1
|
Stehlin F, Khoudja RY, Al-Otaibi I, ALMuhizi F, Fein M, Gilbert L, Tsoukas C, Ben-Shoshan M, Copaescu AM, Isabwe GAC. COVID-19 booster vaccine acceptance following allergy evaluation in individuals with allergies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:242-245.e2. [PMID: 37802251 DOI: 10.1016/j.jaip.2023.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/10/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Florian Stehlin
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Center (MUHC), McGill University, Montreal, QC, Canada; Division of Clinical Immunology and Allergy, Department of Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Rabea Y Khoudja
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Center (MUHC), McGill University, Montreal, QC, Canada; The Research Institute of McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Ibtihal Al-Otaibi
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Center (MUHC), McGill University, Montreal, QC, Canada; Division of Allergy and Clinical Immunology, Department of Pediatrics, Al Yamammah Hospital, Central Second Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
| | - Faisal ALMuhizi
- Division of Allergy and Clinical Immunology, 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 Center (MUHC), McGill University, Montreal, QC, Canada
| | - Louise Gilbert
- The Research Institute of McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Christos Tsoukas
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Center (MUHC), McGill University, Montreal, QC, Canada; The Research Institute of McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Moshe Ben-Shoshan
- The Research Institute of McGill University Health Center, McGill University, Montreal, QC, Canada; Division of Pediatric Allergy and Clinical Immunology, Department of Medicine, Montreal General Hospital McGill University Health Centre, Montreal, QC, Canada
| | - Ana-Maria Copaescu
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Center (MUHC), McGill University, Montreal, QC, Canada; The Research Institute of McGill University Health Center, McGill University, Montreal, QC, Canada; Center for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia
| | - Ghislaine Annie Clarisse Isabwe
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Center (MUHC), McGill University, Montreal, QC, Canada; The Research Institute of McGill University Health Center, McGill University, Montreal, QC, Canada.
| |
Collapse
|
2
|
Gulas E, Bant A, Kruszewski J, Betiuk B, Niedoszytko M, Chciałowski A. The usability of testing skin reaction applying skin prick tests with Comirnaty (Pfizer, USA) vaccine in detecting the risk of developing post-vaccination immediate hypersensitivity response (anaphylaxis) after administration of this vaccine. Postepy Dermatol Alergol 2023; 40:655-660. [PMID: 38028424 PMCID: PMC10646719 DOI: 10.5114/ada.2023.131860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/18/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction COVID-19 vaccines became a relevant element of prevention during COVID-19 pandemic. It is worth highlighting the importance of severe allergic post-vaccination reactions. Aim To evaluate the usability of skin reaction tests using skin prick tests with Comirnaty (Pfizer, USA) vaccine in risk detection of the post-vaccine immediate hypersensitivity reaction (anaphylaxis) after administration of this vaccine [PvIHR(A)]. Material and methods The analysis embraces 102 people, 85 women and 17 men with a history of immediate hypersensitivity (anaphylaxis) [IHR(A)]. Detailed medical history was collected and skin prick tests were made among participants. The positive and negative test results were illustrated in Figure 1. Results As it stands in Table 1, considering all participants of the study, a positive result of the skin prick tests was obtained only in 2 cases, a negative result in 99 and 1 result was questionable. The two positive results were found in participants from a group with a previous PvIHR(A) in their past medical history and they decided not to get vaccinated. The one questionable result was of a person that had PvIHR(A) after administration of the first dose of Comirnaty vaccine (Pfizer, USA). This person decided to get vaccinated again and there was no PvIHR(A) observed. Conclusions COVID-19 vaccination involves a low risk of anaphylaxis. Purposefulness of providing the skin prick tests using the mRNA vaccine is questionable, due to their low sensitivity and low specificity.
Collapse
Affiliation(s)
- Ewelina Gulas
- Department of Infectious Diseases and Allergology, Military Institute of Medicine, National Research Institute, Warsaw, Poland
| | - Andrzej Bant
- Department of Infectious Diseases and Allergology, Military Institute of Medicine, National Research Institute, Warsaw, Poland
| | - Jerzy Kruszewski
- Department of Infectious Diseases and Allergology, Military Institute of Medicine, National Research Institute, Warsaw, Poland
| | - Barbara Betiuk
- Vaccination Clinic of Military Instytute of Medicine, National Research Institute, Warsaw, Poland
| | - Marek Niedoszytko
- Allergology Department, Medical University of Gdansk, Gdansk, Poland
| | - Andrzej Chciałowski
- Department of Infectious Diseases and Allergology, Military Institute of Medicine, National Research Institute, Warsaw, Poland
| |
Collapse
|
3
|
Roche R, Odeh NH, Andar AU, Tulapurkar ME, Roche JA. Protection against Severe Illness versus Immunity-Redefining Vaccine Effectiveness in the Aftermath of COVID-19. Microorganisms 2023; 11:1963. [PMID: 37630523 PMCID: PMC10459411 DOI: 10.3390/microorganisms11081963] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/03/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023] Open
Abstract
Anti-SARS-CoV-2 vaccines have played a pivotal role in reducing the risk of developing severe illness from COVID-19, thus helping end the COVID-19 global public health emergency after more than three years. Intriguingly, as SARS-CoV-2 variants emerged, individuals who were fully vaccinated did get infected in high numbers, and viral loads in vaccinated individuals were as high as those in the unvaccinated. However, even with high viral loads, vaccinated individuals were significantly less likely to develop severe illness; this begs the question as to whether the main effect of anti-SARS-CoV-2 vaccines is to confer protection against severe illness or immunity against infection. The answer to this question is consequential, not only to the understanding of how anti-SARS-CoV-2 vaccines work, but also to public health efforts against existing and novel pathogens. In this review, we argue that immune system sensitization-desensitization rather than sterilizing immunity may explain vaccine-mediated protection against severe COVID-19 illness even when the SARS-CoV-2 viral load is high. Through the lessons learned from COVID-19, we make the case that in the disease's aftermath, public health agencies must revisit healthcare policies, including redefining the term "vaccine effectiveness."
Collapse
Affiliation(s)
- Renuka Roche
- Occupational Therapy Program, School of Health Sciences, College of Health and Human Services, Eastern Michigan University, Ypsilanti, MI 48197, USA;
| | - Nouha H. Odeh
- Ph.D. Program in Immunology and Microbiology, Department of Biochemistry, Microbiology & Immunology, School of Medicine, Wayne State University, Detroit, MI 48201, USA;
| | - Abhay U. Andar
- Baltimore County, Translational Life Science Technology, University of Maryland, Rockville, MD 20850, USA;
| | - Mohan E. Tulapurkar
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Joseph A. Roche
- Physical Therapy Program, Department of Health Care Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA
| |
Collapse
|
4
|
Stone CA, Garvey LH, Nasser S, Lever C, Triggiani M, Parente R, Phillips EJ. Identifying and Managing Those at Risk for Vaccine-Related Allergy and Anaphylaxis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2008-2022. [PMID: 37182566 DOI: 10.1016/j.jaip.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/13/2023] [Accepted: 05/01/2023] [Indexed: 05/16/2023]
Abstract
Immediate hypersensitivity reactions to vaccines, the most severe of which is anaphylaxis, are uncommon events occurring in fewer than 1 in a million doses administered. These reactions are infrequently immunoglobulin E-mediated. Because they are unlikely to recur, a reaction to a single dose of a vaccine is rarely a contraindication to redosing. This narrative review article contextualizes the recent knowledge we have gained from the coronavirus 2019 (COVID-19) pandemic rollout of the new mRNA platform with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines within the much broader context of what is known about immediate reactions to other vaccinations of routine and global importance. We focus on what is known about evidence-based approaches to diagnosis and management and what is new in our understanding of mechanisms of immediate vaccine reactions. Specifically, we review the epidemiology of immediate hypersensitivity vaccine reactions, differential diagnosis for immune-mediated and nonimmune reaction clinical phenotypes, including how to recognize immunization stress-related responses. In addition, we highlight what is known about mechanisms and review the rare but important contribution of excipient allergies and specifically when to consider testing for them as well as other key features that contribute to safe evaluation and management.
Collapse
Affiliation(s)
- Cosby A Stone
- Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Lene H Garvey
- Allergy Clinic, Department of Dermatology and Allergy, Copenhagen University Hospital-Herlev and Gentofte, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Shuaib Nasser
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Charley Lever
- Department of Allergy, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Massimo Triggiani
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Roberta Parente
- Division of Allergy and Clinical Immunology, University of Salerno, Salerno, Italy
| | - Elizabeth J Phillips
- Department of Dermatology, Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tenn; Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tenn; Institute for Immunology & Infectious Diseases, Murdoch University, Murdoch, Perth, Western Australia.
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Khalid MB, Frischmeyer-Guerrerio PA. The conundrum of COVID-19 mRNA vaccine-induced anaphylaxis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:1-13. [PMID: 36532656 PMCID: PMC9746073 DOI: 10.1016/j.jacig.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/19/2022] [Accepted: 10/26/2022] [Indexed: 12/14/2022]
Abstract
Novel messenger RNA (mRNA) vaccines have proven to be effective tools against coronavirus disease 2019, and they have changed the course of the pandemic. However, early reports of mRNA vaccine-induced anaphylaxis resulted in public alarm, contributing toward vaccine hesitancy. Although initial reports were concerning for an unusually high rate of anaphylaxis to the mRNA vaccines, the true incidence is likely comparable with other vaccines. These reactions occurred predominantly in young to middle-aged females, and many had a history of allergies. Although initially thought to be triggered by polyethylene glycol (PEG), lack of reproducibility of these reactions with subsequent dosing and absent PEG sensitization point away from an IgE-mediated PEG allergy in most. PEG skin testing has poor posttest probability and should be reserved for evaluating non-vaccine-related PEG allergy without influencing decisions for subsequent mRNA vaccination. Immunization stress-related response can closely mimic vaccine-induced anaphylaxis and warrants consideration as a potential etiology. Current evidence suggests that many individuals who developed anaphylaxis to the first dose of an mRNA vaccine can likely receive a subsequent dose after careful evaluation. The need to understand these reactions mechanistically remains critical because the mRNA platform is rapidly finding its way into other vaccinations and therapeutics.
Collapse
Key Words
- AE, Adverse event
- BAT, Basophil activation test
- CARPA, Complement activation–related pseudoallergy
- COVID-19
- COVID-19, Coronavirus disease 2019
- ISRR
- ISRR, Immunization stress–related response
- LNP, Lipid nanoparticle
- PAF, Platelet-activating factor
- PEG
- PEG, Polyethylene glycol
- SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2
- VAERS, Vaccine adverse event reporting system
- allergic reaction
- allergy
- anaphylaxis
- immunization stress–related response
- mRNA
- mRNA, Messenger RNA
- polyethylene glycol
- vaccine
Collapse
Affiliation(s)
| | - Pamela A. Frischmeyer-Guerrerio
- Corresponding author: Pamela A. Frischmeyer-Guerrerio, MD, PhD, Laboratory of Allergic Diseases, Food Allergy Research Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, MSC 1881, 10 Center Dr, Bethesda, MD 20892
| |
Collapse
|
8
|
Podevin P, Vanlerberghe J, Templier C, Lannoy D, Azib S, Staumont-Sallé D, Mortier L, Dezoteux F. Anaphylactic reaction to checkpoint inhibitors with confirmed hypersensitivity to polysorbate 80. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:655-657. [PMID: 36572183 DOI: 10.1016/j.jaip.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 12/01/2022] [Accepted: 12/08/2022] [Indexed: 12/25/2022]
Affiliation(s)
| | | | | | - Damien Lannoy
- CHU Lille, Univ. Lille, Institut de Pharmacie, ULR7365 GRITA Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Selma Azib
- CHU Lille, Service de Dermatologie, Lille, France
| | - Delphine Staumont-Sallé
- CHU Lille, Univ. Lille, Service de Dermatologie, U1286 Inserm INFINITE Institute for Translational Research in Inflammation, Lille, France
| | - Laurent Mortier
- CHU Lille, CARADERM and University of Lille, Service de Dermatologie, U1189 Inserm, Lille, France
| | - Frédéric Dezoteux
- CHU Lille, Univ. Lille, Service de Dermatologie, U1286 Inserm INFINITE Institute for Translational Research in Inflammation, Lille, France
| |
Collapse
|
9
|
Mortz CG, Kjaer HF, Georgsen TK, Rasmussen TH, Rasmussen HM, Broesby‐Olsen S, Bindslev‐Jensen C. Fractionated vaccination with mRNA COVID-19 vaccine is safe for patients with polyethylene glycol allergy. Clin Transl Allergy 2023; 13:e12217. [PMID: 36705506 PMCID: PMC9860462 DOI: 10.1002/clt2.12217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Charlotte G. Mortz
- Department of Dermatology and Allergy CentreOdense Research Centre for Anaphylaxis (ORCA)Odense University HospitalUniversity of Southern DenmarkOdenseDenmark
| | - Henrik F. Kjaer
- Department of Dermatology and Allergy CentreOdense Research Centre for Anaphylaxis (ORCA)Odense University HospitalUniversity of Southern DenmarkOdenseDenmark
| | - Torbjørn Kabel Georgsen
- Department of Dermatology and Allergy CentreOdense Research Centre for Anaphylaxis (ORCA)Odense University HospitalUniversity of Southern DenmarkOdenseDenmark
| | - Trine H. Rasmussen
- Department of Dermatology and Allergy CentreOdense Research Centre for Anaphylaxis (ORCA)Odense University HospitalUniversity of Southern DenmarkOdenseDenmark
| | - Helene M. Rasmussen
- Department of Dermatology and Allergy CentreOdense Research Centre for Anaphylaxis (ORCA)Odense University HospitalUniversity of Southern DenmarkOdenseDenmark
| | - Sigurd Broesby‐Olsen
- Department of Dermatology and Allergy CentreOdense Research Centre for Anaphylaxis (ORCA)Odense University HospitalUniversity of Southern DenmarkOdenseDenmark
| | - Carsten Bindslev‐Jensen
- Department of Dermatology and Allergy CentreOdense Research Centre for Anaphylaxis (ORCA)Odense University HospitalUniversity of Southern DenmarkOdenseDenmark
| |
Collapse
|
10
|
AlOtaibi I, Almuhizi F, Ton-Leclerc S, Fein M, Tsoukas C, Garvey LH, Lee D, Ben-Shoshan M, Isabwe GAC, Copaescu AM. Anaphylaxis induced by mRNA COVID-19 vaccines: follow-up and booster dose after previous desensitization. FRONTIERS IN ALLERGY 2023; 4:1056619. [PMID: 37207267 PMCID: PMC10189778 DOI: 10.3389/falgy.2023.1056619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 04/12/2023] [Indexed: 05/21/2023] Open
Affiliation(s)
- Ibtihal AlOtaibi
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre (MUHC), McGill University, Montreal, QC, Canada
- Division of Allergy and Clinical Immunology Department of Paediatrics, Central Second Health Cluster, Ministry of Health, Riyadh, Saudi Arabia
| | - Faisal Almuhizi
- 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 (MUHC), McGill University, Montreal, QC, Canada
| | - Christos Tsoukas
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre (MUHC), McGill University, Montreal, QC, Canada
- The Research Institute of the McGill University Health Centre, McGill University, McGill University Health Centre (MUHC), 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, McGill University Health Centre (MUHC), Montreal, QC, Canada
- Division of Allergy, Immunology and Dermatology, Montreal Children’s Hospital, McGill University Health Centre (MUHC), McGill University, Montreal, QC, Canada
| | - Ghislaine A. C. Isabwe
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre (MUHC), McGill University, Montreal, QC, Canada
| | - Ana M. Copaescu
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre (MUHC), McGill University, Montreal, QC, Canada
- The Research Institute of the McGill University Health Centre, McGill University, McGill University Health Centre (MUHC), Montreal, QC, Canada
- Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, VIC, Australia
- Correspondence: Ana M. Copaescu
| |
Collapse
|
11
|
Yang BC, Castells MC. Utilizing Biologics in Drug Desensitization. Curr Allergy Asthma Rep 2023; 23:1-11. [PMID: 36445652 PMCID: PMC9707161 DOI: 10.1007/s11882-022-01052-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE OF REVIEW The purpose of this literature review was to review the latest advancements with biologics in rapid drug desensitization. Our methodology was to highlight both desensitization to biologics themselves and the use of biologics in desensitization to both biologic and nonbiologic drugs. RECENT FINDINGS Biologics are a vast category of drugs that include monoclonal antibodies, nanobodies, modern vaccinations, and even hormones. Desensitization to biologics can be safely performed through standardized procedure. Biomarkers are used both in vitro and in vivo to help identify and classify hypersensitivity reactions. Hypersensitivity reactions to the mRNA vaccinations against SARS-CoV-2 present their own unique challenges to management. There are specific excipients in monoclonal antibodies that are thought to be responsible for many of their hypersensitivity reactions. Certain biologics can even be used to assist in desensitization to other drugs. Rapid drug desensitization is a standardized procedure that may be able to help many patients who have experienced hypersensitivity reactions to biologics and would best be treated with them to continue to receive them. Biologic drugs have opened a new era in medicine for the prevention and treatment of infectious diseases, cancer, and inflammatory diseases. Hypersensitivity reactions to biologics are quite common. This literature review presents the latest advancements in our understanding of hypersensitivity reactions to biologics, how rapid drug desensitization can be used to continue therapy despite history of hypersensitivity, and how biologics themselves can be used to aid in desensitization itself.
Collapse
Affiliation(s)
- Barbara C Yang
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Hale Building for Transformative Medicine, 60 Fenwood Road, Room 5002-B, Boston, MA, 02115, USA.
- Ribon Therapeutics, 35 Cambridgepark Drive Suite 300, Cambridge, MA, 02140, USA.
| | - Mariana C Castells
- Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Hale Building for Transformative Medicine, 60 Fenwood Road, Room 5002-B, Boston, MA, 02115, USA
| |
Collapse
|
12
|
Nicaise-Roland P, Granger V, Soria A, Barbaud A, Pallardy M, Chollet-Martin S, de Chaisemartin L. Immediate hypersensitivity to COVID-19 vaccines: Focus on biological diagnosis. FRONTIERS IN ALLERGY 2022; 3:1007602. [PMID: 36249342 PMCID: PMC9561365 DOI: 10.3389/falgy.2022.1007602] [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: 07/30/2022] [Accepted: 09/15/2022] [Indexed: 11/18/2022] Open
Abstract
Soon after the release of the new anti-COVID mRNA vaccines, reports came in from the US and the UK of anaphylactic reactions. Fueled by the necessary caution toward these new vaccine platforms, these reports had a great impact and were largely commented upon in the scientific literature and global media. The current estimated frequency is of 5 cases per million doses. Very little biological data are presented in the literature to support the anaphylaxis diagnosis in these patients in addition to skin tests. Allergic reactions to vaccines are rare and mostly due to vaccine excipient. Therefore, the poly-ethylene-glycol (PEG) present in both mRNA formulation, and already known to be immunogenic, was soon suspected to be the potential culprit. Several hypersensitivity mechanisms to PEG or to other vaccine components can be suspected, even if the classical IgE-dependent anaphylaxis seems to be one of the most plausible candidates. In the early 2022, the international guidelines recommended to perform skin prick tests and basophil activation tests (BAT) in people experiencing allergic reaction to the first dose of COVID-19 vaccine or with a history of PEG allergy. The aim of this review is to discuss the main potential mechanisms of immediate allergy to COVID19 vaccines based on published data, together with the various techniques used to confirm or not sensitization to one component.
Collapse
Affiliation(s)
- Pascale Nicaise-Roland
- Service d’Immunologie Biologique, Hôpital Bichat, DMU BIOGÉM, APHP, Paris, France
- Université Paris Cité, Inserm PHERE, Paris, France
| | - Vanessa Granger
- Service d’Immunologie Biologique, Hôpital Bichat, DMU BIOGÉM, APHP, Paris, France
- Université Paris-Saclay, Inserm, Inflammation Microbiome Immunosurveillance, Orsay, France
| | - Angèle Soria
- Département de Dermatologie et Allergologie, Sorbonne Université, Hôpital Tenon, Paris, France
- Centre D'immunologie et des Maladies Infectieuses - Paris (Cimi-Paris), INSERM, Paris, France
| | - Annick Barbaud
- Département de Dermatologie et Allergologie, Sorbonne Université, INSERM, Institut Pierre Louis D'Epidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Tenon, Paris, France
| | - Marc Pallardy
- Université Paris-Saclay, Inserm, Inflammation Microbiome Immunosurveillance, Orsay, France
| | - Sylvie Chollet-Martin
- Service d’Immunologie Biologique, Hôpital Bichat, DMU BIOGÉM, APHP, Paris, France
- Université Paris-Saclay, Inserm, Inflammation Microbiome Immunosurveillance, Orsay, France
- Correspondence: Sylvie Chollet-Martin
| | - Luc de Chaisemartin
- Service d’Immunologie Biologique, Hôpital Bichat, DMU BIOGÉM, APHP, Paris, France
- Université Paris-Saclay, Inserm, Inflammation Microbiome Immunosurveillance, Orsay, France
| |
Collapse
|
13
|
Esmaeilzadeh A, Maleki AJ, Moradi A, Siahmansouri A, Yavari MJ, Karami P, Elahi R. Major severe acute respiratory coronavirus-2 (SARS-CoV-2) vaccine-associated adverse effects; benefits outweigh the risks. Expert Rev Vaccines 2022; 21:1377-1394. [DOI: 10.1080/14760584.2022.2116008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Abdolreza Esmaeilzadeh
- Department of Immunology, Zanjan University of Medical Sciences, Zanjan, Iran
- Cancer Gene Therapy Research Center (CGRC), Zanjan University of Medical Sciences, Zanjan, Iran
| | - Armin Jahani Maleki
- M.D., School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Amirhosein Moradi
- M.D., School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Amir Siahmansouri
- M.D., School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | - Parsa Karami
- M.D., School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Reza Elahi
- M.D., School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| |
Collapse
|
14
|
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.
Collapse
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.
| |
Collapse
|
15
|
Tolerance of the mRNA COVID-19 vaccines in patients with reported taxane reactions. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:2169-2171.e2. [PMID: 35690371 PMCID: PMC9181631 DOI: 10.1016/j.jaip.2022.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/06/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022]
|
16
|
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.
Collapse
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
| |
Collapse
|
17
|
Copaescu AM, Rosa Duque JS, Phillips EJ. What have we learned about the allergenicity and adverse reactions associated with the severe acute respiratory syndrome coronavirus 2 vaccines: One year later. Ann Allergy Asthma Immunol 2022; 129:40-51. [PMID: 35390476 PMCID: PMC8979618 DOI: 10.1016/j.anai.2022.03.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to the most rapid response and scale-up in vaccine and therapeutic development in history. We highlight the history of these amazing achievements with a focus on the description of the classification and mechanisms of allergic reactions and adverse events relevant to the allergist and immunologist that have been associated with the SARS-CoV-2 vaccines. Finally, we offer a detailed management approach in the context of a possible allergic reaction. DATA SOURCES Using defined search strategy, we identified peer-reviewed articles within PubMed that were published between January 1, 2019, and December 4, 2021. STUDY SELECTIONS All recent articles on COVID-19 published in English were reviewed with focus on the immunogenicity and allergenicity of the current existing COVID-19 vaccines. RESULTS Following a detailed literature review, we discuss the evolution and development of the new vaccines for SARS-CoV-2. Furthermore, we provide evidence regarding the significance and mechanisms of allergic reactions associated with the vaccines and offer a management approach for those with an increased risk of presenting an allergic or other relevant vaccine reaction. CONCLUSION The international rollout of COVID-19 vaccination started with reports of immediate allergic reactions. Although we still need to understand the mechanisms of these reactions, we can be reassured that patients with underlying allergic disease will not need to avoid SARS-CoV-2 vaccination. In addition, the vast majority of those with a first-dose reaction will tolerate subsequent doses.
Collapse
Affiliation(s)
- Ana M Copaescu
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Jaime S Rosa Duque
- Li Ka Shing Faculty of Medicine, Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Elizabeth Jane Phillips
- Center for Drug Safety and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee; Institute for Immunology & Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia.
| |
Collapse
|
18
|
Escudero C, Prieto-Montaño P, Audicana MT. Adverse Reactions to Anti-Infective Vaccines: an Emerging Problem in the COVID-19 Era. CURRENT TREATMENT OPTIONS IN ALLERGY 2022; 9:250-272. [PMID: 35789930 PMCID: PMC9244417 DOI: 10.1007/s40521-022-00311-8] [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: 06/13/2022] [Indexed: 11/23/2022]
Abstract
Purpose of review Vaccines are an essential tool for preventing infectious diseases and reducing associated morbidity and mortality. Vaccination has a significant impact at both individual and community levels, and COVID‐19 vaccination programs are a new example of the great value of this public health strategy. However, adverse reactions, especially severe reactions such as anaphylaxis, prevent these programs from progressing properly, thus limiting vaccination uptake in the population. Recent findings The frequency of reactions and types of vaccine components, with special attention to COVID-19 vaccines studies, provides information on the magnitude and causes of adverse events. The understanding of mechanisms involved has made it possible to adequately guide diagnosis, especially to COVID-19 vaccine components, such as polyethylene glycol, trometamol, and polysorbate-80. Summary This review focuses on adverse reactions to vaccines, with emphasis on allergic reactions. A diagnostic pathway is suggested that, on the one hand, enables to take the necessary precautions in persons with a history of allergy to vaccine components or allergic reactions to vaccines and, on the other, supports administration of subsequent doses. The overall objective is to ensure that people with allergy can be vaccinated in the same way as the rest of the population, and that they are offered alternatives where necessary.
Collapse
|
19
|
ALMuhizi F, Fein M, Gabrielli S, Gilbert L, Tsoukas C, Ben-Shoshan M, Copaescu AM, Isabwe GAC. Allergic Reactions to the COVID-19 vaccine (ARCOV) study: the McGill University Health Center (MUHC) experience. Ann Allergy Asthma Immunol 2022; 129:182-188.e1. [PMID: 35609744 PMCID: PMC9124043 DOI: 10.1016/j.anai.2022.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/06/2022] [Accepted: 05/16/2022] [Indexed: 12/01/2022]
Abstract
Background Messenger RNA coronavirus disease 2019 (COVID-19) vaccines have been associated with allergic reactions. A history of anaphylaxis has been suggested as a risk factor for such reactions. Polyethylene glycol (PEG) has been proposed as a possible culprit allergen. Objective To investigate possible PEG or polysorbate allergy among patients reporting prior reactions to COVID-19 vaccines or PEG and to report their subsequent tolerance of COVID-19 vaccines. Methods From January 1, 2021, to October 31, 2021, adult patients referred to the McGill University Health Centre allergy clinics who were considered at risk of anaphylaxis were prospectively recruited. The entry criteria were any documented history of reaction to a COVID-19 vaccine or reported allergy to PEG or polysorbate. Evaluated patients underwent skin prick testing (SPT) with PEG and polysorbate. After SPT, placebo-controlled vaccine challenges were carried out. Results Of the 44 patients recruited, 40 (90.1%) had reacted to the first vaccine dose, with 18 (45%) of them had anaphylactic reaction. All patients underwent SPT and 5 (11.3%) had a positive test result. A total of 39 patients (88.6%) underwent COVID-19 vaccine challenge at the allergy clinic. Most tolerated the vaccine, with 18 (40.1%) received a single full dose, 20 (45.4%) 2 split doses, and 6 (13.6%) a graded dosing protocol. Of the 40 patients who reacted to the first dose, 2 had immediate nonsevere allergic reactions to the second dose. Conclusion In this cohort of patients with a history of anaphylaxis and increased risk of allergic reactions to the COVID-19 vaccines, after allergist evaluation, including negative PEG skin testing result, the vaccine was safely administered without any serious adverse events.
Collapse
Affiliation(s)
- Faisal ALMuhizi
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre (MUHC), McGill University, Montreal, Quebec, Canada; Division of Allergy and Clinical Immunology, 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 (MUHC), McGill University, Montreal, Quebec, Canada; The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Sofianne Gabrielli
- Division of Pediatric Allergy and Clinical Immunology, Department of Medicine, Montréal General Hospital McGill University Health Centre, Montreal, Quebec, Canada
| | - Louise Gilbert
- The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Christos Tsoukas
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre (MUHC), McGill University, Montreal, Quebec, Canada; The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Moshe Ben-Shoshan
- The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Division of Pediatric Allergy and Clinical Immunology, Department of Medicine, Montréal General Hospital McGill University Health Centre, Montreal, Quebec, Canada
| | - Ana M Copaescu
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre (MUHC), McGill University, Montreal, Quebec, Canada; The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Centre for Antibiotic Allergy and Research, Department of Infectious Diseases, Austin Health, Heidelberg, Victoria, Australia
| | - Ghislaine A C Isabwe
- Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre (MUHC), McGill University, Montreal, Quebec, Canada; The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada.
| |
Collapse
|