Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Division of Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tenn.
J Allergy Clin Immunol. 2021 Jun;147(6):2075-2082.e2. doi: 10.1016/j.jaci.2021.04.002. Epub 2021 Apr 20.
Anaphylaxis to vaccines is historically a rare event. The coronavirus disease 2019 pandemic drove the need for rapid vaccine production applying a novel antigen delivery system: messenger RNA vaccines packaged in lipid nanoparticles. Unexpectedly, public vaccine administration led to a small number of severe allergic reactions, with resultant substantial public concern, especially within atopic individuals. We reviewed the constituents of the messenger RNA lipid nanoparticle vaccine and considered several contributors to these reactions: (1) contact system activation by nucleic acid, (2) complement recognition of the vaccine-activating allergic effector cells, (3) preexisting antibody recognition of polyethylene glycol, a lipid nanoparticle surface hydrophilic polymer, and (4) direct mast cell activation, coupled with potential genetic or environmental predispositions to hypersensitivity. Unfortunately, measurement of anti-polyethylene glycol antibodies in vitro is not clinically available, and the predictive value of skin testing to polyethylene glycol components as a coronavirus disease 2019 messenger RNA vaccine-specific anaphylaxis marker is unknown. Even less is known regarding the applicability of vaccine use for testing (in vitro/vivo) to ascertain pathogenesis or predict reactivity risk. Expedient and thorough research-based evaluation of patients who have suffered anaphylactic vaccine reactions and prospective clinical trials in putative at-risk individuals are needed to address these concerns during a public health crisis.
疫苗过敏反应在历史上是一种罕见的事件。2019 年冠状病毒病大流行促使人们需要快速生产疫苗，应用了一种新型抗原传递系统：包裹在脂质纳米颗粒中的信使 RNA 疫苗。出乎意料的是，公众疫苗接种导致了少数严重过敏反应，引起了公众的极大关注，特别是在特应性个体中。我们回顾了信使 RNA 脂质纳米颗粒疫苗的成分，并考虑了导致这些反应的几个因素：（1）核酸激活接触系统，（2）补体识别疫苗激活的过敏效应细胞，（3）预先存在的针对聚乙二醇（脂质纳米颗粒表面亲水聚合物）的抗体识别，以及（4）直接肥大细胞激活，同时伴有潜在的过敏易感性的遗传或环境倾向。不幸的是，体外测量抗聚乙二醇抗体目前在临床上不可用，皮试对聚乙二醇成分作为 2019 年冠状病毒病信使 RNA 疫苗特异性过敏反应标志物的预测价值尚不清楚。对于疫苗用于测试（体外/体内）以确定发病机制或预测反应性风险的适用性，了解得就更少了。在公共卫生危机期间，需要对遭受过敏反应性疫苗反应的患者进行快速和彻底的基于研究的评估，并对可能存在风险的个体进行前瞻性临床试验，以解决这些问题。
