Review 2: "Adverse reactions to BNT162b2 mRNA COVID-19 vaccine in medical staffs with a history of allergy"

RR:C19 Evidence Scale rating by reviewer:

• Potentially informative. The main claims made are not strongly justified by the methods and data, but may yield some insight. The results and conclusions of the study may resemble those from the hypothetical ideal study, but there is substantial room for doubt. Decision-makers should consider this evidence only with a thorough understanding of its weaknesses, alongside other evidence and theory. Decision-makers should not consider this actionable, unless the weaknesses are clearly understood and there is other theory and evidence to further support it.

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Review:

The authors provide a retrospective study on the general safety of COVID-19 vaccines, focusing mainly on potential adverse effects on the so-called "allergic" (in truth, the "self-reported allergic"). Noteworthy, none of the authors seem to be involved in the care of allergic patients/work in allergology. This fact is quite patent, namely on the rationale of this work. Furthermore, there is a mix-up of concepts. Pathologies with completely diverse mechanisms - asthma, allergic rhinitis, drug allergy, food allergy, anaphylaxis, and adverse drug reactions - are placed in the same box. The authors also show that those with the so-called "history of allergy" have worse outcomes regarding short-term and long-term adverse reactions. However, they fail to provide a rationale for this event in the discussion. They fail to mention why, for instance, drug allergy would be more likely a cause for allergy/anaphylaxis to these vaccines. I urge the authors not to give up on this publication which certainly has its merits, but strongly advise that an allergologist be involved in this work so that the methods may be revised. The manuscript/rationale may be improved upon.