoV-2 (COVID-19) pandemic: expert opinions.J Allergy Clin Immunol. 2020; 146: 300-306Abstract Full Text Full Text PDF PubMed Scopus (18) Google ScholarAt the beginning of the worldwide COVID-19 vaccination campaign, several reports indicated an increased incidence of anaphylaxis (0.2 and 1.2/100,000 doses for Moderna [Spikevax, Cambridge, MA] and Pfizer-BioNTech [Comirnaty, New York, NY and Maguncia, Mainz, Germany], respectively) that was up to 10 times higher than for other vaccines.3Rama T.A. Álvarez-Twose I. Delving into COVID-19 vaccination-induced anaphylaxis: are mRNA vaccines safe in mast cell disorders?.J Investig Allergol Clin Immunol. 2021; 31: 193-195Crossref PubMed Scopus (5) Google Scholar The European Competence Network on Mastocytosis (ECNM) and the Spanish Network on Mastocytosis (REMA) offered several recommendations including maintenance of MC-mediator blocking drugs during COVID-19 infections and before the administration of COVID-19 vaccines as an effective and preventive measure previously known regarding safety with other vaccines.3Rama T.A. Álvarez-Twose I. Delving into COVID-19 vaccination-induced anaphylaxis: are mRNA vaccines safe in mast cell disorders?.J Investig Allergol Clin Immunol. 2021; 31: 193-195Crossref PubMed Scopus (5) Google Scholar,4Bonadonna P. Brockow K. Niedoszytko M. Elberink H.O. Akin C. Nedoszytko B. et al.COVID-19 vaccination in mastocytosis: Recommendations of the European Competence Network on Mastocytosis (ECNM) and American Initiative in Mast Cell Diseases (AIM).J Allergy Clin Immunol Pract. 2021; 9: 2139-2144Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar Furthermore, they urged these patients to get the corresponding doses in a hospital environment capable of treating serious reactions.3Rama T.A. Álvarez-Twose I. Delving into COVID-19 vaccination-induced anaphylaxis: are mRNA vaccines safe in mast cell disorders?.J Investig Allergol Clin Immunol. 2021; 31: 193-195Crossref PubMed Scopus (5) Google Scholar To date, three different case reports with a total of 44 cases of vaccinated SM or MC disorder patients were reported, all of which were well-tolerated.5Rama T.A. Moreira A. Castells M. mRNA COVID-19 vaccine is well tolerated in patients with cutaneous and systemic mastocytosis with mast cell activation symptoms and anaphylaxis.J Allergy Clin Immunol. 2021; 147: 877-878Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar, 6Rosman Y. Lavi N. Meir-Shafrir K. Lachover-Roth I. Cohen-Engler A. Mekori Y.A. et al.Safety of BNT162b2 mRNA COVID-19 vaccine in patients with mast cell disorders.J Allergy Clin Immunol Pract. 2021; 9: 3487-3489Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar, 7Kaakati R. Khokhar D. Akin C. Safety of COVID-19 vaccination in patients with mastocytosis and monoclonal mast cell activation syndrome.J Allergy Clin Immunol Pract. 2021; 9: 3198-3199Abstract Full Text Full Text PDF PubMed Scopus (11) Google ScholarThe goal of this multicenter study carried out in two Spanish tertiary hospitals was to evaluate the safety of administering COVID-19 vaccines in a large series of patients diagnosed with clonal MCD. For that purpose, we included a total of 119 patients with a diagnosis of monoclonal MCAS or SM after a complete bone marrow study according to the World Health Organization 2016 proposed criteria,1Akin C. Mast cell activation syndromes.J Allergy Clin Immunol. 2017; 140: 349-355Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar including bone marrow mastocytosis cytology, histology, and immunochemistry; flow cytometry immunophenotyping; and the study of KIT mutation. We performed a retrospective review of all patients with a diagnosis of a clonal MCD observed at the Ramon y Cajal Hospital, Madrid, and Hospital Clinic, Barcelona. We contacted all of these patients by phone call within 1 week after the end of the vaccination campaign to confirm whether they took an antihistamine before vaccination and to evaluate any MC release symptoms or adverse reactions (ARs) after COVID-19 vaccination. The study was approved by the local ethical committee and enrolled patients gave their consent to participate. We included only patients who had received the full vaccination schedule (two doses or a single dose for the Janssen vaccine). Thus, five patients were excluded from the main patient cohort (n = 124) because they had received a single vaccine dose (except those who received the Janssen vaccine); they were considered immunologically protected because they suffered COVID-19 infection in the previous 6 months. According to the recommendation of ECNM/REMA, patients took an antihistamine 1 hour before administration of the vaccine and remained under observation for at least 45 minutes. The demographic characteristics, type of clonal MCD, vaccines administered, and related reactions are detailed in Table I and Table E1 (in this article’s Online Repository at www.jaci-inpractice.org).Table IDemographic characteristics of patients, type of clonal mast cell disease, vaccines administered, and reactions presented after administrationVariableTotal number of patients (n = 119)Patients with AR after vaccine (n = 26)Sex Female66 (55.5)15 (57.7) Male53 (44.5)6 (23.1)Age, y Mean (range)54.7 (20-86)50.8 (30-73)Allergy background†Patients may have more than one allergic pathology and may be placed in more than one of the disease groups in the table.49 (41.2)9 (34.6) Anaphylaxis27 (22.7)‡Causes of anaphylaxis in patients were drug allergy (10), food allergy (seven), hymenoptera venom allergy (nine), and idiopathic (one). More details may be found in Table E1.4 (15.3)§Causes of anaphylaxis in the population with adverse reactions to vaccine were food allergy (two) and hymenoptera venom allergy (two). More details may be found in Table E1. Drug allergy19 (16)3 (11.5) Food allergy16 (13.4)4 (15.3) Hymenoptera venom allergy11 (9.2)2 (7.7) Respiratory allergy14 (11.8)3 (11.5) Skin allergy3 (2.5)0 (0)Clonal mast cell disorder type Monoclonal mast cell activation syndrome2 (1.7)0 (0) Bone marrow mastocytosis35 (29.4)0 (0) Indolent systemic mastocytosis79 (66.4)25 (96.2) Smoldering systemic mastocytosis1 (0.8)0 (0) Systemic mastocytosis with associated clonal hematologic non-mast cell lineage disease∗One of patient presented with acute myeloid leukemia, and the other with mucosa-associated lymphoid tissue–type lymphoma.2 (1.7)1 (3.8)Type of COVID-19 vaccine Comirnaty (Pfizer-BioNTech)62 (52.1)10 (38.5) Spikevax (Moderna)37 (31.1)12 (46.1) Vaxzevria (AstraZeneca)18 (15.1)4 (15.4) Janssen (Johnson & Johnson)2 (1.7)0 (0)Characteristics of ARs to vaccineWe considered an adverse reaction, as defined by the World Health Organization, to be “any noxious and unintended response to the administration of the vaccine, which occurs at doses normally used in man. In other words, an AR is harm directly caused by the medicine at normal doses, during normal use.” All ARs reported in our series appeared within 48 hours after administration of the vaccine. Local reaction¶A local or injection-site reaction was considered to be any pain, swelling, rash, bleeding, or redness that occurred at the site of injection.NA14 (11.3) FeverNA10 (8) Local reaction and feverNA1 (0.8) Local reaction, fever, and lymphadenopathyNA1 (0.8)Results are expressed as the number of patients per total patients studied (percentage).AR, adverse reaction; NA; not applicable.∗ One of patient presented with acute myeloid leukemia, and the other with mucosa-associated lymphoid tissue–type lymphoma.† Patients may have more than one allergic pathology and may be placed in more than one of the disease groups in the table.‡ Causes of anaphylaxis in patients were drug allergy (10), food allergy (seven), hymenoptera venom allergy (nine), and idiopathic (one). More details may be found in Table E1.§ Causes of anaphylaxis in the population with adverse reactions to vaccine were food allergy (two) and hymenoptera venom allergy (two). More details may be found in Table E1.|| We considered an adverse reaction, as defined by the World Health Organization, to be “any noxious and unintended response to the administration of the vaccine, which occurs at doses normally used in man. In other words, an AR is harm directly caused by the medicine at normal doses, during normal use.” All ARs reported in our series appeared within 48 hours after administration of the vaccine.¶ A local or injection-site reaction was considered to be any pain, swelling, rash, bleeding, or redness that occurred at the site of injection. Open table in a new tab A total of 119 patients were included. Of these, 49 (41.2%) had an atopy background and 27 (22.7%) had a history of anaphylaxis (Tables I and E1). Four patients (3.5%) had experienced COVID-19 infection more than 6 months before receiving the corresponding COVID-19 vaccine, so they received the full vaccination schedule. Moreover, 101 patients (84.9%) took an antihistamine as premedication between 30 minutes and 1 hour before the administration of each dose of vaccine. In addition, 101 (84.9%) were vaccinated in a hospital setting and the remaining 18 (15.1%) were vaccinated in a health care center (n = 9) or in one of the national facilities centers authorized for the safe administration of COVID-19 vaccine (n = 9).No recruited patients had significant MC-release symptoms or exacerbations of clonal MCD after administration of the vaccine, as defined by the World Health Organization,8Edwards I.R. Aronson J.K. Adverse drug reactions: definitions, diagnosis, and management.Lancet. 2000; 356: 1255-1259Abstract Full Text Full Text PDF PubMed Scopus (1933) Google Scholar AR was observed in 26 patients (21%). Only one (0.8%) reacted to both doses and had fever both times. The remaining 25 patients had a reaction only after one dose (nine after the first dose and 16 after the second one). Among the 16 patients with a local reaction, 11 (69%) had received Spikevax (Moderna) and all but one were premedicated (Tables I and E1). All ARs occurred within the first 48 hours, but none took place in the first hour after administration of the vaccine. We observed a comparable rate of AR to COVID-19 vaccine in patients compared to data provided by the Spanish Agency for Drugs and Health Products for the general population, in which local reactions were observed in 5% to 18% of patients and fever in 35% to 51%, with a variable frequency depending on the type of vaccine.9Spanish Agency for Drugs and Health Products. 8th National Pharmacovigilance Report on COVID-19 Vaccines.https://www.aemps.gob.es/informa/boletines-aemps/boletin-fv/2021-boletin-fv/8o-informe-de-farmacovigilancia-sobre-vacunas-covid-19/?lang=enGoogle ScholarAll but four patients who had an AR had been medicated before administration of the vaccine. Of 26 patients, 21 were vaccinated at a hospital center (81%), four in a national facilities center authorized for the safe administration of COVID-19 vaccine (15%), and one in a health care center (4%).In line with these results, COVID-19 vaccination in patients with clonal MCD in this series turned out to be safe, and the rate of AR was comparable to that in the general population. A limitation of this study is the recall bias, because it was impossible to ensure compliance with measures recommended by the ECNM/REMA and because the time between the phone call and the vaccination was not the same in all patients. Thus, further prospective studies are needed. However, the proposed approach appears to be an effective preventive measure for managing patients with SM in the context of COVID-19 vaccination. Clinical ImplicationsIn our series, COVID-19 vaccination in patients with clonal mast cell disease who received antihistamine before vaccination turned out to be safe, and the rate of adverse reactions was comparable to that of the general population. In our series, COVID-19 vaccination in patients with clonal mast cell disease who received antihistamine before vaccination turned out to be safe, and the rate of adverse reactions was comparable to that of the general population. In our series, COVID-19 vaccination in patients with clonal mast cell disease who received antihistamine before vaccination turned out to be safe, and the rate of adverse reactions was comparable to that of the general population. Mast cell activation syndromes (MCAS) encompass a heterogeneous group of pathologies characterized by the presence of symptoms resulting from the release of mast cell (MC) mediators. The presenting symptomatology may vary from mild to severe symptoms, including anaphylaxis.1Akin C. Mast cell activation syndromes.J Allergy Clin Immunol. 2017; 140: 349-355Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar Mast cell activation syndromes are classified as secondary (to allergy or owing to other underlying diseases), idiopathic, and primary. The latter may be also divided into (1) clonal or monoclonal MCAS, is a condition that courses with systemic symptoms owing to the release of MC mediators and the presence of clonal MCs (the expression of CD25 and/or KIT mutation) although complete diagnostic criteria for systemic mastocytosis (SM) are not met; and (2) SM, a disease characterized by the proliferation and accumulation of neoplastic MCs in extracutaneous organs, with well-defined diagnostic criteria.1Akin C. Mast cell activation syndromes.J Allergy Clin Immunol. 2017; 140: 349-355Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar It is widely known that patients with clonal MC diseases (MCDs) have a permanent risk for several MC-release symptoms evoked by different triggers, such as viral infections or vaccine administration. During the coronavirus pandemic (COVID-19) and subsequent severe acute respiratory syndrome (SARS-CoV-2), many questions have arisen about how infection with this virus could affect patients with SM. Some of these questions have already been answered by experts in the field.2Valent P. Akin C. Bonadonna P. Brockow N. Niedoszytko M. Butterfield J. et al.Risk and management of patients with mastocytosis and MCAS in the SARS-CoV-2 (COVID-19) pandemic: expert opinions.J Allergy Clin Immunol. 2020; 146: 300-306Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar It was reported that in SM patients infected with SARS-CoV-2, symptoms, severity, and mortality rates were comparable to those in the general population.2Valent P. Akin C. Bonadonna P. Brockow N. Niedoszytko M. Butterfield J. et al.Risk and management of patients with mastocytosis and MCAS in the SARS-CoV-2 (COVID-19) pandemic: expert opinions.J Allergy Clin Immunol. 2020; 146: 300-306Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar At the beginning of the worldwide COVID-19 vaccination campaign, several reports indicated an increased incidence of anaphylaxis (0.2 and 1.2/100,000 doses for Moderna [Spikevax, Cambridge, MA] and Pfizer-BioNTech [Comirnaty, New York, NY and Maguncia, Mainz, Germany], respectively) that was up to 10 times higher than for other vaccines.3Rama T.A. Álvarez-Twose I. Delving into COVID-19 vaccination-induced anaphylaxis: are mRNA vaccines safe in mast cell disorders?.J Investig Allergol Clin Immunol. 2021; 31: 193-195Crossref PubMed Scopus (5) Google Scholar The European Competence Network on Mastocytosis (ECNM) and the Spanish Network on Mastocytosis (REMA) offered several recommendations including maintenance of MC-mediator blocking drugs during COVID-19 infections and before the administration of COVID-19 vaccines as an effective and preventive measure previously known regarding safety with other vaccines.3Rama T.A. Álvarez-Twose I. Delving into COVID-19 vaccination-induced anaphylaxis: are mRNA vaccines safe in mast cell disorders?.J Investig Allergol Clin Immunol. 2021; 31: 193-195Crossref PubMed Scopus (5) Google Scholar,4Bonadonna P. Brockow K. Niedoszytko M. Elberink H.O. Akin C. Nedoszytko B. et al.COVID-19 vaccination in mastocytosis: Recommendations of the European Competence Network on Mastocytosis (ECNM) and American Initiative in Mast Cell Diseases (AIM).J Allergy Clin Immunol Pract. 2021; 9: 2139-2144Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar Furthermore, they urged these patients to get the corresponding doses in a hospital environment capable of treating serious reactions.3Rama T.A. Álvarez-Twose I. Delving into COVID-19 vaccination-induced anaphylaxis: are mRNA vaccines safe in mast cell disorders?.J Investig Allergol Clin Immunol. 2021; 31: 193-195Crossref PubMed Scopus (5) Google Scholar To date, three different case reports with a total of 44 cases of vaccinated SM or MC disorder patients were reported, all of which were well-tolerated.5Rama T.A. Moreira A. Castells M. mRNA COVID-19 vaccine is well tolerated in patients with cutaneous and systemic mastocytosis with mast cell activation symptoms and anaphylaxis.J Allergy Clin Immunol. 2021; 147: 877-878Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar, 6Rosman Y. Lavi N. Meir-Shafrir K. Lachover-Roth I. Cohen-Engler A. Mekori Y.A. et al.Safety of BNT162b2 mRNA COVID-19 vaccine in patients with mast cell disorders.J Allergy Clin Immunol Pract. 2021; 9: 3487-3489Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar, 7Kaakati R. Khokhar D. Akin C. Safety of COVID-19 vaccination in patients with mastocytosis and monoclonal mast cell activation syndrome.J Allergy Clin Immunol Pract. 2021; 9: 3198-3199Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar The goal of this multicenter study carried out in two Spanish tertiary hospitals was to evaluate the safety of administering COVID-19 vaccines in a large series of patients diagnosed with clonal MCD. For that purpose, we included a total of 119 patients with a diagnosis of monoclonal MCAS or SM after a complete bone marrow study according to the World Health Organization 2016 proposed criteria,1Akin C. Mast cell activation syndromes.J Allergy Clin Immunol. 2017; 140: 349-355Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar including bone marrow mastocytosis cytology, histology, and immunochemistry; flow cytometry immunophenotyping; and the study of KIT mutation. We performed a retrospective review of all patients with a diagnosis of a clonal MCD observed at the Ramon y Cajal Hospital, Madrid, and Hospital Clinic, Barcelona. We contacted all of these patients by phone call within 1 week after the end of the vaccination campaign to confirm whether they took an antihistamine before vaccination and to evaluate any MC release symptoms or adverse reactions (ARs) after COVID-19 vaccination. The study was approved by the local ethical committee and enrolled patients gave their consent to participate. We included only patients who had received the full vaccination schedule (two doses or a single dose for the Janssen vaccine). Thus, five patients were excluded from the main patient cohort (n = 124) because they had received a single vaccine dose (except those who received the Janssen vaccine); they were considered immunologically protected because they suffered COVID-19 infection in the previous 6 months. According to the recommendation of ECNM/REMA, patients took an antihistamine 1 hour before administration of the vaccine and remained under observation for at least 45 minutes. The demographic characteristics, type of clonal MCD, vaccines administered, and related reactions are detailed in Table I and Table E1 (in this article’s Online Repository at www.jaci-inpractice.org). Results are expressed as the number of patients per total patients studied (percentage). AR, adverse reaction; NA; not applicable. A total of 119 patients were included. Of these, 49 (41.2%) had an atopy background and 27 (22.7%) had a history of anaphylaxis (Tables I and E1). Four patients (3.5%) had experienced COVID-19 infection more than 6 months before receiving the corresponding COVID-19 vaccine, so they received the full vaccination schedule. Moreover, 101 patients (84.9%) took an antihistamine as premedication between 30 minutes and 1 hour before the administration of each dose of vaccine. In addition, 101 (84.9%) were vaccinated in a hospital setting and the remaining 18 (15.1%) were vaccinated in a health care center (n = 9) or in one of the national facilities centers authorized for the safe administration of COVID-19 vaccine (n = 9). No recruited patients had significant MC-release symptoms or exacerbations of clonal MCD after administration of the vaccine, as defined by the World Health Organization,8Edwards I.R. Aronson J.K. Adverse drug reactions: definitions, diagnosis, and management.Lancet. 2000; 356: 1255-1259Abstract Full Text Full Text PDF PubMed Scopus (1933) Google Scholar AR was observed in 26 patients (21%). Only one (0.8%) reacted to both doses and had fever both times. The remaining 25 patients had a reaction only after one dose (nine after the first dose and 16 after the second one). Among the 16 patients with a local reaction, 11 (69%) had received Spikevax (Moderna) and all but one were premedicated (Tables I and E1). All ARs occurred within the first 48 hours, but none took place in the first hour after administration of the vaccine. We observed a comparable rate of AR to COVID-19 vaccine in patients compared to data provided by the Spanish Agency for Drugs and Health Products for the general population, in which local reactions were observed in 5% to 18% of patients and fever in 35% to 51%, with a variable frequency depending on the type of vaccine.9Spanish Agency for Drugs and Health Products. 8th National Pharmacovigilance Report on COVID-19 Vaccines.https://www.aemps.gob.es/informa/boletines-aemps/boletin-fv/2021-boletin-fv/8o-informe-de-farmacovigilancia-sobre-vacunas-covid-19/?lang=enGoogle Scholar All but four patients who had an AR had been medicated before administration of the vaccine. Of 26 patients, 21 were vaccinated at a hospital center (81%), four in a national facilities center authorized for the safe administration of COVID-19 vaccine (15%), and one in a health care center (4%). In line with these results, COVID-19 vaccination in patients with clonal MCD in this series turned out to be safe, and the rate of AR was comparable to that in the general population. A limitation of this study is the recall bias, because it was impossible to ensure compliance with measures recommended by the ECNM/REMA and because the time between the phone call and the vaccination was not the same in all patients. Thus, further prospective studies are needed. However, the proposed approach appears to be an effective preventive measure for managing patients with SM in the context of COVID-19 vaccination. Online RepositoryTable E1Demographic data and characteristics of patientsPatient IDSexAge, yAllergy backgroundClonal mast cell disorder typeCOVID-19 vaccineVaccine doses received, nAdverse reaction to vaccineH1 blocker premedicationReactive doseSymptoms1Male50NoneISMJohnson & Johnson1NANoneYes2Male66FA‡Anaphylaxis.BMMVaxzevria2NANoneYes3Female28NoneISMComirnaty2NANoneYes4Female70HA‡Anaphylaxis.BMMComirnaty2NANoneYes5Female73DAISMComirnaty2NANoneYes6Female39NoneISMComirnaty2NANoneYes7Male69HA‡Anaphylaxis.BMMComirnaty2NANoneYes8Male43SAISMVaxzevria2NANoneYes9Male73NoneISMComirnaty2NANoneYes10Male40FA, HA‡Anaphylaxis.BMMVaxzevria2NANoneYes11Female66DAISMVaxzevria2NANoneYes12Female63DAISMComirnaty2FirstFVYes13Male48HA‡Anaphylaxis.BMMComirnaty2NANoneYes14Female64FA‡Anaphylaxis.BMMVaxzevria2NANoneYes15Male40FA‡Anaphylaxis.BMMVaxzevria2NANoneYes16Male57NoneBMMComirnaty2NANoneYes17Female35NoneISMComirnaty2NANoneYes18Male40NoneISMComirnaty2FirstFVYes19Female35NoneISMVaxzevria2NANoneYes20Male27RA, FA‡Anaphylaxis.BMMComirnaty2NANoneYes21Male49NoneBMMComirnaty2NANoneYes22Female45NoneISMComirnaty2NANoneYes23Male63NoneSM AHNMD∗One presented with acute myeloid leukemia and the other had mucosa-associated lymphoid tissue–type lymphoma.Comirnaty2FirstFVYes24Female53SAISMComirnaty2NANoneYes25Female66NoneISMVaxzevria2SecondFVYes26Female42NoneISMComirnaty2NANoneYes27Male85DABMMComirnaty2NANoneYes28Female47NoneISMSpikevax2NANoneYes29Male53NoneSSMComirnaty2NANoneYes30Female38NoneISMSpikevax2NANoneYes31Male79HA, FABMMComirnaty2NANoneYes32Female84NoneBMMComirnaty2NANoneYes33Male61DA, FA, RA, HA‡Anaphylaxis.BMMVaxzevria2SecondFVYes34Female66FA‡Anaphylaxis.BMMSpikevax2NANoneYes35Female76FAISMComirnaty2NANoneYes36Female66FAISMSpikevax2NANoneYes37Female47NoneISMSpikevax2NANoneYes38Male66DA‡Anaphylaxis.BMMVaxzevria2NANoneYes39Female52NoneISMComirnaty2NANoneYes40Male49FA, RABMMComirnaty2NANoneYes41Female30RAISMSpikevax2SecondLRYes42Female41NoneBMMComirnaty2NANoneYes43Female84NoneISMComirnaty2NANoneYes44Female37NoneISMSpikevax2First and secondFVYes45Female48FA, RABMMComirnaty2NANoneYes46Female80NoneISMComirnaty2NANoneYes47Female51NoneISMVaxzevria2FirstFVYes48Male48IA‡Anaphylaxis.BMMComirnaty2NANoneYes49Female64NoneISMComirnaty2NANoneNo50Female43DAMMASComirnaty2NANoneYes51Male62NoneISMSpikevax2FirstLRYes52Female31NoneISMSpikevax2NANoneYes53Female36FABMMSpikevax2SecondLRYes54Female49NoneISMComirnaty2NANoneYes55Female56DABMMSpikevax2SecondLRYes56Male65DA, FABMMVaxzevria2NANoneYes57Male60NoneISMSpikevax2NANoneYes58Female64DA‡Anaphylaxis.BMMComirnaty2NANoneYes59Male69NoneBMMVaxzevria2NANoneYes60Male74NoneISMComirnaty2NANoneYes61Female63NoneISMVaxzevria2NANoneYes62Female54NoneISMComirnaty2NANoneYes63Male57NoneISMJohnson & Johnson1NANoneYes64Male68HA‡Anaphylaxis.BMMComirnaty2NANoneYes65Male55HA‡Anaphylaxis.BMMSpikevax2SecondLRYes66Female55DAISMVaxzevria2NANoneYes67Male45NoneISMComirnaty2NANoneNo68Male76NoneISMComirnaty2NANoneYes69Male62NoneBMMVaxzevria2NANoneYes70Male73NoneMMASComirnaty2NANoneYes71Male59DA‡Anaphylaxis.ISMComirnaty2NANoneYes72Female43NoneISMComirnaty2NANoneYes73Male48NoneISMComirnaty2NANoneYes74Female35NoneISMComirnaty2SecondFVYes75Female54HA‡Anaphylaxis.ISMComirnaty2NANoneYes76Female50NoneISMComirnaty2FirstFVYes77Male86RAISMComirnaty2NANoneYes78Female49RAISMComirnaty2NANoneYes79Male58NoneISMSpikevax2SecondLRYes80Female42NoneISMSpikevax2NANoneYes81Female41NoneISMSpikevax2SecondLR. FVYes82Female53NoneBMMComirnaty2SecondLRYes83Female79NoneISMComirnaty2NANoneNo84Female65NoneISMSpikevax2NANoneYes85Male54RA, DA‡Anaphylaxis.ISMComirnaty2NANoneNo86Female78NoneISMSpikevax2NANoneYes87Male56FA‡Anaphylaxis.ISMComirnaty2SecondFVYes88Male43NoneISMSpikevax2NANoneYes89Female58NoneISMComirnaty2SecondLRYes90Male75DA‡Anaphylaxis.ISMSpikevax2NANoneYes91Male68DA‡Anaphylaxis.SM-AHNMD∗One presented with acute myeloid leukemia and the other had mucosa-associated lymphoid tissue–type lymphoma.Spikevax2NANoneYes92Male73NoneISMComirnaty2SecondLRNo93Female23NoneISMSpikevax2NANoneNo94Female67NoneISMSpikevax2FirstLRNo95Male72HA‡Anaphylaxis.BMMComirnaty2NANoneNo96Male58FA‡Anaphylaxis.BMMSpikevax2SecondLR. FE. LYYes97Female56RAISMComirnaty2SecondLRNo98Female63NoneISMVaxzevria2FirstLRNo99Female58NoneISMSpikevax2NANoneYes100Female32NoneISMSpikevax2NANoneYes101Female23RAISMSpikevax2NANoneYes102Female39NoneISMSpikevax2NANoneYes103Female36NoneISMVaxzevria2NANoneNo104Male40NoneISMSpikevax2FirstLRYes105Male43DA‡Anaphylaxis.BMMSpikevax2NANoneYes106Female53NoneISMSpikevax2NANoneYes107Female57DA‡Anaphylaxis.ISMSpikevax2NANoneYes108Female44NoneISMSpikevax2NANoneYes109Female69NoneBMMSpikevax2FirstLRYes110Male49NoneISMSpikevax2NANoneYes111Female41NoneISMSpikevax2NANoneYes112Male45NoneBMMComirnaty2NANoneNo113Female58DA‡Anaphylaxis.BMMComirnaty2NANoneYes114Male46NoneISMSpikevax2NANoneNo115Male70NoneISMComirnaty2NANoneNo116Male20DA‡Anaphylaxis.ISMComirnaty2NANoneNo117Male49RAISMComirnaty2NANoneNo118Male77NoneISMComirnaty2NANoneNo119Female38SA, RAISMComirnaty2NANoneNoBMM, bone marrow mastocytosis; DA, frug allergy; FA, food allergy; FV, fever; HA, Hymenoptera allergy; IA, idiopathic anaphylaxis; ISM, indolent systemic mastocytosis; LR, local reaction; LY, lymphadenopathy; NA, not applicable; MMAS, monoclonal mast cell activation syndrome; RA, respiratory allergy; SA, skin allergy; SM-AHNMD, systemic mastocytosis with associated hematologic non-mast cell lineage disease; SSM, smoldering systemic mastocytosis.∗ One presented with acute myeloid leukemia and the other had mucosa-associated lymphoid tissue–type lymphoma.‡ Anaphylaxis. Open table in a new tab BMM, bone marrow mastocytosis; DA, frug allergy; FA, food allergy; FV, fever; HA, Hymenoptera allergy; IA, idiopathic anaphylaxis; ISM, indolent systemic mastocytosis; LR, local reaction; LY, lymphadenopathy; NA, not applicable; MMAS, monoclonal mast cell activation syndrome; RA, respiratory allergy; SA, skin allergy; SM-AHNMD, systemic mastocytosis with associated hematologic non-mast cell lineage disease; SSM, smoldering systemic mastocytosis.