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Pignatti P, Ramirez GA, Russo M, Marraccini P, Nannipieri S, Asperti C, Torre FD, Tiri A, Gatti BM, Gurrado A, Meriggi A, Benanti G, Cilona MB, Pigatto P, Burastero SE, Dagna L, Yacoub MR. Hypersensitivity reactions to anti-SARS-CoV-2 vaccines: Basophil reactivity to excipients. Vaccine 2023:S0264-410X(23)00714-4. [PMID: 37349223 DOI: 10.1016/j.vaccine.2023.06.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/09/2023] [Accepted: 06/11/2023] [Indexed: 06/24/2023]
Abstract
Basophil activation test (BAT) can tackle multiple mechanisms underlying acute and delayed hypersensitivity to drugs and vaccines and might complement conventional allergy diagnostics but its role in anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine-related hypersensitivity is ill-defined. Therefore, 89 patients with possible hypersensitivity (56 % with delayed mucocutaneous manifestations) to anti-SARS-CoV-2 vaccines were tested with BAT for Macrogol 3350, DMG-PEG 2000, PEG 20000, polysorbate-80 and trometamol and compared to 156 subjects undergoing pre-vaccine BAT. A positive BAT was associated with delayed reaction onset (p = 0.010) and resolution (p = 0.011). BAT was more frequently positive to DMG-PEG 2000 than to other excipients in both groups (p < 0.001). DMG-PEG 2000 reactivity was less frequent in vaccine-naïve (6 %) than vaccinated subjects (35 %, p < 0.001) and associated with mRNA-1273 vaccination. DMG-PEG 2000 BAT might therefore have a diagnostic role in subjects with delayed hypersensitivity reactions. Natural immunity might be a key player in basophil activation.
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Affiliation(s)
- Patrizia Pignatti
- Allergy and Immunology Unit, Istituti Clinici Scientifici Maugeri IRCCS Pavia, 27100 Pavia, Italy
| | - Giuseppe Alvise Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Marco Russo
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Marraccini
- Preventive and Occupational Medicine Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Foundation Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Serena Nannipieri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Chiara Asperti
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | | | | | | | - Antonella Gurrado
- Allergy and Immunology Unit, Istituti Clinici Scientifici Maugeri IRCCS Pavia, 27100 Pavia, Italy
| | | | - Giovanni Benanti
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Bernadette Cilona
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Pigatto
- Section of Clinical Dermatology, Department of Biomedical, Surgical and Dental Sciences, IRCCS Galeazzi Orthopedic Institute, University of Milan, Milan, Italy
| | - Samuele E Burastero
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Mona-Rita Yacoub
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy
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2
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Özden Ş, Tepetam FM, Atik Ö. [Vaccination approach in patients with an allergic reaction to COVID-19 vaccines or at risk of developing allergic reactions]. Tuberk Toraks 2023; 71:166-175. [PMID: 37345399 PMCID: PMC10795276 DOI: 10.5578/tt.20239920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] Open
Abstract
Introduction There is consensus that patients at risk of developing an allergic reaction to COVID-19 vaccines should be evaluated by an immunologist-allergist to determine whether vaccination should be recommended. We wanted to share our experiences in the management of these high-risk patients, from diagnostic tests in allergological evaluation to the vaccination process. Materials and Methods Our retrospective cross-sectional study included patients who had previously developed an allergic reaction to COVID-19 vaccines or drugs and therefore were referred to our allergy and immunology clinic. Prick and intradermal tests were performed on all patients with methylprednisolone acetate (Depo-Medrol®, Pfizer) 40 mg/mL containing polyethylene Glycol (PEG) and triamcinolone acetonide (Kenacort®, Deva) 40 mg/mL containing polysorbate 80. While vaccination with desensitization was recommended for all patients with positive skin tests, split-dose vaccination was recommended for patients with negative skin tests. After explaining the risks and benefits, the choice of the vaccine (Pfizer/BioNTech or Sinovac/ CoronoVac) was left to the patients' discretion. Result A total of 41 patients, 10 males, and 31 females, with a mean age of 42.37 ± 14.177 years were included. Eighteen patients with a history of allergy after COVID-19 vaccines were analyzed according to the type of reaction and type of vaccine administered (Pfizer/BioNTech/Coronovac; Anaphylaxis: 4/1, Urticaria: 11/2). Moreover, there was a history of drug allergy in 23 patients who had not been vaccinated before. Skin tests with PEG were positive in a total of seven patients while skin tests with polysorbate 80 were negative in all patients. No allergic reaction developed in seven patients who underwent desensitization and in 34 patients who received a split dose. Conclusions Considering the potentially life-saving benefits of vaccination in a global pandemic environment, it is a safe and effective method to administer vaccines to at-risk patients using desensitization or split dosing techniques, based on their sensitivity status determined through a PEG skin test. This approach allows for the avoidance of preventing access to vaccines, while still ensuring the safety of patients.
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Affiliation(s)
- Şeyma Özden
- Clinic of Immunology and Allergy, University of Health Sciences Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Fatma Merve Tepetam
- Clinic of Immunology and Allergy, University of Health Sciences Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Özge Atik
- Clinic of Immunology and Allergy, University of Health Sciences Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Türkiye
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Nappi E, Racca F, Piona A, Messina MR, Ferri S, Lamacchia D, Cataldo G, Costanzo G, Del Moro L, Puggioni F, Canonica GW, Heffler E, Paoletti G. Polyethylene Glycol and Polysorbate 80 Skin Tests in the Context of an Allergic Risk Assessment for Hypersensitivity Reactions to Anti-SARS-CoV-2 mRNA Vaccines. Vaccines (Basel) 2023; 11:vaccines11050915. [PMID: 37243019 DOI: 10.3390/vaccines11050915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Concern has arisen about hypersensitivity reactions in patients with allergic reactions to drugs containing polyethylene glycol (PEG) or polysorbate 80 (PS80), excipients of currently available anti-SARS-CoV-2 mRNA vaccines. However, the actual utility of PEG and PS80 skin allergy testing is currently still debated. We retrospectively analyzed all cases of patients on whom we performed allergometric skin tests for PEG and PS80 in the context of a pre-vaccination screening (for patients with multiple hypersensitivity reactions to drugs for which these excipients were among the suspected agents) or following suspected hypersensitivity reactions to anti-SARS-CoV-2 vaccines. A total of 134 tests were performed for PEG and PS80, eight of which produced uninterpretable results (due to dermographism or non-specific reactions). Of the remaining 126 cases (85 pre-vaccinal and 41 post-vaccine reactions), 16 (12.7%) were positive for PEG and/or PS80. Stratifying by clinical indication, there were no statistically significant differences in the proportion of positive tests between patients evaluated in the context of the pre-vaccination screening and those evaluated after a vaccine reaction (10.6% vs. 17.1%, respectively, p = 0.306). Allergometric skin tests for PEG and PS80 in our case series resulted positive in an unexpectedly high proportion of patients, suggesting that testing for allergy to these two excipients should not be ignored in case of reasonable clinical suspicion.
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Affiliation(s)
- Emanuele Nappi
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Francesca Racca
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Alessandra Piona
- Allergy Service, Humanitas San Pio X Hospital, 20159 Milano, Italy
| | - Maria Rita Messina
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Sebastian Ferri
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Donatella Lamacchia
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Giuseppe Cataldo
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Giovanni Costanzo
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Lorenzo Del Moro
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Clinical and Experimental Medicine, University of Florence, 50121 Firenze, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
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Messina MR, Crisciotti C, Pellegrini L, Nappi E, Racca F, Costanzo G, Del Moro L, Ferri S, Puggioni F, Canonica GW, Heffler E, Paoletti G. Desensitization Protocols for Anti-SARS-CoV-2 Vaccines in Patients with High Risk of Allergic Reactions. Vaccines (Basel) 2023; 11:vaccines11050910. [PMID: 37243013 DOI: 10.3390/vaccines11050910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/20/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Vaccines for SAR-CoV-2 are the most effective preventive treatment able to reduce the risk of contracting the infection and experiencing worse outcomes whenever the infection is contracted. Despite their rarity, hypersensitivity reactions to the anti-SARS-CoV-2 vaccine have been described and could become the reason not to complete the vaccination. Desensitization protocols for other vaccines have been described and validated, while the use of this approach for anti-SARS-CoV-2 vaccines is still anecdotal. We herein describe our experience with 30 patients with previous allergic reactions to anti-SARS-CoV-2 vaccines or to any of their excipients, proving that they are effective and safe; only two patients experienced hypersensitivity reaction symptoms during the desensitization procedure. Moreover, in this article, we propose desensitization protocols for the most common anti-SARS-CoV-2 vaccines.
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Affiliation(s)
- Maria Rita Messina
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Carlotta Crisciotti
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Laura Pellegrini
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Emanuele Nappi
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Francesca Racca
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Giovanni Costanzo
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Lorenzo Del Moro
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Clinical and Experimental Medicine, University of Florence, 50139 Florence, Italy
| | - Sebastian Ferri
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy
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Koesnoe S, Maria S, Widhani A, Hasibuan AS, Karjadi TH, Khoirunnisa D, Yusuf M, Sumariyono S, Liastuti LD, Djauzi S, Rengganis I, Yunihastuti E. COVID-19 vaccine provocation test outcome in high-risk allergic patients: A retrospective study from a tertiary hospital in Indonesia. World Allergy Organ J 2023; 16:100734. [PMID: 36530537 PMCID: PMC9744675 DOI: 10.1016/j.waojou.2022.100734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/30/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
Background High COVID-19 vaccine coverage is essential. Patients who are considered high risk for hypersensitivity reactions and have had an allergic reaction to the COVID-19 vaccine are usually referred to an allergist for assessment of vaccination. Administration of a vaccine graded challenge (also known as a provocation test) is an option that can be considered in this population. This primary objective of this study is to describe the outcome of the COVID-19 vaccine provocation test and to understand the predicting factors associated with hypersensitivity reaction after the provocation test as the secondary objective. Methods Adult patients with a history of hypersensitivity reaction to the first COVID-19 vaccine and high-allergic patients who underwent COVID-19 vaccine provocation test up until May 2022 were included. A protocol using skin prick test (SPT), intradermal test (IDT), followed by graded challenge was developed for the determined vaccine used. Results A total of 232 patients were included in the analysis. Twenty-eight had hypersensitivity to their first COVID-19 vaccine dose and 204 were high risk for allergic reaction. Hypersensitivity reactions occurred in 20 patients (8.6%, 95% CI: 5-12.2%), consisting of 4 reactions after SPT, 9 after IDT, 7 during or after titrated challenge. Half of the reactions were mild; however, 3 patients developed severe reactions. Patients with history of anaphylaxis were more likely to experience hypersensitivity reaction after provocation test (aRR = 2.79, 95% CI: 1.05-7.42). Conclusion Provocation test in COVID-19 vaccination has a high success rate in patients with a history of hypersensitivity to the first COVID-19 vaccine and in high allergic patients. History of anaphylaxis is associated with hypersensitivity reaction after a COVID-19 vaccine provocation test.
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Key Words
- ACAAI, The American College of Allergy, Asthma, and Immunology
- ADR, adverse drug reaction
- AE, adverse events
- Allergy
- Anaphylaxis
- BMI, body mass index
- CDC, The Center for Disease Control and Prevention
- CI, confidence interval
- COVID-19
- COVID-19, coronavirus disease
- IDT, intradermal test
- Provocation test
- SD, standard deviation
- SJS, Stevens-Johnson syndrome
- SPT, skin prick test
- TEN, toxic epidermal necrolysis
- Vaccination
- aRR, adjusted risk ratio
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Affiliation(s)
- Sukamto Koesnoe
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia,Corresponding author. Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jl. Diponegoro No. 71, Jakarta 10430, Indonesia
| | - Suzy Maria
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Alvina Widhani
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Anshari S. Hasibuan
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Teguh H. Karjadi
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Dhiya Khoirunnisa
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Muhammad Yusuf
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | | | | - Samsuridjal Djauzi
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Iris Rengganis
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Evy Yunihastuti
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Haq HN, Khan H, Chaudhry H, Nimmala S, Demidovich J, Papudesi BN, Potluri SD. Pfizer-BioNTech (BNT162b2), Moderna (mRNA-1273) COVID-19 mRNA vaccines and hypersensitivity reactions. J Natl Med Assoc 2022; 114:601-612. [PMID: 36511275 PMCID: PMC9613973 DOI: 10.1016/j.jnma.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 06/13/2022] [Accepted: 08/24/2022] [Indexed: 11/05/2022]
Abstract
The SARS-CoV-2 Virus (COVID-19) is responsible for over 239 million cases and 4.8 million deaths globally (Data source WHO COVID-19 Dashboard accessed on October 14, 2021). It continues to surge and ravage countries, leaving healthcare systems in constant struggle and uncertainty. A variety of vaccines were developed to combat the spread of the COVID-19 Virus. Reports of possible allergic reactions with COVID-19 vaccines are a significant cause of public concern, especially among those with a known history of a severe allergic reaction (e.g., anaphylaxis). Here we review articles relevant to COVID-19 vaccines and their excipients (especially PEG (Polyethylene glycol) and hypersensitivity reactions associated with COVID-19 vaccines (including clinical features, pathophysiology, special populations receiving COVID-19 vaccinations, potential diagnostic tests, and preventive measures that can be taken to minimize the risks of hypersensitivity reactions with COVID-19 vaccines).
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Affiliation(s)
- Hannah N Haq
- Department of Medicine, All Saints University, School of Medicine, Roseau, Dominica.
| | - Hafiz Khan
- Dept. of Internal Medicine, Suburban Community Hospital Norristown PA 19401, United States
| | - Haroon Chaudhry
- Dept. of Internal Medicine, Suburban Community Hospital Norristown PA 19401, United States
| | - Swathi Nimmala
- Dept. of Internal Medicine, Suburban Community Hospital Norristown PA 19401, United States
| | - Joseph Demidovich
- Dept. of Internal Medicine, Suburban Community Hospital Norristown PA 19401, United States
| | | | - Sai Deepika Potluri
- Dept. of Internal Medicine MedStar Union Memorial Hospital 201 E University Pkwy, Baltimore, MD 21218 Unites States
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Bent RK, Faihs V, Tizek L, Biedermann T, Zink A, Brockow K. PEG allergy - A COVID-19 pandemic-made problem? A German perspective. World Allergy Organ J 2022; 15:100714. [PMID: 36337297 PMCID: PMC9618425 DOI: 10.1016/j.waojou.2022.100714] [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: 08/05/2022] [Revised: 09/22/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background Polyethylene glycol (PEG) has been used for decades, but only caused allergic reactions exceptionally. Introduction of PEG-containing COVID-19 vaccines might have fostered public interest beyond medical reasoning. Objectives To investigate the impact of the SARS-CoV-2 pandemic on the public interest in PEG allergy in Germany and the published PEG allergy cases worldwide. Methods A retrospective longitudinal study was conducted to measure public interest in PEG allergy analyzing Google search volume in Germany from February 2018 to January 2022. Medically confirmed “PEG allergy” cases were analyzed by looking at the numbers of PubMed case reports and case series from 1977 until January 2022. Results Web results in Germany before COVID-19 show search volumes related to “PEG allergy/testing” was negligible, with 10 search queries per month. The pandemic led to a >200-fold increase from 250 queries 2 years before to 55 720 queries 2 years thereafter, reflecting tremendous public interest. Additionally, the maximum monthly search volume from before to during the pandemic increased immensely for “vaccination” (57-fold), “vaccination and adverse effects” (85-fold), “vaccination and allergy” (71-fold). In contrast, the increase of publication numbers for the search term “PEG allergy” was small from 2019 to 2021 (2.5-fold). Only a very low number of 211 cases with “PEG allergy” worldwide since 1977 could be identified. Conclusion PEG allergy became a topic of major public interest because of COVID-19 vaccination. Scientific publications have increased to a lesser extent, probably promoted by public awareness. Conversely, the overall number of cases published with PEG allergy remain very low. The current high demand for COVID-19 vaccination allergy testing is triggered by public interest instead of medical reasoning.
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Affiliation(s)
| | | | | | | | | | - Knut Brockow
- Corresponding author. Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein Technische Universität München, Biedersteiner Str. 29, 80802 München, Germany
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Rivolta F, Camilla C, Sangalli A, Chiei Gallo A, Pravettoni V. Successful fractionated undiluted doses of COVID-19 vaccine in five cases of suspected allergic reactions to the first dose. Clin Case Rep 2022; 10:e6348. [PMID: 36245445 PMCID: PMC9552543 DOI: 10.1002/ccr3.6348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/30/2022] [Accepted: 07/23/2022] [Indexed: 11/10/2022] Open
Abstract
After a suspected allergic reaction to first dose of mRNA COVID-19 vaccine, given the PEG skin tests negativity and tolerance in vivo to PEG containing drugs, five patients were vaccinated with the second dose of Pfizer-Biontech undergoing a fractional protocol, with antihistamine premedication, without presenting immediate or delayed reactions.
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Affiliation(s)
- Federica Rivolta
- UOC General Medicine Immunology and AllergologyFoundation IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | | | - Andrea Sangalli
- Allergy and Clinical Immunology ResidencyUniversity of MilanMilanItaly
| | | | - Valerio Pravettoni
- UOC General Medicine Immunology and AllergologyFoundation IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
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Cha B, Kwon KS, Lee HL, Kim CW. Successful mRNA COVID-19 Vaccination and Colonoscopy After Oral Desensitization in a Patient With Polyethylene Glycol Allergy. J Korean Med Sci 2022; 37:e251. [PMID: 35971765 PMCID: PMC9424693 DOI: 10.3346/jkms.2022.37.e251] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/10/2022] [Indexed: 12/01/2022] Open
Abstract
Anaphylaxis to polyethylene glycol (PEG) is rare and mainly occurs with the use of laxatives containing PEG. Recently, an increasing number of PEG allergies have been reported, particularly those related to coronavirus disease 2019 (COVID-19) vaccines. mRNA COVID-19 vaccines, such as the BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) vaccines, contain PEG2000 as an excipient and are contraindicated when allergy to a vaccine component exist. We report a 55-year-old woman's history as a case of successful mRNA COVID-19 vaccination and colonoscopy after oral desensitization to PEG in a patient with PEG allergy who required both COVID-19 vaccination and colon evaluation. Allergy to PEG was diagnosed based on clinical history, skin test results, and basophil histamine release testing. Oral desensitization effectively suppressed histamine release from basophils in response to PEG stimulation, suggesting that oral desensitization using PEG-based laxatives may be an effective treatment option for patients with allergy to the substance.
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Affiliation(s)
- Boram Cha
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Kye Sook Kwon
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Hong Lyeol Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Cheol-Woo Kim
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea.
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Jover Cerdá V, Rodríguez Pacheco R, Doménech Witek J, Alonso Hernández S, Durán García R, Real Panisello M, Marco de la Calle FM. Allergological study in patients vaccinated against COVID-19 with suspected allergic reactions. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2022; 18:43. [PMID: 35624518 PMCID: PMC9136194 DOI: 10.1186/s13223-022-00685-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/08/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND One of the main barriers to vaccination against SARS-CoV-2 is the fear of developing hypersensitivity reactions to any of its components. Although these reactions are very rare, it is necessary to establish an effective protocol to detect patients at risk of developing them. The aim of this study was to evaluate hypersensitivity reactions in vaccinated patients in order to allow or not to complete the vaccination protocol. METHODS Descriptive and cross-sectional study in which patients with suspected hypersensitivity to SARS-CoV-2 vaccines were evaluated. All patients underwent skin prick test (SPT) and/or intradermal test (IDT) with the vaccines and their excipients. In patients with positive IDT with the vaccine, a histopathological and immunohistochemical study was performed by skin biopsy. A basophil activation test (BAT) and a lymphoblastic transformation test (LTT) were also performed. RESULTS Sixteen patients with suspected hypersensitivity to SARS-CoV-2 vaccine (12 received Comirnaty®, 3 received Vaxzevria®, and 1 received Spikevax®) were evaluated. Half had immediate hypersensitivity reactions and half had delayed reactions. All SPTs to excipients and vaccines were negative. IDTs with all excipients were negative. IDTs with vaccines were positive in 11 patients and negative in 5. The histological and immunohistochemical study of the two selected patients with positive IDT with vaccine showed T-lymphocyte involvement. BAT and LTT were negative in both cases. The vaccination protocol could be completed in 7 of 16 patients (44%) studied. The remaining 9 patients did not receive the second dose: 5 because vaccination was not required and 4 because they refused to be vaccinated. CONCLUSIONS Thanks to the allergological and immunohistochemical study, the vaccination protocol could be completed in about half of the patients who presented suspected hypersensitivity reactions to SARS-CoV-2 vaccines. IDTs with vaccines could be a valuable method for assessing the immunogenicity of the vaccines.
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Affiliation(s)
- Vicente Jover Cerdá
- Allergology Department, General University Hospital of Elda, Ctra. De Sax, s/n - 03600 Elda, Alicante, Spain.
| | - Ramón Rodríguez Pacheco
- Allergology Department, General University Hospital of Elda, Ctra. De Sax, s/n - 03600 Elda, Alicante, Spain
| | - Joan Doménech Witek
- Allergology Department, General University Hospital of Elda, Ctra. De Sax, s/n - 03600 Elda, Alicante, Spain
| | | | - Rafael Durán García
- Pathologic Anatomy Department, General University Hospital of Elda, Alicante, Spain
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Rama TA, Miranda J, Silva D, Amaral L, Castro E, Coimbra A, Moreira A, Plácido JL. COVID-19 Vaccination Is Safe among Mast Cell Disorder Patients, under Adequate Premedication. Vaccines (Basel) 2022; 10:vaccines10050718. [PMID: 35632474 PMCID: PMC9146268 DOI: 10.3390/vaccines10050718] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
Reported cases of anaphylaxis following COVID-19 vaccination raised concerns about the safety of these vaccines, namely in patients suffering from clonal mast cell (MC) disorders—a heterogenous group of disorders in which patients may be prone to anaphylaxis caused by vaccination. This study aimed to assess the safety of COVID-19 vaccines in patients with clonal MC disorders. We performed an ambidirectional cohort study with 30 clonal MC disorder patients (n = 26 in the prospective arm and n = 4 in the retrospective arm), that were submitted to COVID-19 vaccination. Among these, 11 (37%) were males, and median age at vaccination date was 41 years (range: 5y to 76y). One patient had prior history of anaphylaxis following vaccination. Those in the prospective arm received a premedication protocol including H1- and H2-antihistamines and montelukast, while those in the retrospective arm did not premedicate. Overall, patients received a total of 81 doses, 73 under premedication and 8 without premedication. No MC activation symptoms were reported. COVID-19 vaccination seems to be safe in patients with clonal mast cell disorders, including those with prior anaphylaxis following vaccination. Robust premedication protocols may allow for vaccination in ambulatory settings.
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Affiliation(s)
- Tiago Azenha Rama
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
- EPIUnit—Institute of Public Health, University of Porto, 4050-600 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
- Correspondence:
| | - Joana Miranda
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
| | - Diana Silva
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
- EPIUnit—Institute of Public Health, University of Porto, 4050-600 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
| | - Luís Amaral
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
| | - Eunice Castro
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
| | - Alice Coimbra
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
| | - André Moreira
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
- EPIUnit—Institute of Public Health, University of Porto, 4050-600 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
| | - José Luís Plácido
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
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AlMuhizi F, Ton-Leclerc S, Fein M, Tsoukas C, Garvey LH, Lee D, Ben-Shoshan M, Isabwe GAC, Copaescu AM. Successful Desensitization to mRNA COVID-19 Vaccine in a Case Series of Patients With a History of Anaphylaxis to the First Vaccine Dose. FRONTIERS IN ALLERGY 2022; 3:825164. [PMID: 35386647 PMCID: PMC8974752 DOI: 10.3389/falgy.2022.825164] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/11/2022] [Indexed: 02/02/2023] Open
Abstract
Background Coronavirus disease 2109 (COVID-19) vaccines have recently been approved to curb the global pandemic. The risk of allergic reactions to the vaccine polyethylene glycol (PEG) component has raised significant public concern. Desensitization is suggested in cases of vaccine related hypersensitivity reactions. After comprehensive literature review on the topic, our aim was to establish a safe and effective desensitization protocol for patients with suspected or confirmed immediate type hypersensitivity reactions to the COVID-19 vaccine. Methods Participants were referred to the McGill University Health Center (MUHC) Allergy-Immunology department for clinical evaluation following a reported reaction to their first dose of Moderna® mRNA-1273 or Pfizer-BioNTech® BNT162b2 vaccines. They underwent skin prick testing (SPT) with higher and lower molecular weight (MW) PEG and polysorbate 80, as per published protocols. Their second dose was administered following a desensitization protocol consisting of multiple dose-administration steps followed by a 60-min observation period. Results Among a cohort of 142 patients with an increased risk for allergic reactions to the COVID-19 vaccines, six individuals were selected to undergo desensitization. All were female with allergic background including chronic spontaneous urticaria, anaphylaxis to medications, and/or vaccines. The main symptom after their first dose was difficulty swallowing with lightheadedness or immediate urticaria, angioedema, and/or dizziness. Two patients had positive skin testing. One patient was on chronic antihistamines which resulted in an inconclusive PEG skin test and the skin testing was negative for the three other patients. During the desensitization, two patients reported cutaneous symptoms of an immediate reaction and were managed with antihistamines. One of these patients also complained of ear pressure and had a drop in her systolic blood pressure, treated with intravenous fluids. Conclusion This study suggests that some individuals with an immediate-type hypersensitivity reaction to their first dose of mRNA COVID-19 vaccine may safely receive their second dose using a desensitization protocol. The success of this desensitization protocol is a step forward in the fight against COVID-19, allowing more individuals to be immunized.
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Affiliation(s)
- Faisal AlMuhizi
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, McGill University, Montreal, QC, Canada
- Department of Internal Medicine, Security Forces Hospital Program, Riyadh, Saudi Arabia
| | | | - Michael Fein
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, McGill University, Montreal, QC, Canada
- The Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Christos Tsoukas
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, McGill University, Montreal, QC, Canada
- The Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Lene Heise Garvey
- Allergy Clinic, Copenhagen University Hospital, Gentofte, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Derek Lee
- Pharmacy Department, Montreal General Hospital, Montreal, QC, Canada
| | - Moshe Ben-Shoshan
- The Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
- Division of Pediatric Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Ghislaine A. C. Isabwe
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, McGill University, Montreal, QC, Canada
- The Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Ana M. Copaescu
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, McGill University, Montreal, QC, Canada
- The Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
- Department of Infectious Diseases, Centre for Antibiotic Allergy and Research, Austin Health, Heidelberg, VIC, Australia
- *Correspondence: Ana M. Copaescu
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13
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Maltezou HC, Anastassopoulou C, Hatziantoniou S, Poland GA, Tsakris A. Anaphylaxis rates associated with COVID-19 vaccines are comparable to those of other vaccines. Vaccine 2021; 40:183-186. [PMID: 34863620 PMCID: PMC8626274 DOI: 10.1016/j.vaccine.2021.11.066] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 02/02/2023]
Abstract
We retrieved data on 8940 anaphylaxis cases post-COVID-19 vaccination from the US Vaccine Adverse Event Reporting System and the European EudraVigilance from week 52/2020 through week 31/2021 and compared them with those of other vaccines. Overall, 837,830,000 COVID-19 vaccine doses were delivered in the US and Europe during the study period, for which the vaccine name was known. The mean anaphylaxis rate was estimated at 10.67 cases per 106 doses of COVID-19 vaccines (range: 7.99-19.39 cases per 106 doses depending on the vaccine). COVID-19 vaccines ranked fifth in reported anaphylaxis rates, behind rabies, tick-borne encephalitis, measles-mumps-rubella-varicella, and human papillomavirus vaccines (70.77, 20, 19.8, and 13.65 cases per 106 vaccine doses, respectively). COVID-19 vaccines are within the range of anaphylaxis rates reported across several common vaccines in these two passive reporting systems. These data should be communicated to reassure the general population about the safety profile of COVID-19 vaccines.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece.
| | - Cleo Anastassopoulou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia Hatziantoniou
- Laboratory of Pharmaceutical Technology, Department of Pharmacy, School of Health Sciences, University of Patras, Patras, Greece
| | - Gregory A Poland
- Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, MN, United States
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Brockow K, Mathes S, Fischer J, Volc S, Darsow U, Eberlein B, Biedermann T. Experience with polyethylene glycol allergy-guided risk management for COVID-19 vaccine anaphylaxis. Allergy 2021; 77:2200-2210. [PMID: 34806775 PMCID: PMC9011687 DOI: 10.1111/all.15183] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/29/2022]
Abstract
Background Polyethylene glycol (PEG) may elicit anaphylaxis to COVID‐19 mRNA vaccines, and guidance for patients at risk is needed. Methods In retrospective patients with PEG allergy collected from 2006 till 2019, clinical, skin, and basophil activation test (BAT) characteristics discriminative for PEG allergy were analyzed and compared with the literature. In 421 prospective real‐life patients asking for allergy workup for COVID‐19 vaccine hypersensitivity in 2020/2021, risk assessment was performed and tolerance of the recommended vaccination approach was assessed. Results Ten patients with PEG allergy were found in the retrospective cohort. Patients reacted with immediate anaphylaxis (100%) not only to PEG‐based laxatives/bowel preparations or injections, but also to cold medication, antiseptics, analgetics, or antibiotics. Skin tests ± BAT with PEG ± elicitors were positive in 10/10. Provocation tests were positive in 7/9 patients. From the prospective cohort, 370/421 patients self‐reporting increased risk for vaccine allergy lacked criteria necessitating allergy workup and were recommended for routine vaccination. A total of 51/421 patients were tested, and three (6%) with PEG allergy were identified, whereas 48 patients remained negative in skin tests. Vaccination was recommended in all those patients. No hypersensitivity reactions were reported to vaccination including six PEG‐allergic patients tolerating COVID‐19 vaccination. Conclusions Taking a detailed history excluded PEG allergy in most referred patients and enabled direct safe vaccination. Immediate urticaria/anaphylaxis to typical elicitors identified patients requiring PEG allergy workup. Skin tests ± BAT identified PEG allergy and helped to select the vaccine and the vaccination approach. Even PEG‐allergic patients can tolerate COVID‐19 vaccines.
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Affiliation(s)
- Knut Brockow
- Department of Dermatology and Allergy Biederstein Faculty of Medicine Technical University of Munich Munich Germany
| | - Sonja Mathes
- Department of Dermatology and Allergy Biederstein Faculty of Medicine Technical University of Munich Munich Germany
| | - Jörg Fischer
- Department of Dermatology Eberhard Karls University Tübingen Germany
- Division of Experimental Allergy and Immunodermatology University of Oldenburg Oldenburg Germany
| | - Sebastian Volc
- Department of Dermatology Eberhard Karls University Tübingen Germany
| | - Ulf Darsow
- Department of Dermatology and Allergy Biederstein Faculty of Medicine Technical University of Munich Munich Germany
| | - Bernadette Eberlein
- Department of Dermatology and Allergy Biederstein Faculty of Medicine Technical University of Munich Munich Germany
| | - Tilo Biedermann
- Department of Dermatology and Allergy Biederstein Faculty of Medicine Technical University of Munich Munich Germany
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15
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Tozinameran. REACTIONS WEEKLY 2021. [PMCID: PMC8586630 DOI: 10.1007/s40278-021-05457-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Yacoub MR, Cucca V, Asperti C, Ramirez GA, Della-Torre E, Moro M, Zandalasini C, Di Napoli D, Ambrosio A, Signorelli C, Colombo S, Beretta L, Ciceri F, Zangrillo A, Dagna L. Efficacy of a rational algorithm to assess allergy risk in patients receiving the BNT162b2 vaccine. Vaccine 2021; 39:6464-6469. [PMID: 34598820 DOI: 10.1016/j.vaccine.2021.09.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/17/2021] [Accepted: 09/19/2021] [Indexed: 02/02/2023]
Abstract
Among 6146 hospital employees, 118 subjects with severe allergic background were identified through a screening questionnaire and stratified into 3 groups (Low-risk (LR), Intermediate (IR) and High-risk (HR) group), based on their allergic anamnesis. Data reports on hypersensitivity reactions (HypR) have been collected in both allergic and non-allergic subjects. Seventeen patients (14%) in the allergic population had a HypR after the first, the second or both doses. Skin manifestations were the most frequent ones. Allergic events were more frequent in HR (35%) than IR (10%; p = 0.005) or LR (0%; p = 0.074) subjects. No patient had anaphylaxis. All patients completed the vaccination schedule. 13 HypR occurred in patients without severe allergic background (13/6028, 0,2%) including one (1/6148, 0.016% of total population) WAO grade-4 anaphylaxis. Our data suggest that BNT162b2 mRNA Covid-19 vaccine is relatively safe also in patients with severe allergic background; however, some precautions are required for high-risk patients.
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Affiliation(s)
- Mona-Rita Yacoub
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Valentina Cucca
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Giuseppe A Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Emanuel Della-Torre
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Matteo Moro
- Medical Affairs Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Davide Di Napoli
- Medical Affairs Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Ambrosio
- Medical Affairs Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Carlo Signorelli
- School of Hygiene and Public Health, Vita-Salute San Raffaele University, Milan, Italy
| | - Sergio Colombo
- Vita-Salute San Raffaele University, Milan, Italy; Anaesthesiology and Intensive Care Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luigi Beretta
- Vita-Salute San Raffaele University, Milan, Italy; Anaesthesiology and Intensive Care Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Fabio Ciceri
- Vita-Salute San Raffaele University, Milan, Italy; Haematology and Bone Marrow Transplantation Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Zangrillo
- Vita-Salute San Raffaele University, Milan, Italy; Anaesthesiology and Intensive Care Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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Challenges to Vaccination against SARS-CoV-2 in Patients with Immune-Mediated Diseases. Vaccines (Basel) 2021; 9:vaccines9101147. [PMID: 34696255 PMCID: PMC8537812 DOI: 10.3390/vaccines9101147] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/30/2021] [Accepted: 10/05/2021] [Indexed: 12/22/2022] Open
Abstract
Aberrant deployment of the immune response is a hallmark pathogenic feature of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related disease (COVID-19), possibly accounting for high morbidity and mortality, especially in patients with comorbidities, including immune-mediated disorders. Immunisation with SARS-COV-2 vaccines successfully instructs the immune system to limit viral spread into tissues, mitigate COVID-19 manifestations and prevent its most detrimental inflammatory complications in the general population. Patients with immune-mediated diseases have been excluded from vaccine registration trials, foreclosing the acquisition of specific efficacy and safety data. In this review, we aimed to summarise and critically discuss evidence from real-world studies addressing this issue to provide a comprehensive view of the impact of vaccination practices in patients with allergy, autoimmunity or immunodeficiency. We analysed clinical and laboratory data from 34 studies involving more than 13,000 subjects with various immune disorders who were vaccinated with mRNA- DNA- or inactivated viral particle-based vaccines. These data globally support the safe and effective use of SARS-CoV-2 vaccines in patients with immune-mediated diseases, although patient-tailored strategies to determine vaccination timing, vaccine choice and background therapy management are warranted to optimise vaccination outcomes. More data are needed regarding patients with primary immunodeficiencies.
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A case series of cutaneous COVID-19 vaccine reactions at Loma Linda University Department of Dermatology. JAAD Case Rep 2021; 16:53-57. [PMID: 34423106 PMCID: PMC8372465 DOI: 10.1016/j.jdcr.2021.07.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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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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