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Corey KB, Koo G, Phillips EJ. Adverse Events and Safety of SARS-CoV-2 Vaccines: What's New and What's Next. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2254-2266. [PMID: 35550878 PMCID: PMC9085443 DOI: 10.1016/j.jaip.2022.04.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/26/2022] [Accepted: 04/27/2022] [Indexed: 12/29/2022]
Abstract
Just over 1 year following rollout of the first vaccines for coronavirus disease 2019, 572 million doses have been administered in the United States. Compared with the number of vaccines administered, adverse effects such as anaphylaxis have been rare, and seemingly, the more serious the effect, the rarer the occurrence. Despite these adverse effects, there are few, if any, true contraindications to coronavirus disease 2019 vaccination and most individuals recover without further sequelae. This review provides guidance for the allergist/immunologist regarding appropriate next steps based on patient's known allergy history or adverse reaction after receipt of coronavirus disease 2019 vaccine to assist in safe global immunization.
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Affiliation(s)
- Kristen B Corey
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Grace Koo
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Elizabeth J Phillips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, WA, Australia.
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52
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Takakura Y, Takahashi Y. Strategies for persistent retention of macromolecules and nanoparticles in the blood circulation. J Control Release 2022; 350:486-493. [PMID: 36029894 DOI: 10.1016/j.jconrel.2022.05.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/23/2022] [Indexed: 12/22/2022]
Abstract
The enhanced permeability and retention (EPR) effect has been the gold standard in developing drug delivery systems for passive tumor targeting. Although the importance of this concept remains unchanged, some controversies have arisen. In this review, various strategies for tumor targeting using macromolecules and nanoparticles based on the EPR effect are discussed from the viewpoint of pharmacokinetics. Overall, such strategies seek to retain therapeutic material in the blood circulation, which is a key factor for successful targeting. Strategies using macromolecules, including antibody-drug conjugates, serum albumin-based delivery systems, PEGylated recombinant proteins, and stealth liposomes as well as nanoparticle-based strategies such as those based on lipid nanoparticles, and polymeric micelles, have been discussed. The feasibility of small extracellular vesicles, a new class of nanosized delivery carriers, is also discussed.
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Affiliation(s)
- Yoshinobu Takakura
- Department of Biopharmaceutics and Drug Metabolism, Graduate School of Pharmaceutical Sciences, Kyoto University, 46-29 Yoshidashimoadachi-cho, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Yuki Takahashi
- Department of Biopharmaceutics and Drug Metabolism, Graduate School of Pharmaceutical Sciences, Kyoto University, 46-29 Yoshidashimoadachi-cho, Sakyo-ku, Kyoto 606-8501, Japan
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53
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Ju Y, Lee WS, Pilkington EH, Kelly HG, Li S, Selva KJ, Wragg KM, Subbarao K, Nguyen THO, Rowntree LC, Allen LF, Bond K, Williamson DA, Truong NP, Plebanski M, Kedzierska K, Mahanty S, Chung AW, Caruso F, Wheatley AK, Juno JA, Kent SJ. Anti-PEG Antibodies Boosted in Humans by SARS-CoV-2 Lipid Nanoparticle mRNA Vaccine. ACS NANO 2022; 16:11769-11780. [PMID: 35758934 PMCID: PMC9261834 DOI: 10.1021/acsnano.2c04543] [Citation(s) in RCA: 95] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/21/2022] [Indexed: 05/16/2023]
Abstract
Humans commonly have low level antibodies to poly(ethylene) glycol (PEG) due to environmental exposure. Lipid nanoparticle (LNP) mRNA vaccines for SARS-CoV-2 contain small amounts of PEG, but it is not known whether PEG antibodies are enhanced by vaccination and what their impact is on particle-immune cell interactions in human blood. We studied plasma from 130 adults receiving either the BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) mRNA vaccines or no SARS-CoV-2 vaccine for PEG-specific antibodies. Anti-PEG IgG was commonly detected prior to vaccination and was significantly boosted a mean of 13.1-fold (range 1.0-70.9) following mRNA-1273 vaccination and a mean of 1.78-fold (range 0.68-16.6) following BNT162b2 vaccination. Anti-PEG IgM increased 68.5-fold (range 0.9-377.1) and 2.64-fold (0.76-12.84) following mRNA-1273 and BNT162b2 vaccination, respectively. The rise in PEG-specific antibodies following mRNA-1273 vaccination was associated with a significant increase in the association of clinically relevant PEGylated LNPs with blood phagocytes ex vivo. PEG antibodies did not impact the SARS-CoV-2 specific neutralizing antibody response to vaccination. However, the elevated levels of vaccine-induced anti-PEG antibodies correlated with increased systemic reactogenicity following two doses of vaccination. We conclude that PEG-specific antibodies can be boosted by LNP mRNA vaccination and that the rise in PEG-specific antibodies is associated with systemic reactogenicity and an increase of PEG particle-leukocyte association in human blood. The longer-term clinical impact of the increase in PEG-specific antibodies induced by lipid nanoparticle mRNA vaccines should be monitored. It may be useful to identify suitable alternatives to PEG for developing next-generation LNP vaccines to overcome PEG immunogenicity in the future.
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Affiliation(s)
- Yi Ju
- Department of Microbiology and Immunology, Peter
Doherty Institute for Infection and Immunity, The University of
Melbourne, Melbourne, VIC 3000, Australia
- School of Health and Biomedical Sciences,
RMIT University, Bundoora, VIC 3083,
Australia
- Department of Chemical Engineering, The
University of Melbourne, Melbourne, VIC 3000,
Australia
| | - Wen Shi Lee
- Department of Microbiology and Immunology, Peter
Doherty Institute for Infection and Immunity, The University of
Melbourne, Melbourne, VIC 3000, Australia
| | - Emily H. Pilkington
- Department of Microbiology and Immunology, Peter
Doherty Institute for Infection and Immunity, The University of
Melbourne, Melbourne, VIC 3000, Australia
- Department of Drug Delivery, Disposition and Dynamics,
Monash Institute of Pharmaceutical Sciences, Monash University,
Melbourne, VIC 3000, Australia
| | - Hannah G. Kelly
- Department of Microbiology and Immunology, Peter
Doherty Institute for Infection and Immunity, The University of
Melbourne, Melbourne, VIC 3000, Australia
| | - Shiyao Li
- Department of Chemical Engineering, The
University of Melbourne, Melbourne, VIC 3000,
Australia
| | - Kevin J. Selva
- Department of Microbiology and Immunology, Peter
Doherty Institute for Infection and Immunity, The University of
Melbourne, Melbourne, VIC 3000, Australia
| | - Kathleen M. Wragg
- Department of Microbiology and Immunology, Peter
Doherty Institute for Infection and Immunity, The University of
Melbourne, Melbourne, VIC 3000, Australia
| | - Kanta Subbarao
- Department of Microbiology and Immunology, Peter
Doherty Institute for Infection and Immunity, The University of
Melbourne, Melbourne, VIC 3000, Australia
- WHO Collaborating Centre for Reference and Research on
Influenza, Peter Doherty Institute for Infection and Immunity,
Melbourne, VIC 3000, Australia
| | - Thi H. O. Nguyen
- Department of Microbiology and Immunology, Peter
Doherty Institute for Infection and Immunity, The University of
Melbourne, Melbourne, VIC 3000, Australia
| | - Louise C. Rowntree
- Department of Microbiology and Immunology, Peter
Doherty Institute for Infection and Immunity, The University of
Melbourne, Melbourne, VIC 3000, Australia
| | - Lilith F. Allen
- Department of Microbiology and Immunology, Peter
Doherty Institute for Infection and Immunity, The University of
Melbourne, Melbourne, VIC 3000, Australia
| | - Katherine Bond
- Department of Microbiology, Royal Melbourne
Hospital, Melbourne, VIC 3000, Australia
| | - Deborah A. Williamson
- Department of Microbiology and Immunology, Peter
Doherty Institute for Infection and Immunity, The University of
Melbourne, Melbourne, VIC 3000, Australia
- Department of Microbiology, Royal Melbourne
Hospital, Melbourne, VIC 3000, Australia
| | - Nghia P. Truong
- Department of Microbiology and Immunology, Peter
Doherty Institute for Infection and Immunity, The University of
Melbourne, Melbourne, VIC 3000, Australia
- Department of Drug Delivery, Disposition and Dynamics,
Monash Institute of Pharmaceutical Sciences, Monash University,
Melbourne, VIC 3000, Australia
| | - Magdalena Plebanski
- School of Health and Biomedical Sciences,
RMIT University, Bundoora, VIC 3083,
Australia
| | - Katherine Kedzierska
- Department of Microbiology and Immunology, Peter
Doherty Institute for Infection and Immunity, The University of
Melbourne, Melbourne, VIC 3000, Australia
| | - Siddhartha Mahanty
- Department of Infectious Diseases, Peter Doherty Institute
for Infection and Immunity, The University of Melbourne,
Melbourne, VIC 3000, Australia
| | - Amy W. Chung
- Department of Microbiology and Immunology, Peter
Doherty Institute for Infection and Immunity, The University of
Melbourne, Melbourne, VIC 3000, Australia
| | - Frank Caruso
- Department of Chemical Engineering, The
University of Melbourne, Melbourne, VIC 3000,
Australia
| | - Adam K. Wheatley
- Department of Microbiology and Immunology, Peter
Doherty Institute for Infection and Immunity, The University of
Melbourne, Melbourne, VIC 3000, Australia
| | - Jennifer A. Juno
- Department of Microbiology and Immunology, Peter
Doherty Institute for Infection and Immunity, The University of
Melbourne, Melbourne, VIC 3000, Australia
| | - Stephen J. Kent
- Department of Microbiology and Immunology, Peter
Doherty Institute for Infection and Immunity, The University of
Melbourne, Melbourne, VIC 3000, Australia
- Melbourne Sexual Health Centre and Department of Infectious
Diseases, Alfred Hospital and Central Clinical School, Monash
University, Melbourne, VIC 3000, Australia
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54
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Monitoring Anti-PEG Antibodies Level upon Repeated Lipid Nanoparticle-Based COVID-19 Vaccine Administration. Int J Mol Sci 2022; 23:ijms23168838. [PMID: 36012103 PMCID: PMC9408675 DOI: 10.3390/ijms23168838] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 12/04/2022] Open
Abstract
PEGylated lipids are one of the four constituents of lipid nanoparticle mRNA COVID-19 vaccines. Therefore, various concerns have been raised on the generation of anti-PEG antibodies and their potential role in inducing hypersensitivity reactions following vaccination or in reducing vaccine efficacy due to anti-carrier immunity. Here, we assess the prevalence of anti-PEG antibodies, in a cohort of vaccinated individuals, and give an overview of their time evolution after repeated vaccine administrations. Results indicate that, in our cohort, the presence of PEG in the formulation did not influence the level of anti-Spike antibodies generated upon vaccination and was not related to any reported, serious adverse effects. The time-course analysis of anti-PEG IgG showed no significant booster effect after each dose, whereas for IgM a significant increase in antibody levels was detected after the first and third dose. Data suggest that the presence of PEG in the formulation does not affect safety or efficacy of lipid-nanoparticle-based COVID-19 vaccines.
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55
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Pawankar R, Thong BYH, Tiongco-Recto M, Wang JY, Latiff AHA, Leung TF, Li PH, Lobo RCM, Lucas M, Oh JW, Kamchaisatian W, Nagao M, Rengganis I, Udwadia ZF, Dhar R, Munkhbayarlakh S, Narantsetseg L, Pham DL, Zhang Y, Zhang L. Asia Pacific perspectives on the second year of the COVID-19 pandemic: A follow-up survey. Clin Exp Allergy 2022; 52:965-973. [PMID: 35906963 PMCID: PMC9353384 DOI: 10.1111/cea.14191] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/08/2022] [Accepted: 06/20/2022] [Indexed: 11/26/2022]
Abstract
Background The Coronavirus disease 2019 (COVID‐19) pandemic is currently in its third year. This follow‐up survey was commissioned by the Asia Pacific Association of Allergy Asthma and Clinical Immunology (APAAACI) Task Force on COVID‐19 to compare and contrast changes in the epidemiology, clinical profile, therapeutics and public health measures of the pandemic in the Asia Pacific region. Methods A questionnaire‐based survey comprising 32 questions was electronically sent out to all 15 member countries of APAAACI using Survey Monkey® from 1 December 2021 to 28 February 2022. Results Seventeen responses were received from 14/15 (93.4%) member countries and 3 individual members. Mild‐to‐moderate COVID‐19 predominated over severe infection, largely contributed by COVID‐19 vaccination programmes in the region. The incidence of vaccine adverse reactions in particular anaphylaxis from messenger ribonucleic acid (mRNA) vaccines was no longer as high as initially anticipated, although perimyocarditis remains a concern in younger males. Novel therapeutics for mild‐to‐moderate disease including neutralizing antibodies casirivimab/imdevimab (REGEN‐COV®) and sotrovimab (Xevudy®), anti‐virals Paxlovid® (nirmatrelvir and ritonavir) and Molnupiravir pre‐exposure prophylaxis for high‐risk persons with Tixagevimab and Cilgavimab (Evusheld) are now also available to complement established therapeutics (e.g., remdesivir, dexamethasone and baricitinib) for severe disease. In the transition to endemicity, public health measures are also evolving away from containment/elimination strategies. Conclusions With access to internationally recommended standards of care including public health preventive measures, therapeutics and vaccines among most APAAACI member countries, much progress has been made over the 2‐year period in minimizing the morbidity and mortality from COVID‐19 disease.
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Affiliation(s)
- Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Bernard Yu-Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Marysia Tiongco-Recto
- Division of Allergy and Immunology, Department of Pediatrics, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Jiu-Yao Wang
- Allergy, Immunology, and Microbiome (A.I.M.) Research Centre, China Medical University Children's Hospital, Taichung, Taiwan
| | | | - Ting Fan Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Philip Hei Li
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong
| | - Rommel Crisenio M Lobo
- Philippine Childrens Medical Center Hospital of Infant Jesus Medical Center, Fe del Mundo Medical Center, Quezon City, Philippines
| | - Michela Lucas
- Department of Clinical Immunology, Sir Charles Gairdner Hospital, Perth Children's Hospital, Perth, WA, Australia.,Medical School, University of Western Australia, Perth, WA, Australia
| | - Jae-Won Oh
- Department of Pediatrics, Hanyang University Guri Hospital, Guri, South Korea
| | - Wasu Kamchaisatian
- Pediatric Allergy and Immunology, Samitivej Children's Hospital, Bangkok, Thailand
| | - Mizuho Nagao
- National Hospital Organization Mie National Hospital, Institute for Clinical Research, Tsu, Japan
| | - Iris Rengganis
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Cipto Mangunkusumo General Hopsital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Zarir F Udwadia
- P.D. Hinduja National Hospital and Medical Research Centre, Breach Candy Hospital, in Mumbai, Mumbai, India
| | | | - Sonomjamts Munkhbayarlakh
- Department of Pulmonology and Allergology, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Logii Narantsetseg
- Department of Biochemistry, School of Biomedicine, National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Duy Le Pham
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Yuan Zhang
- Department of Allergy, Beijing TongRen Hospital, Capital Medical University, Beijing, China
| | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital, Capital Medical University, Beijing, China
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56
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Recent progress in application of nanovaccines for enhancing mucosal immune responses. Acta Pharm Sin B 2022. [DOI: 10.1016/j.apsb.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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57
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Modeling COVID-19 Vaccine Adverse Effects with a Visualized Knowledge Graph Database. Healthcare (Basel) 2022; 10:healthcare10081419. [PMID: 36011076 PMCID: PMC9407998 DOI: 10.3390/healthcare10081419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
In this study, we utilized ontology and machine learning methods to analyze the current results on vaccine adverse events. With the VAERS (Vaccine Adverse Event Reporting System) Database, the side effects of COVID-19 vaccines are summarized, and a relational/graph database was implemented for further applications and analysis. The adverse effects of COVID-19 vaccines up to March 2022 were utilized in the study. With the built network of the adverse effects of COVID-19 vaccines, the API can help provide a visualized interface for patients, healthcare providers and healthcare officers to quickly find the information of a certain patient and the potential relationships of side effects of a certain vaccine. In the meantime, the model was further applied to predict the key feature symptoms that contribute to hospitalization and treatment following receipt of a COVID-19 vaccine and the performance was evaluated with a confusion matrix method. Overall, our study built a user-friendly visualized interface of the side effects of vaccines and provided insight on potential adverse effects with ontology and machine learning approaches. The interface and methods can be expanded to all FDA (Food and Drug Administration)-approved vaccines.
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58
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Hsieh MH, Yamaguchi Y. Immune Response in Regard to Hypersensitivity Reactions after COVID-19 Vaccination. Biomedicines 2022; 10:biomedicines10071641. [PMID: 35884946 PMCID: PMC9312871 DOI: 10.3390/biomedicines10071641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), is a member of the genus Betacoronavirus. This virus was first detected in December 2019, and the situation quickly escalated to cause a global pandemic within a few months. COVID-19 had caused more than 5.5 million deaths as of January 2022. Hence, the urgency of effective vaccination contributed to the fastest rate of vaccine development seen to date (i.e., within 1.5 years). Despite reports of good vaccine efficacy without severe systemic reactions at the clinical trial stage, hypersensitivity reactions have been reported following worldwide vaccination campaigns. We provide a brief review regarding the structure of SARS-CoV-2. We also review the most acceptable types of vaccines in terms of safety profiles, namely the BNT162b2, mRNA-1273, and AZD1222 vaccines. This review aims to facilitate an understanding of the possible immune mechanisms regarding COVID-19-vaccination-related hypersensitivity reactions, such as thrombosis and thrombocytopenia, cutaneous adverse reactions, myocarditis, and perimyocarditis.
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59
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Paul P, Janjua E, AlSubaie M, Ramadorai V, Mushannen B, Vattoth AL, Khan W, Bshesh K, Nauman A, Mohammed I, Bouhali I, Khalid M, Zakaria D. Anaphylaxis and Related Events Post-COVID-19 Vaccination: A Systematic Review. J Clin Pharmacol 2022; 62:1335-1349. [PMID: 35794852 PMCID: PMC9349886 DOI: 10.1002/jcph.2120] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/29/2022] [Indexed: 11/10/2022]
Abstract
The Coronavirus Disease 2019 (COVID-19), induced by the SARS CoV-2 virus, is responsible for a global pandemic following widespread transmission and death. Several vaccines have been developed to counter this public health crisis using both novel and conventional methods. Following approval based on promising efficacy and safety data, the AstraZeneca, Janssen, Moderna, Pfizer/BioNTech, and SinoVac vaccines have been administered globally among different populations with various reported side effects. Reports of life-threatening anaphylaxis following administration were of particular concern for both healthcare providers and the public. A systematic literature search using PubMed, Embase, Scopus, Web of Science, Science Direct, MedRxiv, and Lens.org databases identified relevant studies reporting anaphylaxis following vaccine administration. This systematic review includes 41 studies reporting anaphylaxis out of 19908 studies that were retrieved for screening. A total of 7942 cases, including 43 deaths, were reported across 14 countries. Most cases occurred following the administration of the first dose. Importantly, the benefits of vaccination far outweigh the risks of anaphylaxis. Subsequently, as populations continue to get vaccinated, it is important for healthcare providers to be able to recognize individuals at risk of developing anaphylaxis. Furthermore, they must be familiar with both the clinical hallmarks and treatment of anaphylactic reactions to minimize long term sequalae and prevent death in vaccinated individuals. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Pradipta Paul
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Emmad Janjua
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Mai AlSubaie
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Vinutha Ramadorai
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Beshr Mushannen
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | | | - Wafa Khan
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Khalifa Bshesh
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Areej Nauman
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Ibrahim Mohammed
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar.,Internal Medicine, Albany Medical Center Hospital, Albany, New York, USA
| | - Imane Bouhali
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Mohammed Khalid
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Dalia Zakaria
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
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60
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Banerji A, Norton AE, Blumenthal KG, Stone CA, Phillips E. Rapid progress in our understanding of COVID-19 vaccine allergy: A cause for optimism, not hesitancy. J Allergy Clin Immunol 2022; 150:12-16. [PMID: 35398412 PMCID: PMC8988439 DOI: 10.1016/j.jaci.2022.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 01/31/2023]
Abstract
Anaphylaxis is a life-threatening condition and when associated with vaccination, leads to vaccine hesitancy. The concerns around vaccine-related anaphylaxis have become even more important during the coronavirus disease 2019 (COVID-19) pandemic where the COVID-19 vaccines remain one of our most important tools. Although rates of anaphylaxis to COVID-19 vaccines are not significantly different from those to other vaccines, Centers for Disease Control and Prevention guidance recommends avoidance of the same COVID-19 vaccine in individuals who had an allergic reaction or are allergic to a COVID-19 vaccine component. Fortunately, our understanding of COVID-19 vaccine allergic reactions has improved dramatically in the past year in large part due to important research efforts from individuals in the allergy community. Initially, researchers published algorithmic approaches using risk stratification and excipient skin testing. However, as our experience and knowledge improved with ongoing research, we have better data showing safety of repeat vaccination despite an initial reaction. We review our progress starting in December 2020 when the Food and Drug Administration approved the first COVID-19 vaccine in the United States through early 2022, highlighting our success in understanding COVID-19 vaccine reactions.
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Affiliation(s)
- Aleena Banerji
- Division of Rheumatology Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Allison E Norton
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, Tenn
| | - Kimberly G Blumenthal
- Division of Rheumatology Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass; Edward P. Lawrence Center for Quality and Safety, Massachusetts General Hospital, Boston, Mass
| | - Cosby A Stone
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Elizabeth Phillips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
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61
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Fay JM, Lim C, Finkelstein A, Batrakova EV, Kabanov AV. PEG-Free Polyion Complex Nanocarriers for Brain-Derived Neurotrophic Factor. Pharmaceutics 2022; 14:pharmaceutics14071391. [PMID: 35890287 PMCID: PMC9317007 DOI: 10.3390/pharmaceutics14071391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/29/2022] [Accepted: 06/29/2022] [Indexed: 12/10/2022] Open
Abstract
Many therapeutic formulations incorporate poly(ethylene glycol) (PEG) as a stealth component to minimize early clearance. However, PEG is immunogenic and susceptible to accelerated clearance after multiple administrations. Here, we present two novel reformulations of a polyion complex (PIC), originally composed of poly(ethylene glycol)113-b-poly(glutamic acid)50 (PEG-PLE) and brain-derived neurotrophic factor (BDNF), termed Nano-BDNF (Nano-BDNF PEG-PLE). We replace the PEG based block copolymer with two new polymers, poly(sarcosine)127-b-poly(glutamic acid)50 (PSR-PLE) and poly(methyl-2-oxazolines)38-b-poly(oxazolepropanoic acid)27-b-poly(methyl-2-oxazoline)38 (PMeOx-PPaOx-PMeOx), which are driven to association with BDNF via electrostatic interactions and hydrogen bonding to form a PIC. Formulation using a microfluidic mixer yields small and narrowly disperse nanoparticles which associate following similar principles. Additionally, we demonstrate that encapsulation does not inhibit access by the receptor kinase, which affects BDNF’s physiologic benefits. Finally, we investigate the formation of nascent nanoparticles through a series of characterization experiments and isothermal titration experiments which show the effects of pH in the context of particle self-assembly. Our findings indicate that thoughtful reformulation of PEG based, therapeutic PICs with non-PEG alternatives can be accomplished without compromising the self-assembly of the PIC.
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Affiliation(s)
- James M. Fay
- Center for Nanotechnology in Drug Delivery, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599-7362, USA; (J.M.F.); (C.L.); (E.V.B.)
- Department of Biochemistry and Biophysics, School of Medicine, University of North Carolina, Chapel Hill, NC 27599-7260, USA
| | - Chaemin Lim
- Center for Nanotechnology in Drug Delivery, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599-7362, USA; (J.M.F.); (C.L.); (E.V.B.)
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599-7260, USA
| | - Anna Finkelstein
- Center for Nanotechnology in Drug Delivery, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599-7362, USA; (J.M.F.); (C.L.); (E.V.B.)
| | - Elena V. Batrakova
- Center for Nanotechnology in Drug Delivery, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599-7362, USA; (J.M.F.); (C.L.); (E.V.B.)
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599-7260, USA
| | - Alexander V. Kabanov
- Center for Nanotechnology in Drug Delivery, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599-7362, USA; (J.M.F.); (C.L.); (E.V.B.)
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599-7260, USA
- Laboratory of Chemical Design of Bionanomaterials, Faculty of Chemistry, M.V. Lomonosov Moscow State University, 119992 Moscow, Russia
- Correspondence:
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Pendlebury GA, Oro P, Haynes W, Merideth D, Bartling S, Bongiorno MA. The Impact of COVID-19 Pandemic on Dermatological Conditions: A Novel, Comprehensive Review. Dermatopathology (Basel) 2022; 9:212-243. [PMID: 35892480 PMCID: PMC9326733 DOI: 10.3390/dermatopathology9030027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 01/09/2023] Open
Abstract
Background: The earliest cases of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, in December 2019. Since the declaration as a pandemic on 11 March 2020, further dermatological conditions continue to be documented. We herein present a novel literature review of dermatological manifestations associated with the Coronavirus Disease 2019 (COVID-19) pandemic. To date, this literature review is the first broad-spectrum examination that analyzes a range of dermatological manifestations related to the COVID-19 pandemic: infection, vaccinations, personal protective equipment (PPE), and psychosocial factors. Methods: A detailed literature search was conducted using key terms for cutaneous manifestations associated with the scope of this review. The search retrieved 2199 articles. Results: The COVID-19 pandemic has triggered a significant range of dermatologic sequela. Etiologies of lesions continue to be investigated. Proposed mechanisms include inflammatory response to spike protein, vitamin D deficiency, ACE2 receptor activation, androgen levels, and increased psychological stress. One prominent mechanism describes viral spike protein invasion into the dermis by binding to the angiotensin-converting enzyme 2 (ACE-2) receptors in keratinocytes, with a secondary immunological response. Conclusions: Dermatologists play an integral role in the proper diagnosis and treatment of COVID-related lesions. Early treatment regimens and timely prophylaxis have been shown to safely reduce infection-related dermatological sequelae. Additional investigations and data collection can reduce disease burden and improve overall prognosis.
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Affiliation(s)
- Gehan A. Pendlebury
- College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Peter Oro
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA; (P.O.); (W.H.); (D.M.)
| | - William Haynes
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA; (P.O.); (W.H.); (D.M.)
| | - Drew Merideth
- School of Osteopathic Medicine in Arizona, A.T. Still University, Mesa, AZ 85206, USA; (P.O.); (W.H.); (D.M.)
| | - Samantha Bartling
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA; (S.B.); (M.A.B.)
| | - Michelle A. Bongiorno
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA; (S.B.); (M.A.B.)
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63
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Evaluation of Patients with Vaccine Allergies Prior to mRNA-Based COVID-19 Vaccination. Vaccines (Basel) 2022; 10:vaccines10071025. [PMID: 35891189 PMCID: PMC9319755 DOI: 10.3390/vaccines10071025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 11/19/2022] Open
Abstract
During the initial rollout of coronavirus disease 2019 (COVID-19) vaccination in Singapore, the Ministry of Health (MOH) issued a recommendation that patients with a history of any previous vaccine allergy be referred to an allergist for further review of their suitability to proceed with mRNA-based COVID-19 vaccines. Patients fulfilling the above criterion were divided into three groups: immediate reaction (Group A), delayed reaction (Group B) and no/irrelevant reaction (Group C). They were subjected to either a skin prick test (SPT) and intradermal test (IDT) with polyethylene glycol (PEG) or polysorbate-containing products; direct injection with the Pfizer BNT162b2 vaccine in the allergy clinic; or injection at community vaccination centres, respectively. Groups A and B were also invited to complete a questionnaire survey on post-vaccination reactions, and blood sampling pre-vaccination and 1 h after the first dose of the BNT162b2 vaccine to measure immunoglobulin (Ig) G, IgM and IgE antibodies to the Pfizer BNT162b2 vaccine via ELISA assays immobilised with the BNT162b2 vaccine, as well as levels of allergic cytokines interleukin (IL)-4 and IL-33, complement C5a and the endothelial activation marker intercellular adhesion molecule-1 (ICAM-1). Groups A and B comprised 62 (20.5%) patients each. In Group A, two subjects (3.2%) with equivocal IDT results tolerated both doses of the BNT162b2 vaccine without major allergic reactions. The remaining 60 (96.8%) in Group A and 62 (100%) in Group B completed both doses of BNT162b2 vaccination without major adverse reactions. Among the 99 who completed the questionnaire survey, 13 (13%) patients reported mild allergic reactions after the first dose of the vaccine. Immunoglobulin (Ig) G and M antibodies, but not IgE antibodies to the Pfizer BNT162b2 vaccine were detected in 67 subjects prior to vaccination. The presence of anti-Pfizer BNT162b2 IgG and IgM prior to vaccination did not result in major allergic reactions nor increases in Th2-related cytokines (IL-4, IL-33), complement activation products (C5a) or endothelial activation (ICAM-1). The majority of those with suspected reactions to non-COVID-19 polysorbate-containing vaccines tolerated the BNT162b2 vaccine. Excipient skin tests for PEG and polysorbate prior to vaccination are unnecessary.
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Allergic Reactions to COVID-19 Vaccines: Risk Factors, Frequency, Mechanisms and Management. BioDrugs 2022; 36:443-458. [PMID: 35696066 PMCID: PMC9190452 DOI: 10.1007/s40259-022-00536-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 12/01/2022]
Abstract
Conventional vaccines have been widely studied, along with their risk of causing allergic reactions. These generally consist of mild local reactions and only rarely severe anaphylaxis. Although all the current COVID-19 vaccines marketed in Europe have been shown to be safe overall in the general population, early post-marketing evidence has shown that mRNA-based vaccines using novel platforms (i.e., lipid nanoparticles) were associated with an increased risk of severe allergic reactions as compared to conventional vaccines. In this paper we performed an updated literature review on frequency, risk factors, and underlying mechanisms of COVID-19 vaccine-related allergies by searching MEDLINE and Google Scholar databases. We also conducted a qualitative search on VigiBase and EudraVigilance databases to identify reports of “Hypersensitivity” and “Anaphylactic reaction” potentially related to COVID-19 vaccines (Comirnaty, Spikevax, Vaxzevria and COVID-19 Janssen Vaccine), and in EudraVigilance to estimate the reporting rates of “Anaphylactic reaction” and “Anaphylactic shock” after COVID-19 vaccination in the European population. We also summarized the scientific societies’ and regulatory agencies’ recommendations for prevention and management of COVID-19 vaccine-related allergic reactions, especially in those with a history of allergy.
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Padín-González E, Lancaster P, Bottini M, Gasco P, Tran L, Fadeel B, Wilkins T, Monopoli MP. Understanding the Role and Impact of Poly (Ethylene Glycol) (PEG) on Nanoparticle Formulation: Implications for COVID-19 Vaccines. Front Bioeng Biotechnol 2022; 10:882363. [PMID: 35747492 PMCID: PMC9209764 DOI: 10.3389/fbioe.2022.882363] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/09/2022] [Indexed: 12/27/2022] Open
Abstract
Poly (ethylene glycol) (PEG) is a widely used polymer in a variety of consumer products and in medicine. PEGylation refers to the conjugation of PEG to drugs or nanoparticles to increase circulation time and reduce unwanted host responses. PEG is viewed as being well-tolerated, but previous studies have identified anti-PEG antibodies and so-called pseudoallergic reactions in certain individuals. The increased use of nanoparticles as contrast agents or in drug delivery, along with the introduction of mRNA vaccines encapsulated in PEGylated lipid nanoparticles has brought this issue to the fore. Thus, while these vaccines have proven to be remarkably effective, rare cases of anaphylaxis have been reported, and this has been tentatively ascribed to the PEGylated carriers, which may trigger complement activation in susceptible individuals. Here, we provide a general overview of the use of PEGylated nanoparticles for pharmaceutical applications, and we discuss the activation of the complement cascade that might be caused by PEGylated nanomedicines for a better understanding of these immunological adverse reactions.
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Affiliation(s)
| | - Pearl Lancaster
- Department of Chemistry, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Massimo Bottini
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Lang Tran
- Institute of Occupational Medicine, Edinburgh, United Kingdom
| | - Bengt Fadeel
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Terence Wilkins
- School of Chemical and Process Engineering, University of Leeds, Leeds, United Kingdom
- Correspondence: Terence Wilkins, ; Marco P. Monopoli,
| | - Marco P. Monopoli
- Department of Chemistry, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
- Correspondence: Terence Wilkins, ; Marco P. Monopoli,
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66
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Cabanillas B, Novak N, Akdis CA. The form of PEG matters: PEG conjugated with lipids and not PEG alone could be the specific form involved in allergic reactions to COVID-19 vaccines. Allergy 2022; 77:1658-1660. [PMID: 34816455 DOI: 10.1111/all.15187] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/04/2021] [Accepted: 11/21/2021] [Indexed: 12/19/2022]
Abstract
The excipient polyethylene glycol (PEG) contained in the mRNA vaccines for COVID-19 has been pointed out as one of the possible triggers of the hypersensitivity reactions that have been described since the beginning of the vaccine campaigns for COVID-19 protection.1 However, PEG is not present in the mRNA vaccines in an isolated form but in conjugation with lipid-nanoparticles (LNPs), which are spherical vesicles constituted by ionizable lipids, thanks to a process called PEGylation, which could potentially alter the immunogenic properties of PEG. PEG coats the surface of the LNPs reducing opsonization, aggregation, and improving mRNA delivery to the target cells.
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Affiliation(s)
- Beatriz Cabanillas
- Department of Allergy Research Institute Hospital 12 de Octubre Madrid Spain
| | - Natalija Novak
- Department of Dermatology and Allergy University Hospital Bonn Bonn Germany
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
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Li M, Wang H, Tian L, Pang Z, Yang Q, Huang T, Fan J, Song L, Tong Y, Fan H. COVID-19 vaccine development: milestones, lessons and prospects. Signal Transduct Target Ther 2022; 7:146. [PMID: 35504917 PMCID: PMC9062866 DOI: 10.1038/s41392-022-00996-y] [Citation(s) in RCA: 147] [Impact Index Per Article: 73.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 12/15/2022] Open
Abstract
With the constantly mutating of SARS-CoV-2 and the emergence of Variants of Concern (VOC), the implementation of vaccination is critically important. Existing SARS-CoV-2 vaccines mainly include inactivated, live attenuated, viral vector, protein subunit, RNA, DNA, and virus-like particle (VLP) vaccines. Viral vector vaccines, protein subunit vaccines, and mRNA vaccines may induce additional cellular or humoral immune regulations, including Th cell responses and germinal center responses, and form relevant memory cells, greatly improving their efficiency. However, some viral vector or mRNA vaccines may be associated with complications like thrombocytopenia and myocarditis, raising concerns about the safety of these COVID-19 vaccines. Here, we systemically assess the safety and efficacy of COVID-19 vaccines, including the possible complications and different effects on pregnant women, the elderly, people with immune diseases and acquired immunodeficiency syndrome (AIDS), transplant recipients, and cancer patients. Based on the current analysis, governments and relevant agencies are recommended to continue to advance the vaccine immunization process. Simultaneously, special attention should be paid to the health status of the vaccines, timely treatment of complications, vaccine development, and ensuring the lives and health of patients. In addition, available measures such as mix-and-match vaccination, developing new vaccines like nanoparticle vaccines, and optimizing immune adjuvant to improve vaccine safety and efficacy could be considered.
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Affiliation(s)
- Maochen Li
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Han Wang
- Laboratory for Clinical Immunology, Harbin Children's Hospital, Harbin, China
| | - Lili Tian
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Zehan Pang
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Qingkun Yang
- College of Materials Science and Engineering, Beijing University of Chemical Technology, Beijing, China
| | - Tianqi Huang
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Junfen Fan
- Institute of Cerebrovascular Disease Research and Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Lihua Song
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China.
| | - Yigang Tong
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China. .,Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, China.
| | - Huahao Fan
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China.
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68
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Fernandez-Davila N, Taylor MG, Anvari S. Hypersensitivity Reactions to COVID-19 Vaccines-Identify High-risk Children and Vaccinate the Rest. JAMA Pediatr 2022; 176:443-444. [PMID: 35254412 DOI: 10.1001/jamapediatrics.2022.0088] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Natalia Fernandez-Davila
- Division of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Margaret G Taylor
- Division of Infectious Diseases, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Sara Anvari
- Division of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston.,William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston
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69
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Re-directing nanomedicines to the spleen: A potential technology for peripheral immunomodulation. J Control Release 2022; 350:60-79. [DOI: 10.1016/j.jconrel.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 11/23/2022]
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Eberlein B, Mathes S, Fischer J, Darsow U, Biedermann T, Brockow K. Do basophil activation tests help elucidate allergic reactions to the ingredients in COVID-19 vaccines? Allergy 2022; 77:2924-2936. [PMID: 35266570 PMCID: PMC9111482 DOI: 10.1111/all.15278] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 01/27/2023]
Abstract
The worldwide use of COVID-19 vaccines has shown that immediate allergic reactions to the ingredients are rare but should be clarified by means of an allergological work-up. This review aims to highlight the current state of knowledge and possible pathogenesis based on the literature published to date. In addition to recording a detailed history and performing skin tests, cellular tests (basophil activation or basophil histamine release test) by using the vaccines or modified compounds containing polyethylene glycol (PEG), rather than unmodified PEGs, have proven to be particularly helpful. Negative results with vaccines seem to indicate tolerance. Details of the performance of these cellular tests with different vaccines, PEGs of different molecular weights, other ingredients of the vaccines, as well as other PEGylated drugs, and the results in the context of COVID-19 vaccination of various working groups worldwide are summarized.
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Affiliation(s)
- Bernadette Eberlein
- Department of Dermatology and Allergy BiedersteinSchool of MedicineTechnical University of MunichMunichGermany
| | - Sonja Mathes
- Department of Dermatology and Allergy BiedersteinSchool of MedicineTechnical University of MunichMunichGermany
| | - Jörg Fischer
- Department of DermatologyEberhard Karls UniversityTübingenGermany,Division of Experimental Allergy and ImmunodermatologyUniversity of OldenburgOldenburgGermany
| | - Ulf Darsow
- Department of Dermatology and Allergy BiedersteinSchool of MedicineTechnical University of MunichMunichGermany
| | - Tilo Biedermann
- Department of Dermatology and Allergy BiedersteinSchool of MedicineTechnical University of MunichMunichGermany
| | - Knut Brockow
- Department of Dermatology and Allergy BiedersteinSchool of MedicineTechnical University of MunichMunichGermany
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Cutaneous Complications of mRNA and AZD1222 COVID-19 Vaccines: A Worldwide Review. Microorganisms 2022; 10:microorganisms10030624. [PMID: 35336199 PMCID: PMC8953728 DOI: 10.3390/microorganisms10030624] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/07/2022] [Accepted: 03/09/2022] [Indexed: 02/07/2023] Open
Abstract
Because of the increasing emergence of cutaneous reactions from COVID-19 vaccines worldwide, we investigated the published reports of these complications. We searched the PubMed, Google Scholar, and Scopus databases and the preprint server bioRxiv for articles on cutaneous complications linked to mRNA-1273 (Moderna), BNT162b2 (Pfizer–BioNTech), and AZD1222 (AstraZeneca–Oxford University) vaccines published until 30 September 2021. Eighty studies describing a total of 1415 reactions were included. Cutaneous reactions were more prevalent in females (81.6%). Delayed large local reactions were the most common complication (40.4%), followed by local injection site reactions (16.5%), zoster (9.5%), and urticarial eruptions (9.0%). Injection site and delayed large local reactions were predominantly caused by the mRNA-1273 vaccine (79.5% and 72.0%, respectively). BNT162b2 vaccination was more closely linked to distant reactions (50.1%) than mRNA-1273 (30.0%). Zoster was the most common distant reaction. Of reactions with adequate information for both vaccine doses, 58.3% occurred after the first dose only, 26.9% after the second dose only, and 14.8% after both doses. Overall, a large spectrum of cutaneous reaction patterns occurred following the COVID-19 vaccination. Most were mild and without long-term health implications. Therefore, the occurrence of such dermatologic complications does not contraindicate subsequent vaccination.
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Nicaise-Roland P, Mehlal S, Bouz C, Chollet-Martin S. Biomarqueurs et tests fonctionnels dans l’hypersensibilité immédiate aux vaccins ARNm dirigés contre le SARS-CoV-2. REVUE FRANÇAISE D'ALLERGOLOGIE 2022; 62:624-627. [PMID: 35291288 PMCID: PMC8913372 DOI: 10.1016/j.reval.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 11/29/2022]
Abstract
Les phénomènes d’hypersensibilité aux vaccins à ARNm dirigés contre le SARS-CoV-2 sont très rares. Ils peuvent être liés à un mécanisme IgE-dépendant impliquant les PEG contenus dans les vaccins sous forme de liposomes. Une activation directe de la voie classique du complément (CARPA) a été également fortement suspectée. En complément des tests cutanés, des biomarqueurs ont été proposés, en particulier la recherche d’anticorps anti-PEG, le dosage des anaphylatoxines C5a et C3a ou du complexe soluble C5b-9. Les anticorps anti-PEG sont dosables par quelques méthodes non standardisées mais leur présence dans ces réactions n’a pas été confirmée. Il en est de même pour les protéines du complément. L’histamine et la tryptase ont rarement pu être dosées au moment de la réaction et leur augmentation est inconstante selon les études. Une tryptase basale un peu élevée chez certains patients suggère qu’une hyper-alpha-tryptasémie pourrait être impliquée. Le test d’activation des basophiles s’est imposé comme un examen pouvant être utile mais les résultats sont encore difficiles à interpréter en raison de la variabilité des allergènes utilisés : PEG, PEG sous forme de liposomes ou vaccin lui-même. L’absence de positivité des tests cutanés alors que les basophiles sont capables de s’activer en présence du même allergène ex vivo chez certains patients est en faveur, dans ce cas, d’un phénomène non IgE-dépendant. En conclusion, dans l’exploration des réactions immédiates aux vaccins à ARNm contre le SARS-CoV-2, l’importance de la place de marqueurs biologiques nécessite des études complémentaires afin de mieux identifier les acteurs et les mécanismes impliqués.
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Affiliation(s)
- P Nicaise-Roland
- Service d'immunologie biologique « Autoimmunité, Hypersensibiltés et Biothérapies », hôpital Bichat, DMU BIOGéM, APHP, 75018 Paris, France
| | - S Mehlal
- Laboratoire Cerba, Cerba Healthcare, 7/11 rue de l'Equerre, 95310 Saint-Ouen l'Aumône, France
| | - C Bouz
- Laboratoire Eurofins Biomnis, 17/19, avenue Tony-Garnier, BP 7322, 69357 Lyon cedex 07, France
| | - S Chollet-Martin
- Service d'immunologie biologique « Autoimmunité, Hypersensibiltés et Biothérapies », hôpital Bichat, DMU BIOGéM, APHP, 75018 Paris, France
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COVID-19 Vaccination Safety and Tolerability in Patients Allegedly at High Risk for Immediate Hypersensitivity Reactions. Vaccines (Basel) 2022; 10:vaccines10020286. [PMID: 35214744 PMCID: PMC8879861 DOI: 10.3390/vaccines10020286] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/17/2022] [Accepted: 02/10/2022] [Indexed: 12/26/2022] Open
Abstract
The reported incidence of immediate hypersensitivity reactions (IHR) including anaphylaxis after COVID-19 vaccination is 10-fold higher than for other vaccines. Several patient groups are theorized to be at particular risk. Since specific vaccination guidelines for these patients are based on expert opinion, we performed a retrospective monocentric analysis of the tolerability of adenoviral vector and mRNA-based COVID-19 vaccines in a cohort of patients allegedly at high risk of IHR. Reactions were assessed immediately on-site by allergists during a monitored vaccination protocol and after 3–7 days through telephone interviews. The cohort included 196 patients (aged 12–84 years) with primary mast cell disease (pMCD, 50.5%), idiopathic anaphylaxis (IA, 19.9%), hereditary angioedema (HAE, 5.1%) or miscellaneous indications (24.5%). Twenty-five immediate reactions were observed in 221 vaccine doses (11.3%). Most occurred in IA or miscellaneous patients. None fulfilled anaphylaxis criteria and most were mild and self-limiting. Reaction occurrence was significantly associated with female sex. In total, 13.5% of pMCD patients reported mast cell activation-like symptoms within 72 h post-vaccination. All pediatric pMCD patients (n = 9, 12–18 years) tolerated both mRNA-based vaccine doses. In summary, adenoviral vector and mRNA-based COVID-19 vaccines were safe and well-tolerated in patients with pMCD, HAE, and IA. No anaphylaxis was observed. The mild and subjective nature of most reactions suggests a nocebo effect associated with vaccination in a medicalized setting. Patients with pMCD could experience mild flare-ups of mast cell activation-like symptoms, supporting antihistamine premedication.
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A naturally hypersensitive porcine model may help understand the mechanism of COVID-19 mRNA vaccine-induced rare (pseudo) allergic reactions: complement activation as a possible contributing factor. GeroScience 2022; 44:597-618. [PMID: 35146583 PMCID: PMC8831099 DOI: 10.1007/s11357-021-00495-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/20/2021] [Indexed: 12/16/2022] Open
Abstract
A tiny fraction of people immunized with lipid nanoparticle (LNP)-enclosed mRNA (LNP-mRNA) vaccines develop allergic symptoms following their first or subsequent vaccinations, including anaphylaxis. These reactions resemble complement (C) activation-related pseudoallergy (CARPA) to i.v. administered liposomes, for which pigs provide a naturally oversensitive model. Using this model, we injected i.v. the human vaccination dose (HVD) of BNT162b2 (Comirnaty, CMT) or its 2-fold (2x) or 5-fold (5x) amounts and measured the hemodynamic changes and other parameters of CARPA. We observed in 6 of 14 pigs transient pulmonary hypertension along with thromboxane A2 release into the blood and other hemodynamic and blood cell changes, including hypertension, granulocytosis, lymphopenia, and thrombocytopenia. One pig injected with 5x CMT developed an anaphylactic shock requiring resuscitation, while a repeat dose failed to induce the reaction, implying tachyphylaxis. These typical CARPA symptoms could not be linked to animal age, sex, prior immune stimulation with zymosan, immunization of animals with Comirnaty i.v., or i.m. 2 weeks before the vaccine challenge, and anti-PEG IgM levels in Comirnaty-immunized pigs. Nevertheless, IgM binding to the whole vaccine, used as antigen in an ELISA, was significantly higher in reactive animals compared to non-reactive ones. Incubation of Comirnaty with pig serum in vitro showed significant elevations of C3a anaphylatoxin and sC5b-9, the C-terminal complex. These data raise the possibility that C activation plays a causal or contributing role in the rare HSRs to Comirnaty and other vaccines with similar side effects. Further studies are needed to uncover the factors controlling these vaccine reactions in pigs and to understand their translational value to humans.
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75
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Alexandridi M, Mazej J, Palermo E, Hiscott J. The Coronavirus Pandemic – 2022: Viruses, Variants & Vaccines. Cytokine Growth Factor Rev 2022; 63:1-9. [PMID: 35216872 PMCID: PMC8839804 DOI: 10.1016/j.cytogfr.2022.02.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Since the beginning of the COVID-19 pandemic in 2019–2020, Cytokine & Growth Factor Reviews has published several Special Issues focused on the biology, pathogenesis and therapeutic options in the treatment of COVID-19 infection, including articles on the involvement of the chemokine system in the cytokine storm in COVID-19, intervention in the early stages of COVID-19 pneumonia, the therapeutic value of corticosteroid treatment, early clinical intervention with type 1 interferons, progress in vaccine development, and organ specific complications of COVID-19. By 2022, multiple highly efficacious vaccines are available and are being administered in countries around the world, therapeutic options have been clinically evaluated and approved, and SARS-CoV-2 has arguably become the most thoroughly studied virus in history. But, with progress has also come unanticipated problems – misinformation, anti-vaxxers, opposition to protective masks, and politically motivated interference disguised as knowledge. With this issue of CGFR, we continue to document the global coronavirus pandemic and provide an update on the emergence of viral variants, the global effort to administer vaccines and the impediments to progress posed by misinformation and anti-vaccine sentiment.
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Kaplan B, Farzan S, Coscia G, Rosenthal DW, McInerney A, Jongco AM, Ponda P, Bonagura VR. Allergic reactions to coronavirus disease 2019 vaccines and addressing vaccine hesitancy: Northwell Health experience. Ann Allergy Asthma Immunol 2022; 128:161-168.e1. [PMID: 34699968 PMCID: PMC8542398 DOI: 10.1016/j.anai.2021.10.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/03/2021] [Accepted: 10/19/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Allergic and nonallergic adverse reactions have been reported with global coronavirus disease 2019 (COVID-19) vaccination. It was previously hypothesized that polyethylene glycol (PEG) may be responsible for anaphylactic reactions to messenger RNA (mRNA) COVID-19 vaccines. OBJECTIVE To report the workflow established at our institution, types, and frequency of adverse reactions to mRNA COVID-19 vaccines in patients presenting for allergy evaluation. METHODS A COVID-19 vaccine adverse reaction registry was established. We used PEG prick skin testing, followed by PEG challenges in selected cases, to ensure PEG tolerance and encourage completion of COVID-19 vaccination series. RESULTS A total of 113 patients were included. Most vaccine reactions (86.7%) occurred in women. Anaphylaxis occurred only in women, all of which had a history of allergic disease and two-thirds had asthma. Anaphylaxis rate was 40.6 cases per million. None of the anaphylactic cases developed hypotension, required intubation, or required hospital admission. Systemic allergic symptoms, not fulfilling anaphylaxis criteria, were significantly more common in Pfizer-BioNTech than Moderna-vaccinated patients (P = .02). We observed a higher incidence of dermatologic nonurticarial reactions in men (P = .004). Among first-dose reactors, 86.7% received and tolerated the second dose. We observed a high rate of false-positive intradermal skin test results and frequent subjective symptoms with oral PEG challenge. CONCLUSION Intradermal PEG testing has limited utility in evaluating anaphylaxis to mRNA vaccines. Most severe postvaccination allergic symptoms are not caused by hypersensitivity to PEG. Most people with reaction to the initial mRNA vaccine can be safely revaccinated. Patients with anaphylaxis to COVID-19 vaccines benefit from physician-observed vaccination.
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Affiliation(s)
- Blanka Kaplan
- Division of Allergy and Immunology, Northwell Health, Great Neck, New York; Departments of Pediatrics and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York.
| | - Sherry Farzan
- Division of Allergy and Immunology, Northwell Health, Great Neck, New York; Departments of Pediatrics and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
| | - Gina Coscia
- Division of Allergy and Immunology, Northwell Health, Great Neck, New York; Departments of Pediatrics and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - David W Rosenthal
- Division of Allergy and Immunology, Northwell Health, Great Neck, New York; Departments of Pediatrics and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Alissa McInerney
- Division of Allergy and Immunology, Northwell Health, Great Neck, New York
| | - Artemio M Jongco
- Division of Allergy and Immunology, Northwell Health, Great Neck, New York; Departments of Pediatrics and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York
| | - Punita Ponda
- Division of Allergy and Immunology, Northwell Health, Great Neck, New York; Departments of Pediatrics and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
| | - Vincent R Bonagura
- Division of Allergy and Immunology, Northwell Health, Great Neck, New York; Departments of Pediatrics and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
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Eastman J, Kelbel T, Holsworth A, Pebbles T, Hartog N. Cohort experience of second messenger RNA vaccine dose tolerance after an initial-dose reaction. Ann Allergy Asthma Immunol 2022; 128:217-218. [PMID: 34699971 PMCID: PMC8540009 DOI: 10.1016/j.anai.2021.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/03/2021] [Accepted: 10/19/2021] [Indexed: 11/01/2022]
Affiliation(s)
| | - Theodore Kelbel
- Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Amanda Holsworth
- Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Timothy Pebbles
- Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Nicholas Hartog
- Spectrum Health Helen DeVos Children's Hospital, Grand Rapids, Michigan.
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Pitlick MM, Sitek AN, D'Netto ME, Dages KN, Chiarella SE, Gonzalez-Estrada A, Joshi AY, Park MA. Utility and futility of skin testing to address concerns surrounding messenger RNA coronavirus disease 2019 vaccine reactions. Ann Allergy Asthma Immunol 2022; 128:153-160. [PMID: 34798275 PMCID: PMC8594060 DOI: 10.1016/j.anai.2021.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/27/2021] [Accepted: 11/10/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The mechanism of coronavirus disease 2019 (COVID-19) vaccine hypersensitivity reactions is unknown. COVID-19 vaccine excipient skin testing has been used in evaluation of these reactions, but its utility in predicting subsequent COVID-19 vaccine tolerance is also unknown. OBJECTIVE To evaluate the utility of COVID-19 vaccine and vaccine excipient skin testing in both patients with an allergic reaction to their first messenger RNA COVID-19 vaccine dose and patients with a history of polyethylene glycol allergy who have not yet received a COVID-19 vaccine dose. METHODS In this multicenter, retrospective review, COVID-19 vaccine and vaccine excipient skin testing was performed in patients referred to 1 of 3 large tertiary academic institutions. Patient medical records were reviewed after skin testing to determine subsequent COVID-19 vaccine tolerance. RESULTS A total of 129 patients underwent skin testing, in whom 12 patients (9.3%) had positive results. There were 101 patients who received a COVID-19 vaccine after the skin testing, which was tolerated in 90 patients (89.1%) with no allergic symptoms, including 5 of 6 patients with positive skin testing results who received a COVID-19 vaccine after the skin testing. The remaining 11 patients experienced minor allergic symptoms after COVID-19 vaccination, none of whom required treatment beyond antihistamines. CONCLUSION The low positivity rate of COVID-19 vaccine excipient skin testing and high rate of subsequent COVID-19 vaccine tolerance suggest a low utility of this method in evaluation of COVID-19 vaccine hypersensitivity reactions. Focus should shift to the use of existing vaccine allergy practice parameters, with consideration of graded dosing when necessary. On the basis of these results, strict avoidance of subsequent COVID-19 vaccination should be discouraged.
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Affiliation(s)
| | - Andrea N Sitek
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Kelley N Dages
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Avni Y Joshi
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota
| | - Miguel A Park
- Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota
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79
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Sobczak M, Pawliczak R. The risk of anaphylaxis behind authorized COVID-19 vaccines: a meta-analysis. Clin Mol Allergy 2022; 20:1. [PMID: 35039051 PMCID: PMC8762434 DOI: 10.1186/s12948-022-00167-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/06/2022] [Indexed: 12/31/2022] Open
Abstract
Background A serious allergic reaction that may occur in response to medical products is anaphylaxis, which potentially can lead to anaphylactic shock. In the light of recent COVID-19 pandemic, much public attention had been paid to the severe allergic reactions occurring after COVID-19 vaccination. Therefore, in our study we would like to investigate the risk of authorized COVID-19 vaccines to induce anaphylactic reaction, anaphylactoid reaction, anaphylactic shock and anaphylactoid shock. Methods We searched databases, such as PubMed, Web of Science and Embase and found eight articles about the incidence of anaphylactic and anaphylactoid reactions. Also, we used data from four databases from Canada, the U.S., the European Union and the United Kingdom. To calculate effect sizes, we used random effects model with inverse variance method. The risk ratio with 95% confidence interval were used for dichotomous outcomes. Statistical analysis was prepared in R. Results were considered statistically significant at p < 0.05. Results The most cases of anaphylactic reaction, anaphylactoid reaction, anaphylactic shock and anaphylactoid shock were reported in female aged 18–85 years after BNT162b2 vaccine according to data from the EU. Analyzed COVID-19 vaccines can cause the anaphylaxis/anaphylactic reaction with risk of 106.99 (95% CI [39.95; 286.57], p < 0.0001, I2 = 59%), whereas the anaphylactoid reaction, anaphylactic and anaphylactoid shocks with risk of 113.3 (95% CI [28.11; 456.53], p < 0.0001), 344.2 (95% CI [85.77; 1381.39], p < 0.0001), 14.9, 95% CI [1.96; 112.79], p = 0.009), respectively. Conclusions Our meta-analysis shows that the risk of anaphylactic reaction, anaphylactoid reaction, anaphylactic shock and anaphylactoid shock do not occur only after mRNA COVID-19 vaccines. Therefore, vaccination centers should be prepared to render assistance in the event of a reaction in all cases.
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Affiliation(s)
- Marharyta Sobczak
- Department of Immunopathology, Faculty of Medicine, Division of Biomedical Science, Medical University of Lodz, St. Zeligowskiego 7/9, 90-752, Lodz, Poland
| | - Rafał Pawliczak
- Department of Immunopathology, Faculty of Medicine, Division of Biomedical Science, Medical University of Lodz, St. Zeligowskiego 7/9, 90-752, Lodz, Poland.
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80
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Pitlick MM, Joshi AY, Gonzalez-Estrada A, Chiarella SE. Delayed systemic urticarial reactions following mRNA COVID-19 vaccination. Allergy Asthma Proc 2022; 43:40-43. [PMID: 34983709 PMCID: PMC8749242 DOI: 10.2500/aap.2022.43.210101] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: As the vaccination campaign in response to the coronavirus disease 2019 (COVID-19) pandemic continues, concerns with regard to adverse reactions to the vaccine remain. Although immediate hypersensitivity reactions have received much attention, delayed systemic urticarial reactions after vaccination can occur. Objective: To describe the clinical presentation, vaccine excipient skin testing results, and outcomes of subsequent COVID-19 vaccination in patients who experienced delayed systemic urticarial reactions after messenger RNA (mRNA) COVID-19 vaccination. Methods: This was a retrospective case series of 12 patients referred to the Mayo Clinics in Rochester, Minnesota, and Jacksonville, Florida, between January 19, 2021, and April 30, 2021, for evaluation of delayed systemic urticarial reactions after mRNA COVID-19 vaccination. Demographics, medical and allergic history, reaction details, vaccine excipient skin testing results (when performed), and the outcome after subsequent vaccination were collected for each patient. Results: The mean age of the patients was 52 years, all were white, and 9 (75%) were women. Half of the patients had a history of drug allergy, and one had a history of chronic spontaneous urticaria. Seven patients reacted to the Pfizer-BioNTech vaccine and five reacted to the Moderna vaccine. Seven patients developed symptoms between 8 and 24 hours after vaccination. Nine patients required antihistamines for treatment. The median time to symptom resolution was 4 days. Nine patients underwent allergist-directed COVID-19 vaccine excipient skin testing, all of which were negative. Ten patients chose to receive their next mRNA COVID-19 vaccine dose, and four patients experienced recurrent delayed urticaria. Conclusion: Delayed systemic urticarial reactions after mRNA COVID-19 vaccination were not life-threatening, could be treated with antihistamines, and were not predicted with vaccine excipient skin testing. They were not a contraindication to subsequent vaccination, although patients should be counseled with regard to the possibility of recurrence.
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Affiliation(s)
- Mitchell M Pitlick
- From the Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota; and
| | - Avni Y Joshi
- From the Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota; and
| | | | - Sergio E Chiarella
- From the Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota; and
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81
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Matsuzaki S, Kamiya H, Inoshima I, Hirasawa Y, Tago O, Arai M. COVID-19 mRNA Vaccine-induced Pneumonitis. Intern Med 2022; 61:81-86. [PMID: 34707048 PMCID: PMC8810239 DOI: 10.2169/internalmedicine.8310-21] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/08/2021] [Indexed: 11/06/2022] Open
Abstract
A 65-year-old man experienced cough and shortness of breath 3 days after receiving the first dose of the Pfizer-BioNTech coronavirus disease 2019 (COVID-19) vaccine. Chest X-ray revealed bilateral infiltrates, and the desaturation deteriorated rapidly. The symptoms and radiographic abnormalities rapidly improved after the initiation of corticosteroid therapy. Intradermal testing of the Pfizer-BioNTech COVID-19 vaccine showed a delayed positive reaction. Based on these findings, the patient was diagnosed with COVID-19 vaccine-induced pneumonitis. The timing of the onset of pneumonitis after vaccination and the results of intradermal testing suggest that Type IV hypersensitivity against COVID-19 vaccine may have been responsible for this clinical condition.
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Affiliation(s)
- Shinichi Matsuzaki
- Department of Respiratory Medicine, Tatebayashi Kosei General Hospital, Japan
| | - Hiroyuki Kamiya
- Department of Respiratory Medicine, Tatebayashi Kosei General Hospital, Japan
| | - Ichiro Inoshima
- Department of Respiratory Medicine, Tatebayashi Kosei General Hospital, Japan
| | - Yasutaka Hirasawa
- Department of Pulmonology, International University of Health and Welfare, Japan
| | - Osamu Tago
- Department of Dermatology, Tatebayashi Kosei General Hospital, Japan
| | - Masashi Arai
- Department of Internal Medicine, Tatebayashi Kosei General Hospital, Japan
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82
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Mortz CG, Kjaer HF, Rasmussen TH, Rasmussen HM, Garvey LH, Bindslev‐Jensen C. Allergy to polyethylene glycol and polysorbates in a patient cohort: Diagnostic work-up and decision points for vaccination during the COVID-19 pandemic. Clin Transl Allergy 2022; 12:e12111. [PMID: 35028130 PMCID: PMC8742452 DOI: 10.1002/clt2.12111] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/27/2021] [Accepted: 12/30/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic focus has been on polyethylene glycol (PEG) and polysorbate as these excipients are constituents in the first vaccines and possible elicitors of allergic reactions to the vaccines. We aimed to evaluate the possibility of vaccinating patients with PEG and/or polysorbate allergy against COVID-19. METHODS Twenty-five patients with a history of an allergic reaction to drugs, vaccines and mouth hygiene products containing PEG or polysorbate and sensitization (skin test or in vitro test) or a positive challenge were included. We re-evaluated 19 of 21 patients diagnosed before 2021 and four new patients by skin prick tests (SPT) and Basophil Histamine Release (BaHR) for PEGs, polysorbates and approved COVID-19 vaccines as well as measurement of specific IgE (PEG 2000, 10,000). Patients were offered vaccination based on decision points from the primary diagnosis and re-evaluation. RESULTS Most common primary elicitors were depot-steroids and laxatives. Most patients had experienced more than one reaction. SPT was superior to BaHR test although many SPTs became negative over time. After careful re-evaluation three patients were successfully vaccinated with the Pfizer/BioNTech vaccine. Three were vaccinated before referral. Eleven were offered the Johnson-Johnson vaccine; four were vaccinated successfully, seven abstained. Six patients could not be vaccinated with PEG or polysorbate containing vaccines. CONCLUSION Hypersensitivity to excipients in COVID-19 vaccines constitutes a risk to patients with allergy to PEG or polysorbates. After diagnostic evaluation, a safe COVID-19 vaccine could be offered to most patients, the remainders will await new vaccines containing different excipients.
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Affiliation(s)
- Charlotte G. Mortz
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University HospitalUniversity of Southern DenmarkOdense CDenmark
| | - Henrik F. Kjaer
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University HospitalUniversity of Southern DenmarkOdense CDenmark
| | - Trine H. Rasmussen
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University HospitalUniversity of Southern DenmarkOdense CDenmark
| | - Helene M. Rasmussen
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University HospitalUniversity of Southern DenmarkOdense CDenmark
| | - Lene Heise Garvey
- Allergy ClinicCopenhagen University Hospital at GentofteCopenhagenDenmark
| | - Carsten Bindslev‐Jensen
- Department of Dermatology and Allergy Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University HospitalUniversity of Southern DenmarkOdense CDenmark
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83
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Fay JM, Kabanov AV. Interpolyelectrolyte Complexes as an Emerging Technology for Pharmaceutical Delivery of Polypeptides. REVIEWS AND ADVANCES IN CHEMISTRY 2022. [PMCID: PMC9987408 DOI: 10.1134/s2634827622600177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Polyelectrolyte complexes and the derivatives thereof comprise some of the most promising vehicles for the encapsulation and delivery of macromolecular therapeutics. In particular, protein therapeutics, which present a host of special considerations, can often be effectively packaged and delivered using interpolyelectrolyte complexes. While the technologies are still in the developmental phase, there are numerous examples of complexes where control is exerted over spacial and temporal delivery of a model protein cargo or candidate protein therapeutic agent. Here we provide a historical and practical background to promote a deeper understanding of interpolyelectrolyte complexes and the derivative technologies. Additionally, we review the physical principles underlying the association of polyelectrolyte complexes and the application of those principles to novel strategies and technologies driving interpolyelectrolyte complexation. Then, the application of polyelectrolyte complex technology to protein therapeutics is discussed in detail including discussions of several types of protein cargo with a special emphasis on Brain-Derived Neurotrophic Factor. Finally, we focus on the use of stealth polymers in block ionomer complexes, specifically PEG; its benefits, flaws, and possible alternatives. Comprehensive understanding of the field may promote the continued development of derivative technologies for the delivery of particularly intransigent protein therapeutics, much as has been accomplished for small molecule drugs. We also aim to link current advances to the historical developments which inaugurated the field. With consideration to the field, industrial and academic researchers can utilize the discussed technologies and continue to elucidate novel modalities for a myriad of therapeutic and commercial applications.
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Affiliation(s)
- James M. Fay
- Center for Nanotechnology in Drug Delivery, Eshelman School of Pharmacy, University of North Carolina, NC 27599-7362 Chapel Hill, USA ,Department of Biochemistry and Biophysics, School of Medicine, University of North Carolina, NC 27599-7260 Chapel Hill, USA
| | - Alexander V. Kabanov
- Center for Nanotechnology in Drug Delivery, Eshelman School of Pharmacy, University of North Carolina, NC 27599-7362 Chapel Hill, USA ,Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina, NC 27599-7260 Chapel Hill, USA ,Faculty of Chemistry, Moscow State University, 119992 Moscow, Russia
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84
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Deng J, Wang J, Shi J, Li H, Lu M, Fan Z, Gu Z, Cheng H. Tailoring the physicochemical properties of nanomaterials for immunomodulation. Adv Drug Deliv Rev 2022; 180:114039. [PMID: 34742825 DOI: 10.1016/j.addr.2021.114039] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/16/2021] [Accepted: 11/01/2021] [Indexed: 12/13/2022]
Abstract
Immunomodulation is poised to revolutionize the treatment of cancer, autoimmune diseases, and many other inflammation-related disorders. The immune system in these conditions can be either activated or suppressed by nanocarriers loaded with bioactive molecules. Although immunomodulation via these therapeutics has long been recognized, and a broad range of nanocarriers have been designed to accommodate varied usages, less studies have focused on the effects of nanomaterial physicochemical properties on immune responses, especially the immunity altered by nanocarrier materials alone. Conclusions are sometimes seemly inconsistent due to the complexities of nanomaterials and the immune system. An in-depth understanding of the nanocarrier-induced immune responses is essential for clinical applications. In this review, we summarize recent studies of the immune responses influenced by nanomaterial physicochemical properties with an emphasis on the intrinsic features of nanomaterials that modulate the innate and adaptive immunities. We then provide our perspectives on the design of nanomaterials for immunomodulation.
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85
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Chen Y, Xu Z, Wang P, Li XM, Shuai ZW, Ye DQ, Pan HF. New-onset autoimmune phenomena post COVID-19 vaccination. Immunology 2021; 165:386-401. [PMID: 34957554 DOI: 10.1111/imm.13443] [Citation(s) in RCA: 242] [Impact Index Per Article: 80.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/28/2021] [Accepted: 12/22/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to an unprecedented setback for global economy and health. Vaccination is one of the most effective intervention to substantially reduce severe disease and death due to SARS-CoV-2 infection. Vaccination programs are being rolled out globally, but most of these vaccines have been approved without extensive studies on their side effects and efficacy. Recently, new-onset autoimmune phenomena after COVID-19 vaccination have been reported increasingly (e.g., immune thrombotic thrombocytopenia, autoimmune liver diseases, Guillain-Barré syndrome, IgA nephropathy, rheumatoid arthritis and systemic lupus erythematosus, etc.). Molecular mimicry, the production of particular autoantibodies and the role of certain vaccine adjuvants seem to be substantial contributors to autoimmune phenomena. However, whether the association between COVID-19 vaccine and autoimmune manifestations is coincidental or causal remains to be elucidated. Here, we summarize the emerging evidence about autoimmune manifestations occurring in response to certain COVID-19 vaccines. Although information pertaining to the risk of autoimmune disease as a consequence of vaccination is controversial, we merely propose our current understanding of autoimmune manifestations associated with COVID-19 vaccine. In fact, we do not aim to disavow the overwhelming benefits of mass COVID-19 vaccination in preventing COVID-19 morbidity and mortality. These reports could help guide clinical assessment and management of autoimmune manifestations after COVID-19 vaccination.
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Affiliation(s)
- Yue Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Zhiwei Xu
- School of Public Health, Faculty of Medicine, University of Queensland, 288 Herston Road, QLD, 4006, Brisbane, Australia
| | - Peng Wang
- Teaching Center of Preventive Medicine, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Xiao-Mei Li
- Department of Rheumatology, the First Affiliated Hospital of University of Science and Technology of China, 17 Lujiang Road, Hefei, Anhui, 230001, China
| | - Zong-Wen Shuai
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, China
| | - Dong-Qing Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, 81 Meishan Road, Hefei, Anhui, 230032, China
| | - Hai-Feng Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, Anhui, 230032, China.,Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, 81 Meishan Road, Hefei, Anhui, 230032, China
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86
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Al-Musa A, LaBere B, Habiballah S, Nguyen AA, Chou J. Advances in clinical outcomes: what we have learned during the COVID-19 pandemic. J Allergy Clin Immunol 2021; 149:569-578. [PMID: 34958811 PMCID: PMC8704728 DOI: 10.1016/j.jaci.2021.12.775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/12/2021] [Accepted: 12/16/2021] [Indexed: 11/28/2022]
Abstract
Our understanding of risk factors and interventions influencing outcomes from coronavirus disease 2019 (COVID-19) has continued to evolve, revealing advances emerging from hypotheses formed at the start of the pandemic. Epidemiologic studies have shown that asthma control, rather than a diagnosis of asthma, is a determinant of COVID-19 severity. Clinical outcomes in patients with primary immunodeficiencies, even in those with impaired cellular immunity, are variable. IL-6 has emerged as a reliable biomarker of COVID-19 severity, and large clinical trials have shown the potential for improving outcomes through inhibition of IL-6 signaling in some patients. Studies of genetic risk factors for severe COVID-19 have also revealed the importance of interferon homeostasis in the defense against severe acute respiratory syndrome coronavirus 2. Because COVID-19 vaccines constitute the primary tool for ending this pandemic, strategies have been developed to address potential allergic and immune-mediated reactions. Here, we discuss advances in our understanding of COVID-19 risk factors and outcomes within the context of allergic and immunologic mechanisms.
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Affiliation(s)
- Amer Al-Musa
- Division of Immunology, Boston Children's Hospital, Harvard Medical School
| | - Brenna LaBere
- Division of Immunology, Boston Children's Hospital, Harvard Medical School
| | - Saddiq Habiballah
- Division of Immunology, Boston Children's Hospital, Harvard Medical School
| | - Alan A Nguyen
- Division of Immunology, Boston Children's Hospital, Harvard Medical School
| | - Janet Chou
- Division of Immunology, Boston Children's Hospital, Harvard Medical School.
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87
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Abstract
PURPOSE OF REVIEW A known history of a severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine is the only contraindication to coronavirus disease 2019 (COVID-19) mRNA vaccination. It is important for pediatricians to understand the likelihood of an allergic reaction to COVID-19 mRNA vaccines, including its excipients. RECENT FINDINGS Episodes concerning for anaphylaxis were immediately reported following early administration of COVID-19 mRNA vaccines to adults. Although allergic type symptoms were reported equally in recipients of placebos and test vaccines in phase 3 clinical trials, post-authorization prospective studies state that 0.2-2% of vaccine recipients have experienced allergic reactions. Subsequent allergy testing of affected individuals has focused largely on evaluation of allergic sensitization to a novel vaccine excipient, polyethylene glycol (PEG). PEG is a polymer incorporated in numerous pharmaceutical products because of its favorable, inert properties. The results of allergy testing in adults to date indicate that IgE mediated anaphylaxis to PEG allergy is rarely identified after COVID-19 mRNA vaccine reactions. Numerous individuals with presumed anaphylaxis have tolerated a second vaccine after evaluation and testing by an allergist, suggesting either misdiagnosis or a novel immune mechanism. SUMMARY Confirmed anaphylactic reactions to COVID-19 mRNA vaccines are rare, likely due to a lack of preexisting IgE against the vaccine components, including PEG.
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Affiliation(s)
- Kimberly A Risma
- Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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88
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Abstract
Anaphylaxis is a multi-system syndrome resulting from the release of mediators from mast cells and basophils. Drugs are common causes. Anaphylaxis to certain drugs, vaccines, and biological agents present clinical challenges, and merit referral to a board-certified allergist/immunologist for further evaluation and management.
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Affiliation(s)
- Ruchi H Shah
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic
| | - Margaret M Kuder
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic.
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Sellaturay P, Gurugama P, Harper V, Dymond T, Ewan P, Nasser S. The Polysorbate containing AstraZeneca COVID-19 vaccine is tolerated by polyethylene glycol (PEG) allergic patients. Clin Exp Allergy 2021; 52:12-17. [PMID: 34822190 DOI: 10.1111/cea.14064] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/18/2021] [Accepted: 10/28/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Polyethylene glycol (PEG) is the excipient found in the mRNA COVID-19 vaccines. We previously demonstrated PEG allergy was a cause of severe anaphylaxis to the Pfizer/BioNTech COVID-19 vaccine. PEG is widely used in many household products, cosmetics and medicines. However PEG allergy is rare, there have been few confirmed cases of PEG allergy. The excipient of potential concern in the AstraZeneca COVID-19 vaccine is polysorbate 80 (PS80). Cross-reactivity between PEG and polysorbate has been suggested, based on their composition and skin-test data. The aim of this study was to determine whether PEG-allergic patients could be vaccinated with the PS80 containing AstraZeneca COVID-19 vaccine. METHOD Eight patients with PEG allergy were identified by the allergy clinic at Cambridge University Hospital. Patients underwent skin prick testing to PS80 (20%) and to the AstraZeneca COVID-19 vaccine prior to vaccination. RESULTS All eight patients allergic to PEG tolerated the AstraZeneca COVID-19 vaccine, even in 2 patients where the PS80 skin prick test was positive and 1 with a positive skin prick test to the AstraZeneca COVID-19 vaccine. CONCLUSION Patients allergic to PEG, previously denied COVID vaccination, may now be safely vaccinated with the PS80 containing AstraZeneca vaccine and need only avoid the PEG-containing mRNA COVID-19 vaccines. This opens up the possibility that these patients will also tolerate other vaccines containing PS80 such as the Janssen/Johnson and Johnson COVID-19 vaccine. Clinical cross-reactivity between PEG and PS80 did not occur in this vaccine setting.
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Affiliation(s)
- Priya Sellaturay
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Padmalal Gurugama
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Verah Harper
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tom Dymond
- Department of Respiratory, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Pamela Ewan
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Medicine, University of Cambridge Clinical School, Cambridge, UK
| | - Shuaib Nasser
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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90
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Constantin C, Pisani A, Bardi G, Neagu M. Nano-carriers of COVID-19 vaccines: the main pillars of efficacy. Nanomedicine (Lond) 2021; 16:2377-2387. [PMID: 34632802 PMCID: PMC8544481 DOI: 10.2217/nnm-2021-0250] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/09/2021] [Indexed: 12/30/2022] Open
Abstract
As the current COVID-19 pandemic illustrates, vaccination is the most powerful method of disease prevention and public confidence in vaccines depends on their safety and efficacy. The information gathered in the current pandemic is growing at an accelerated pace. Both the key vital protein DNA/RNA messengers and the delivery carriers are the elements of a puzzle including their interactions with the immune system to suppress SARS-CoV-2 infection. A new nano-era is beginning in the vaccine development field and an array of side applications for diagnostic and antiviral tools will likely emerge. This review focuses on the evolution of vaccine carriers up to COVID-19-aimed nanoparticles and the immune-related adverse effects imposed by these nanocarriers.
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Affiliation(s)
- Carolina Constantin
- “Victor Babeş” National Institute of Pathology, 99-101 Spl Independentei, Bucharest, 050096, Romania
- Colentina Clinical Hospital, 19-21, Sos. Stefan cel Mare, Bucharest, Romania
| | - Anissa Pisani
- Nanobiointeractions & Nanodiagnostics, Istituto Italiano di Tecnologia, Via Morego 30, Genova, 16163, Italy
- Department of Chemistry & Industrial Chemistry, University of Genova, Via Dodecaneso 31, Genova, 16146, Italy
| | - Giuseppe Bardi
- Nanobiointeractions & Nanodiagnostics, Istituto Italiano di Tecnologia, Via Morego 30, Genova, 16163, Italy
| | - Monica Neagu
- “Victor Babeş” National Institute of Pathology, 99-101 Spl Independentei, Bucharest, 050096, Romania
- Colentina Clinical Hospital, 19-21, Sos. Stefan cel Mare, Bucharest, Romania
- University of Bucharest, 93–95 Spl Independentei, Bucharest, Romania
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91
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Xu Z, Qu H, Ren Y, Gong Z, Ri HJ, Zhang F, Chen X, Zhu W, Shao S, Chen X. Update on the COVID-19 Vaccine Research Trends: A Bibliometric Analysis. Infect Drug Resist 2021; 14:4237-4247. [PMID: 34703250 PMCID: PMC8523363 DOI: 10.2147/idr.s335745] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/02/2021] [Indexed: 01/03/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic is ravaging the world. To date, there are no standard therapies available to cure the disease. Consequently, research on COVID-19 vaccines is booming. This report aimed to assess the research trends of the global COVID-19 vaccines. Methods The relevant publications on the COVID-19 vaccines were searched in the Web of Science Core Collection Database (WOSCC) database from December 2019 to 11 August 2021. The VOSviewer1.6.16 was used to assess the co-authorship, co-occurrence, citation of countries, institutions, authors, journals, and hotspot keywords. The HistCiteTM (http://www.histcite.com/) software was used to calculate the total local citation score (TLCS) and total global citation score (TGCS) of each variable and generate the citation historiography graph of COVID-19 vaccine development using the citation time series analysis method. Results A total of 5070 studies authored by 21,151 researchers and published by 1364 different journals were eventually included in this study. The bulk of the retrieved studies were original articles (n = 2401, 47.36%). Among these studies, 1204 (23.75%) were published in 2020. A total of 3863 (76.19%) were published in 2021 and 4295 (84.71%) were open access. The highest number of studies was conducted in the USA, followed by England, China, and Germany. The main partners of the USA were China, England, and Canada. The University of Maryland (TLCS: 1618, TGCS: 2991) and Prof. Ugur Sahin from the University Medical Center of the Johannes Gutenberg University (TLCS: 1397, TGCS: 2407) were the most cited institution and author, respectively. The vaccines featured the highest number of papers, with 294 publications (TLCS: 0, TGCS: 1226). The most cited journal was the New England Journal of Medicine (TLCS: 3310, TGCS: 5914), with an impact factor (IF) of 91.245. The related topics included the following six aspects: attitudes towards vaccination, immunoinformatics analysis, clinical research, effectiveness and side effects, and the public management of vaccines. The timing diagram revealed that the research hotspots focused on the side effects of vaccines and public attitude towards vaccination. Conclusion This novel comprehensive bibliometric analysis can help researchers and non-researchers to rapidly identify the potential partners, landmark studies, and research topics within their domains of interest. Through this study, we hope to provide more data to combat the COVID-19 pandemic.
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Affiliation(s)
- ZhaoHui Xu
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, People's Republic of China.,Dalian Medical University, Dalian, People's Republic of China
| | - Hui Qu
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, People's Republic of China.,Dalian Medical University, Dalian, People's Republic of China
| | - YanYing Ren
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, People's Republic of China
| | - ZeZhong Gong
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, People's Republic of China.,Dalian Medical University, Dalian, People's Republic of China
| | - Hyok Ju Ri
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, People's Republic of China.,Dalian Medical University, Dalian, People's Republic of China.,Department of Colorectal Surgery, The Hospital of Pyongyang Medical College, Pyongyang, 999093, People's Republic of Korea
| | - Fan Zhang
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, People's Republic of China
| | - XiaoLiang Chen
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, People's Republic of China
| | - WanJi Zhu
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, People's Republic of China
| | - Shuai Shao
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, People's Republic of China
| | - Xin Chen
- Department of Hernia and Colorectal Surgery, The Second Hospital of Dalian Medical University, Dalian, 116023, People's Republic of China
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92
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Schreiner M, Zobel C, Baumgarten U, Uhlmann T, Vandersee S. Anaphylactic reactions to polyethylene glycol-containing bowel cleansing preparations after Moderna COVID-19 vaccination. Endoscopy 2021; 54:517-518. [PMID: 34710908 PMCID: PMC9023309 DOI: 10.1055/a-1640-9686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Christian Zobel
- Department of Internal Medicine, Bundeswehr Hospital, Berlin, Germany
| | - Ulrich Baumgarten
- Department of Internal Medicine, Bundeswehr Hospital, Berlin, Germany
| | - Tina Uhlmann
- Department of Dermatology, Bundeswehr Hospital, Berlin, Germany
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93
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Laisuan W, Wongsa C, Chiewchalermsri C, Thongngarm T, Rerkpattanapipat T, Iamrahong P, Ruangwattanachok C, Nanthapisal S, Sompornrattanaphan M. CoronaVac COVID-19 Vaccine-Induced Anaphylaxis: Clinical Characteristics and Revaccination Outcomes. J Asthma Allergy 2021; 14:1209-1215. [PMID: 34675550 PMCID: PMC8504472 DOI: 10.2147/jaa.s333098] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 09/16/2021] [Indexed: 12/16/2022] Open
Abstract
Anaphylaxis to CoronaVac, an inactivated vaccine against COVID-19, is extremely rare. We report 12 cases of anaphylaxis after CoronaVac administration, focusing on clinical characteristics and management outcomes. Skin test and graded vaccine challenge were successfully performed in our cases and might be considered if an inactivated vaccine is the only remaining option.
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Affiliation(s)
- Wannada Laisuan
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chamard Wongsa
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chirawat Chiewchalermsri
- Department of Medicine, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
| | - Torpong Thongngarm
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ticha Rerkpattanapipat
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pansa Iamrahong
- Clinical Pharmacy Section, Pharmacy Division, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chulapha Ruangwattanachok
- Clinical Pharmacy Section, Pharmacy Division, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sira Nanthapisal
- Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Mongkhon Sompornrattanaphan
- Division of Allergy and Clinical Immunology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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94
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Gambichler T, Boms S, Susok L, Dickel H, Finis C, Abu Rached N, Barras M, Stücker M, Kasakovski D. Cutaneous findings following COVID-19 vaccination: review of world literature and own experience. J Eur Acad Dermatol Venereol 2021; 36:172-180. [PMID: 34661927 PMCID: PMC8656409 DOI: 10.1111/jdv.17744] [Citation(s) in RCA: 128] [Impact Index Per Article: 42.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/29/2021] [Indexed: 12/11/2022]
Abstract
There is growing evidence that not only the novel coronavirus disease (COVID‐19) but also the COVID‐19 vaccines can cause a variety of skin reactions. In this review article, we provide a brief overview on cutaneous findings that have been observed since the emerging mass COVID‐19 vaccination campaigns all over the world. Unspecific injection‐site reactions very early occurring after the vaccination are most frequent. Type I hypersensitivity reactions (e.g. urticaria, angio‐oedema and anaphylaxis) likely due to allergy to ingredients may rarely occur but can be severe. Type IV hypersensitivity reactions may be observed, including delayed large local skin lesions (“COVID arm”), inflammatory reactions in dermal filler or previous radiation sites or even old BCG scars, and more commonly morbilliform and erythema multiforme‐like rashes. Autoimmune‐mediated skin findings after COVID‐19 vaccination include leucocytoclastic vasculitis, lupus erythematosus and immune thrombocytopenia. Functional angiopathies (chilblain‐like lesions, erythromelalgia) may also be observed. Pityriasis rosea‐like rashes and reactivation of herpes zoster have also been reported after COVID‐19 vaccination. In conclusion, there are numerous cutaneous reaction patterns that may occur following COVID‐19 vaccination, whereby many of these skin findings are of immunological/autoimmunological nature. Importantly, molecular mimicry exists between SARS‐CoV‐2 (e.g. the spike‐protein sequences used to design the vaccines) and human components and may thus explain some COVID‐19 pathologies as well as adverse skin reactions to COVID‐19 vaccinations. Linked Commentary: P. Gisondi et al. J Eur Acad Dermatol Venereol 2022; 36: 165–166. https://doi.org/10.1111/jdv.17854.
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Affiliation(s)
- T Gambichler
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany.,Department of Dermatology, Christian Hospital Unna, Unna, Germany
| | - S Boms
- Department of Dermatology, Christian Hospital Unna, Unna, Germany
| | - L Susok
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - H Dickel
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - C Finis
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - N Abu Rached
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - M Barras
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - M Stücker
- Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - D Kasakovski
- European Center for Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Division of Vascular Oncology and Metastasis, German Cancer Research Center Heidelberg (DKFZ-ZMBH Alliance), Heidelberg, Germany
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95
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Carpenter T, Konig J, Hochfelder J, Siegel S, Gans M. Polyethylene glycol and polysorbate testing in 12 patients before or after coronavirus disease 2019 vaccine administration. Ann Allergy Asthma Immunol 2021; 128:99-101. [PMID: 34648975 PMCID: PMC8505018 DOI: 10.1016/j.anai.2021.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/15/2021] [Accepted: 10/08/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Taya Carpenter
- Department of Pediatrics, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York.
| | - Justin Konig
- Department of Internal Medicine, Westchester Medical Center, Valhalla, New York
| | - Jillian Hochfelder
- Department of Pediatrics, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York; Division of Pediatric Pulmonology, Allergy and Immunology, and Sleep Medicine, Boston Children's Health Physicians, Valhalla, New York; New York Medical College, Valhalla, New York
| | - Subhadra Siegel
- Department of Pediatrics, Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York; Division of Pediatric Pulmonology, Allergy and Immunology, and Sleep Medicine, Boston Children's Health Physicians, Valhalla, New York; New York Medical College, Valhalla, New York
| | - Melissa Gans
- Department of Pediatrics, Division of Allergy and Immunology, University of Miami, Miller School of Medicine, Miami, Florida
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96
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Blumenthal KG, Phadke NA, Bates DW. Safety Surveillance of COVID-19 mRNA Vaccines Through the Vaccine Safety Datalink. JAMA 2021; 326:1375-1377. [PMID: 34477809 DOI: 10.1001/jama.2021.14808] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kimberly G Blumenthal
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Mongan Institute, Massachusetts General Hospital, Boston
| | - Neelam A Phadke
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - David W Bates
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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97
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Greenhawt M, Abrams EM, Shaker M, Chu DK, Khan D, Akin C, Alqurashi W, Arkwright P, Baldwin JL, Ben-Shoshan M, Bernstein J, Bingemann T, Blumchen K, Byrne A, Bognanni A, Campbell D, Campbell R, Chagla Z, Chan ES, Chan J, Comberiati P, Dribin TE, Ellis AK, Fleischer DM, Fox A, Frischmeyer-Guerrerio PA, Gagnon R, Grayson MH, Horner CC, Hourihane J, Katelaris CH, Kim H, Kelso JM, Lang D, Ledford D, Levin M, Lieberman J, Loh R, Mack D, Mazer B, Mosnaim G, Munblit D, Mustafa SS, Nanda A, Oppenheimer J, Perrett KP, Ramsey A, Rank M, Robertson K, Sheikh J, Spergel JM, Stukus D, Tang ML, Tracy JM, Turner PJ, Whalen-Browne A, Wallace D, Wang J, Waserman S, Witry JK, Worm M, Vander Leek TK, Golden DB. The Risk of Allergic Reaction to SARS-CoV-2 Vaccines and Recommended Evaluation and Management: A Systematic Review, Meta-Analysis, GRADE Assessment, and International Consensus Approach. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2021; 9:3546-3567. [PMID: 34153517 PMCID: PMC8248554 DOI: 10.1016/j.jaip.2021.06.006] [Citation(s) in RCA: 138] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/01/2021] [Accepted: 06/11/2021] [Indexed: 01/26/2023]
Abstract
Concerns for anaphylaxis may hamper severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunization efforts. We convened a multidisciplinary group of international experts in anaphylaxis composed of allergy, infectious disease, emergency medicine, and front-line clinicians to systematically develop recommendations regarding SARS-CoV-2 vaccine immediate allergic reactions. Medline, EMBASE, Web of Science, the World Health Organizstion (WHO) global coronavirus database, and the gray literature (inception, March 19, 2021) were systematically searched. Paired reviewers independently selected studies addressing anaphylaxis after SARS-CoV-2 vaccination, polyethylene glycol (PEG) and polysorbate allergy, and accuracy of allergy testing for SARS-CoV-2 vaccine allergy. Random effects models synthesized the data to inform recommendations based on the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach, agreed upon using a modified Delphi panel. The incidence of SARS-CoV-2 vaccine anaphylaxis is 7.91 cases per million (n = 41,000,000 vaccinations; 95% confidence interval [95% CI] 4.02-15.59; 26 studies, moderate certainty), the incidence of 0.15 cases per million patient-years (95% CI 0.11-0.2), and the sensitivity for PEG skin testing is poor, although specificity is high (15 studies, very low certainty). We recommend vaccination over either no vaccination or performing SARS-CoV-2 vaccine/excipient screening allergy testing for individuals without history of a severe allergic reaction to the SARS-CoV-2 vaccine/excipient, and a shared decision-making paradigm in consultation with an allergy specialist for individuals with a history of a severe allergic reaction to the SARS-CoV-2 vaccine/excipient. We recommend further research to clarify SARS-CoV-2 vaccine/vaccine excipient testing utility in individuals potentially allergic to SARS-CoV2 vaccines or their excipients.
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Affiliation(s)
- Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Food Challenge and Research Unit, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo,Corresponding author: Matthew Greenhawt, MD, MBA, MS, Section of Allergy and Clinical Immunology, Food Challenge and Research Unit, Children’s Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave., Aurora, CO 80045
| | - Elissa M. Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Immunology, The University of Manitoba, Winnipeg, Man, Canada
| | - Marcus Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon; Dartmouth Geisel School of Medicine, Hanover, NH
| | - Derek K. Chu
- Department of Medicine, McMaster University Department of Health Research Methods, Evidence and Impact, McMaster University; The Research Institute of St. Joe's Hamilton; Evidence in Allergy Group, McMaster University, Hamilton, Ont, Canada
| | - David Khan
- Division of Allergy and Immunology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Cem Akin
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan School, Ann Arbor, Mich
| | - Waleed Alqurashi
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ont, Canada
| | - Peter Arkwright
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK
| | - James L. Baldwin
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan School, Ann Arbor, Mich
| | - Moshe Ben-Shoshan
- Division of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Center–Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Jonathan Bernstein
- Division of Immunology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Theresa Bingemann
- Division of Allergy, Immunology, and Rheumatology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Katharina Blumchen
- Department of Paediatric and Adolescent Medicine, Paediatric Pneumology, Allergology, and Cystic Fibrosis, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Aideen Byrne
- Children’s Health Ireland at Crumlin, Crumlin, Ireland
| | - Antonio Bognanni
- Department of Health Research Methods, Evidence and Impact, Evidence in Allergy Group, McMaster University, Hamilton, Ont, Canada
| | - Dianne Campbell
- The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Ronna Campbell
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minn
| | - Zain Chagla
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ont, Canada
| | - Edmond S. Chan
- BC Children’s Hospital, Division of Allergy and Immunology, The University of British Columbia, Vancouver, BC, Canada
| | - Jeffrey Chan
- Department of Emergency Medicine, Southlake Regional Medical Center, Newmarket, Ont, Canada
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy, Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Timothy E. Dribin
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Anne K. Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen’s University, Kingston, Ont, Canada
| | - David M. Fleischer
- Section of Allergy and Clinical Immunology, Food Challenge and Research Unit, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Adam Fox
- Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Pamela A. Frischmeyer-Guerrerio
- Laboratory of Allergic Diseases, Food Allergy Research Section, National Institutes of Allergy and Infectious Diseases, the National Institutes of Health, Bethesda, Md
| | - Remi Gagnon
- Clinique Spécialisée en Allergie de la Capitale, Quebec, Quebec, Canada
| | - Mitchell H. Grayson
- Division of Allergy and Immunology, Department of Clinical Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Caroline C. Horner
- Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Mo
| | | | | | - Harold Kim
- Western University, Londo, McMaster University, Hamilton, Ont, Canada
| | - John M. Kelso
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif
| | - David Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dennis Ledford
- Division of Allergy and Immunology, Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Michael Levin
- Division of Paediatric Allergology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jay Lieberman
- Division of Allergy and Immunology, The University of Tennessee, Memphis, Tenn
| | - Richard Loh
- Immunology Department, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Doug Mack
- McMaster University Hamilton, Halton Pediatric Allergy, Burlington, Ont, Canada
| | - Bruce Mazer
- Division of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Center–Montreal Children’s Hospital, Montreal, Quebec, Canada
| | - Giselle Mosnaim
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child’s Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia, Inflammation, Repair, Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| | - S. Shahzad Mustafa
- Rochester Regional Health, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Texas, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Kirsten P. Perrett
- Murdoch Children’s Research Institute, Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Allison Ramsey
- Rochester Regional Health, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Matthew Rank
- Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, Division of Pulmonology, Phoenix Children’s Hospital, Phoenix, Ariz
| | - Kara Robertson
- Division of Clinical Immunology and Allergy, St. Joseph’s Health Care, the Schulich School of Medicine and Dentistry, Western University, London, Ont, Canada
| | - Javed Sheikh
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, Calif
| | - Jonathan M. Spergel
- Division of Allergy and Immunology, Children’s Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa
| | - David Stukus
- Division of Allergy and Immunology, Department of Clinical Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Mimi L.K. Tang
- Murdoch Children’s Research Institute, University of Melbourne, Royal Children’s Hospital, Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia
| | - James M. Tracy
- Allergy, Asthma, and Immunology Associates, PC, Associate Professor of Pediatrics, University of Nebraska School of Medicine, Omaha, Neb
| | - Paul J. Turner
- Imperial College Healthcare NHS Trust and Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Anna Whalen-Browne
- Division of Clinical Immunology and Allergy, Department of Medicine, Evidence in Allergy Group, McMaster University, Hamilton, Ont, Canada
| | - Dana Wallace
- Nova Southeastern University College of Allopathic Medicine, Fort Lauderdale, Fla
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, the Jaffe Food Allergy Institute, New York, NY
| | - Susan Waserman
- Department of Medicine, Clinical Immunology, and Allergy, McMaster University, Hamilton, Ont, Canada
| | - John K. Witry
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Margitta Worm
- Division of Allergology and Immunology, Department of Dermatology, Venereology, and Allergology, Charité- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Timothy K. Vander Leek
- Pediatric Allergy and Asthma, Department of Pediatrics, University of Alberta, Edmonton, Alta, Canada
| | - David B.K. Golden
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Md
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98
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Non-immunoglobulin E-mediated allergy associated with Pfizer-BioNTech coronavirus disease 2019 vaccine excipient polyethylene glycol. Ann Allergy Asthma Immunol 2021; 127:694-696. [PMID: 34547440 PMCID: PMC8457674 DOI: 10.1016/j.anai.2021.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/03/2021] [Accepted: 09/11/2021] [Indexed: 02/02/2023]
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99
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Lim XR, Leung BP, Ng CYL, Tan JWL, Chan GYL, Loh CM, Tan GLX, Goh VHH, Wong LT, Chua CR, Tan SC, Lee SSM, Howe HS, Thong BYH, Leong KP. Pseudo-Anaphylactic Reactions to Pfizer BNT162b2 Vaccine: Report of 3 Cases of Anaphylaxis Post Pfizer BNT162b2 Vaccination. Vaccines (Basel) 2021; 9:vaccines9090974. [PMID: 34579211 PMCID: PMC8471482 DOI: 10.3390/vaccines9090974] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/20/2021] [Accepted: 08/27/2021] [Indexed: 02/02/2023] Open
Abstract
Anaphylactic reactions were observed after Singapore's national coronavirus disease 2019 (COVID-19) vaccination programme started in December 2020. We report the clinical and laboratory features of three patients in our institution who developed anaphylactic reactions after receiving the Pifzer BNT162b2 vaccine. IgM and IgG antibodies, but not IgE antibodies to the Pfizer BNT162b2 vaccine, were detected in all subjects. Similarly, mild to high elevated levels of anti-polyethylene glycol (PEG) IgG (1035-19709 U/mL, vs. vaccine-naive < 265 U/mL, vaccine-tolerant < 785 U/mL) and IgM (1682-5310 U/mL, vs. vaccine-naive < 1011 U/mL, vaccine-tolerant < 1007 U/mL) were detected in two out of three patients via commercial ELISA. High levels of serum anaphylatoxin C3a (79.0 ± 6.3 μg/mL, mean ± SD, vs. normal < 10 μg/mL) were observed in all three patients during the acute phase of the reaction, while tryptase levels, a marker of mast cell activation, were not elevated. Finally, one patient with the highest levels of anti-PEG IgG, IgM, and anti-Pfizer BNT162b2 IgG and IgM exhibited an enhanced Th2 cytokine serum profile during an acute reaction, with high levels of IL-4 (45.7 pg/mL, vs. vaccine-naive/tolerant < 2.30 pg/mL), IL-33 (86.4 pg/mL, vs. vaccine-naive/tolerant < 5.51 pg/mL) and IL-10 (22.9 pg/mL, vs. vaccine-naive/tolerant < 12.49 pg/mL) diminishing over time following corticosteroid treatment. Taken together, we propose these cases of anaphylaxis described are driven by a complement activation-related pseudoallergy (CAPRA), rather than classical IgE-mediated mechanisms.
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Affiliation(s)
- Xin Rong Lim
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (B.P.L.); (J.W.L.T.); (G.Y.L.C.); (S.C.T.); (S.S.M.L.); (H.S.H.); (B.Y.H.T.); (K.P.L.)
- Correspondence: ; Tel.: +(65)-6357-7822; Fax: +(65)-6357-2686
| | - Bernard Pui Leung
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (B.P.L.); (J.W.L.T.); (G.Y.L.C.); (S.C.T.); (S.S.M.L.); (H.S.H.); (B.Y.H.T.); (K.P.L.)
- Health and Social Sciences, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Carol Yee Leng Ng
- Clinical Immunology Laboratory, Tan Tock Seng Hospital, Singapore 308433, Singapore; (C.Y.L.N.); (C.M.L.); (G.L.X.T.); (V.H.H.G.); (L.T.W.); (C.R.C.)
| | - Justina Wei Lynn Tan
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (B.P.L.); (J.W.L.T.); (G.Y.L.C.); (S.C.T.); (S.S.M.L.); (H.S.H.); (B.Y.H.T.); (K.P.L.)
| | - Grace Yin Lai Chan
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (B.P.L.); (J.W.L.T.); (G.Y.L.C.); (S.C.T.); (S.S.M.L.); (H.S.H.); (B.Y.H.T.); (K.P.L.)
| | - Chien Mei Loh
- Clinical Immunology Laboratory, Tan Tock Seng Hospital, Singapore 308433, Singapore; (C.Y.L.N.); (C.M.L.); (G.L.X.T.); (V.H.H.G.); (L.T.W.); (C.R.C.)
| | - Gwendolyn Li Xuan Tan
- Clinical Immunology Laboratory, Tan Tock Seng Hospital, Singapore 308433, Singapore; (C.Y.L.N.); (C.M.L.); (G.L.X.T.); (V.H.H.G.); (L.T.W.); (C.R.C.)
| | - Valerie Hui Hian Goh
- Clinical Immunology Laboratory, Tan Tock Seng Hospital, Singapore 308433, Singapore; (C.Y.L.N.); (C.M.L.); (G.L.X.T.); (V.H.H.G.); (L.T.W.); (C.R.C.)
| | - Lok To Wong
- Clinical Immunology Laboratory, Tan Tock Seng Hospital, Singapore 308433, Singapore; (C.Y.L.N.); (C.M.L.); (G.L.X.T.); (V.H.H.G.); (L.T.W.); (C.R.C.)
| | - Chong Rui Chua
- Clinical Immunology Laboratory, Tan Tock Seng Hospital, Singapore 308433, Singapore; (C.Y.L.N.); (C.M.L.); (G.L.X.T.); (V.H.H.G.); (L.T.W.); (C.R.C.)
| | - Sze Chin Tan
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (B.P.L.); (J.W.L.T.); (G.Y.L.C.); (S.C.T.); (S.S.M.L.); (H.S.H.); (B.Y.H.T.); (K.P.L.)
| | - Samuel Shang Ming Lee
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (B.P.L.); (J.W.L.T.); (G.Y.L.C.); (S.C.T.); (S.S.M.L.); (H.S.H.); (B.Y.H.T.); (K.P.L.)
| | - Hwee Siew Howe
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (B.P.L.); (J.W.L.T.); (G.Y.L.C.); (S.C.T.); (S.S.M.L.); (H.S.H.); (B.Y.H.T.); (K.P.L.)
| | - Bernard Yu Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (B.P.L.); (J.W.L.T.); (G.Y.L.C.); (S.C.T.); (S.S.M.L.); (H.S.H.); (B.Y.H.T.); (K.P.L.)
| | - Khai Pang Leong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore; (B.P.L.); (J.W.L.T.); (G.Y.L.C.); (S.C.T.); (S.S.M.L.); (H.S.H.); (B.Y.H.T.); (K.P.L.)
- Clinical Immunology Laboratory, Tan Tock Seng Hospital, Singapore 308433, Singapore; (C.Y.L.N.); (C.M.L.); (G.L.X.T.); (V.H.H.G.); (L.T.W.); (C.R.C.)
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100
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Cutaneous and hypersensitivity reactions associated with COVID-19 vaccination-a narrative review. Wien Med Wochenschr 2021; 172:63-69. [PMID: 34424434 PMCID: PMC8381144 DOI: 10.1007/s10354-021-00876-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/13/2021] [Indexed: 12/27/2022]
Abstract
Vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV‑2) has become a major tool in the battle against the coronavirus disease 2019 (COVID-19) pandemic. Numerous products have been developed and more are to come. Vaccination success varies greatly between different countries. There are a number of different vaccine types, such as mRNA, DNA vaccines, adenovirus vector vaccines, and full-length spike protein nanoparticles with a special matrix. The different types may also cause a different spectrum of adverse events. With mass vaccination, post-marketing surveillance for product safety becomes increasingly important. In this review, we discuss possible hypersensitivity and cutaneous adverse events related to SARS-CoV‑2 vaccination—from local reactions like COVID arm to systemic and severe reactions like anaphylaxis. Vaccination may also induce or exacerbate preexisting disorders such as herpes zoster infection. This review should provide information to tailor, whenever possible, vaccination to patients’ needs. It is a contribution to patient safety as well. There is general consensus that the benefits of SARS-CoV‑2 vaccination currently outweigh the risks of possible adverse events.
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