Experience with polyethylene glycol allergy-guided risk management for COVID-19 vaccine anaphylaxis.
COVID-19
allergy
allergy testing
hypersensitivity
polyethylene glycol
Journal
Allergy
ISSN: 1398-9995
Titre abrégé: Allergy
Pays: Denmark
ID NLM: 7804028
Informations de publication
Date de publication:
07 2022
07 2022
Historique:
revised:
10
11
2021
received:
06
09
2021
accepted:
11
11
2021
pubmed:
23
11
2021
medline:
2
7
2022
entrez:
22
11
2021
Statut:
ppublish
Résumé
Polyethylene glycol (PEG) may elicit anaphylaxis to COVID-19 mRNA vaccines, and guidance for patients at risk is needed. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 34806775
doi: 10.1111/all.15183
pmc: PMC9011687
doi:
Substances chimiques
COVID-19 Vaccines
0
Polyethylene Glycols
3WJQ0SDW1A
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2200-2210Informations de copyright
© 2021 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.
Références
Allergy. 2022 Jul;77(7):2200-2210
pubmed: 34806775
MMWR Morb Mortal Wkly Rep. 2021 Jan 15;70(2):46-51
pubmed: 33444297
J Allergy Clin Immunol. 2018 Feb;141(2):463-472
pubmed: 29413255
World Allergy Organ J. 2021 Feb;14(2):100517
pubmed: 33558825
Clin Transl Allergy. 2021 Jul;11(5):e12044
pubmed: 34331522
Allergy. 2022 Feb 2;:
pubmed: 35112371
JAMA. 2021 Apr 20;325(15):1562-1565
pubmed: 33683290
J Allergy Clin Immunol Pract. 2021 Apr;9(4):1765
pubmed: 33838847
J Allergy Clin Immunol Pract. 2021 Jun;9(6):2139-2144
pubmed: 33831618
JAMA. 2021 Mar 16;325(11):1101-1102
pubmed: 33576785
Clin Exp Allergy. 2021 Mar;51(3):463-470
pubmed: 33394522
J Allergy Clin Immunol Pract. 2019 May - Jun;7(5):1533-1540.e8
pubmed: 30557713
J Am Acad Dermatol. 2021 Jul;85(1):46-55
pubmed: 33838206
Pediatr Allergy Immunol. 2017 Nov;28(7):628-640
pubmed: 28779496
Allergo J Int. 2021;30(3):79-95
pubmed: 33898162
World Allergy Organ J. 2021 May;14(5):100541
pubmed: 33850601
Allergy. 2021 Jun;76(6):1617-1618
pubmed: 33320974
J Allergy Clin Immunol. 2012 Jul;130(1):155-61
pubmed: 22421265
Allergol Select. 2021 Jan 26;5:72-76
pubmed: 33521511
Contact Dermatitis. 2005 Nov;53(5):303-4
pubmed: 16283913
J Allergy Clin Immunol Pract. 2021 Feb;9(2):670-675
pubmed: 33011299
Clin Exp Allergy. 2021 Jun;51(6):861-863
pubmed: 33825239
A A Case Rep. 2015 Mar 1;4(5):61-4
pubmed: 25730412
JAMA Intern Med. 2021 Nov 1;181(11):1530-1533
pubmed: 34309623
MMW Fortschr Med. 2021 Jan;163(1):48-51
pubmed: 33464512
Allergol Immunopathol (Madr). 2008 Mar-Apr;36(2):110-2
pubmed: 18479663
J Allergy Clin Immunol Pract. 2021 Apr;9(4):1423-1437
pubmed: 33388478
J Allergy Clin Immunol. 2006 Feb;117(2):391-7
pubmed: 16461139
J Investig Allergol Clin Immunol. 2021 Apr 20;31(2):180-181
pubmed: 33648905
Br J Anaesth. 2021 Mar;126(3):e106-e108
pubmed: 33386124
J Clin Pharmacol. 2021 Jun;61(6):832-835
pubmed: 33543766
Clin Exp Allergy. 2016 Jul;46(7):907-22
pubmed: 27196817
J Allergy Clin Immunol Pract. 2021 Oct;9(10):3546-3567
pubmed: 34153517
J Allergy Clin Immunol. 2021 Jul;148(1):91-95
pubmed: 33991580
J Allergy Clin Immunol. 2022 Jan;149(1):168-175.e4
pubmed: 34052265