Management of suspected and confirmed COVID-19 (SARS-CoV-2) vaccine hypersensitivity.
SARS-CoV-2
anaphylaxis
hypersensitivity
polyethylene glycol
vaccination
Journal
Allergy
ISSN: 1398-9995
Titre abrégé: Allergy
Pays: Denmark
ID NLM: 7804028
Informations de publication
Date de publication:
11 2022
11 2022
Historique:
revised:
28
04
2022
received:
16
03
2022
accepted:
03
05
2022
pubmed:
21
6
2022
medline:
1
11
2022
entrez:
20
6
2022
Statut:
ppublish
Résumé
Systemic allergic reactions to vaccines are very rare. In this study we assessed the management and outcome of suspected SARS-CoV-2 vaccine hypersensitivity. Totally, 334 individuals underwent an allergy work up regarding SARS-CoV-2 vaccination (group A: 115 individuals suspected to be at increased risk for vaccine-related reactions before vaccination and group B: 219 patients with reactions after COVID vaccination). The large majority of the SPT/IDT with the vaccines were negative; however, we identified in 14.1% (n = 47) a possible sensitization to the SARS-CoV-2 vaccine and/or its ingredients defined as one positive skin test. Of the 219 individuals (group B) who experienced symptoms suspicious for a hypersensitivity reaction after vaccination, 214 were reported after the first vaccination with a mRNA vaccine (157 mRNA (Comirnaty®, 38 Spikevax®) and 18 with a vector vaccine (Vaxzevria®), 5 cases were after the second vaccination. The symptom profile in group B was as follows: skin symptoms occurred in 115 cases (n = 59 angioedema, n = 50 generalized urticaria and n = 23 erythema/flush. Seventy individuals had cardiovascular, 53 respiratory and 17 gastrointestinal symptoms. Of the overall 334 individuals, 78 patients tolerated (re)-vaccination (out of skin test positive/negative 7/19 from group A and 17/35 from group B). Proven IgE-mediated hypersensitivity to SARS-CoV-2 vaccines is extremely rare and not increased in comparison with reported hypersensitivity to other vaccines. The value of skin tests is unclear and nonspecific reactions, in particular when intradermal testing is applied, should be considered.
Sections du résumé
BACKGROUND
Systemic allergic reactions to vaccines are very rare. In this study we assessed the management and outcome of suspected SARS-CoV-2 vaccine hypersensitivity.
METHODS
Totally, 334 individuals underwent an allergy work up regarding SARS-CoV-2 vaccination (group A: 115 individuals suspected to be at increased risk for vaccine-related reactions before vaccination and group B: 219 patients with reactions after COVID vaccination). The large majority of the SPT/IDT with the vaccines were negative; however, we identified in 14.1% (n = 47) a possible sensitization to the SARS-CoV-2 vaccine and/or its ingredients defined as one positive skin test. Of the 219 individuals (group B) who experienced symptoms suspicious for a hypersensitivity reaction after vaccination, 214 were reported after the first vaccination with a mRNA vaccine (157 mRNA (Comirnaty®, 38 Spikevax®) and 18 with a vector vaccine (Vaxzevria®), 5 cases were after the second vaccination.
RESULTS
The symptom profile in group B was as follows: skin symptoms occurred in 115 cases (n = 59 angioedema, n = 50 generalized urticaria and n = 23 erythema/flush. Seventy individuals had cardiovascular, 53 respiratory and 17 gastrointestinal symptoms. Of the overall 334 individuals, 78 patients tolerated (re)-vaccination (out of skin test positive/negative 7/19 from group A and 17/35 from group B).
CONCLUSION
Proven IgE-mediated hypersensitivity to SARS-CoV-2 vaccines is extremely rare and not increased in comparison with reported hypersensitivity to other vaccines. The value of skin tests is unclear and nonspecific reactions, in particular when intradermal testing is applied, should be considered.
Identifiants
pubmed: 35722723
doi: 10.1111/all.15414
pmc: PMC9350006
doi:
Substances chimiques
COVID-19 Vaccines
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
3426-3434Informations de copyright
© 2022 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.
Références
Worm M, Ring J, Klimek L, et al. Covid-19 vaccination and risk of anaphylaxis - recommendations for practical management. MMW Fortschr Med. 2021;163(1):48-51.
Garvey LH, Nasser S. Anaphylaxis to the first COVID-19 vaccine: is polyethylene glycol (PEG) the culprit? Br J Anaesth. 2021;126(3):e106-e108.
Kraft M, Renaudin JM, Ensina LF, et al. Anaphylaxis to vaccination and polyethylene glycol: a perspective from the European anaphylaxis registry. J Eur Acad Dermatol Venereol. 2021;35:e659-e662.
Dreskin SC, Halsey NA, Kelso JM, et al. International consensus (ICON): allergic reactions to vaccines. World Allergy Organ J. 2016;9(1):32.
Shimabukuro TT, Cole M, Su JR. Reports of anaphylaxis after receipt of mRNA COVID-19 vaccines in the US-December 14, 2020-January 18, 2021. JAMA. 2021;325(11):1101-1102.
Rasmussen TH, Mortz CG, Georgsen TK, Rasmussen HM, Kjaer HF, Bindslev-Jensen C. Patients with suspected allergic reactions to COVID-19 vaccines can be safely revaccinated after diagnostic work-up. Clin Transl Allergys. 2021;11(5):e12044.
Banerji A, Wickner PG, Saff R, et al. mRNA vaccines to prevent COVID-19 disease and reported allergic reactions: current evidence and suggested approach. J Allergy Clin Immunol Pract. 2021;9(4):1423-1437.
Heinzerling L, Mari A, Bergmann KC, et al. The skin prick test - European standards. Clin Transl Allergy. 2013;3(1):3.
Brockow K, Romano A, Blanca M, Ring J, Pichler W, Demoly P. General considerations for skin test procedures in the diagnosis of drug hypersensitivity. Allergy. 2002;57(1):45-51.
Barbaud A, Gonçalo M, Bruynzeel D, Bircher A, European Society of Contact Dermatitis. Guidelines for performing skin tests with drugs in the investigation of cutaneous adverse drug reactions. Contact Dermatitis. 2001;45(6):321-328.
Rüggeberg JU, Gold MS, Bayas JM, et al. Anaphylaxis: case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine. 2007;25(31):5675-5684.
Paul-Ehrlich-Institut, Bericht über Verdachtsfälle von Nebenwirkungen und Impfkomplikationen nach Impfung zum Schutz vor COVID-19 (Berichtszeitraum 27.12. bis 31.07.2021). 2021.
Lange L. Allergene in Impfstoffen. Allergologie. 2016;39(8):357-361.
Nilsson L, Brockow K, Alm J, et al. Vaccination and allergy: EAACI position paper, practical aspects. Pediatr Allergy Immunol. 2017;28(7):628-640.
Stone CA Jr, Rukasin CRF, Beachkofsky TM, Phillips EJ. Immune-mediated adverse reactions to vaccines. Br J Clin Pharmacol. 2019;85(12):2694-2706.
Sellaturay P, Nasser S, Islam S, Gurugama P, Ewan PW. Polyethylene glycol (PEG) is a cause of anaphylaxis to the Pfizer/BioNTech mRNA COVID-19 vaccine. Clin Exp Allergy. 2021;51(6):861-863.
Worm M, Hanschmann-Mohn T, Scherer Hofmeier K, Cardona V, Turner P, Dölle-Bierke S. Drug-induced anaphylaxis-Elicitors, mechanisms and diagnosis. Allergo J Int. 2019;28:327-329.
Krantz MS, Kwah JH, Stone CA Jr, et al. Safety evaluation of the second dose of messenger RNA COVID-19 vaccines in patients with immediate reactions to the first dose. JAMA Intern Med. 2021;181:1530.
Nittner-Marszalska M, Cichocka-Jarosz E. Insect sting allergy in adults: key messages for clinicians. Pol Arch Med Wewn. 2015;125(12):929-937.
Soost S, Leynaert B, Almqvist C, Edenharter G, Zuberbier T, Worm M. Risk factors of adverse reactions to food in German adults. Clin Exp Allergy. 2009;39(7):1036-1044.
Barbaud A, Garvey LH, Arcolaci A, et al. Allergies and COVID-19 vaccines: an ENDA/EAACI position paper. Allergy. 2022:1-22. doi: 10.1111/all.15241
Mortz CG, Kjaer HF, Rasmussen TH, Rasmussen HM, Garvey LH, Bindslev-Jensen C. Allergy to polyethylene glycol and polysorbates in a patient cohort: diagnostic work-up and decision points for vaccination during the COVID-19 pandemic. Clin Transl Allergy. 2022;12(1):e12111.
Bruusgaard-Mouritsen MA, Jensen BM, Poulsen LK, Duus Johansen J, Garvey LH. Optimizing investigation of suspected allergy to polyethylene glycols. J Allergy Clin Immunol. 2021;149(1):168-175.e4.