Harvard Medical School, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass.
Harvard Medical School, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass.
J Allergy Clin Immunol Pract. 2021 Sep;9(9):3308-3320.e3. doi: 10.1016/j.jaip.2021.06.010. Epub 2021 Jun 22.
The Centers for Disease Control and Prevention state that a severe or immediate allergic reaction to the first dose of an mRNA COVID-19 vaccine is a contraindication for the second dose.
To assess outcomes associated with excipient skin testing after a reported allergic reaction to the first dose of mRNA COVID-19 vaccine.
We identified a consecutive sample of patients with reported allergic reactions after the first dose of mRNA COVID-19 vaccine who underwent allergy assessment with skin testing to polyethylene glycol (PEG) and, when appropriate, polysorbate 80. Skin testing results in conjunction with clinical phenotyping of the first-dose mRNA COVID-19 vaccine reaction guided second-dose vaccination recommendation. Second-dose mRNA COVID-19 vaccine reactions were assessed.
Eighty patients with reported first-dose mRNA COVID-19 vaccine allergic reactions (n = 65; 81% immediate onset) underwent excipient skin testing. Of those, 14 (18%) had positive skin tests to PEG (n = 5) and/or polysorbate 80 (n = 12). Skin testing result did not affect tolerance of the second dose in patients with immediate or delayed reactions. Of the 70 patients who received the second mRNA COVID-19 vaccine dose (88%), 62 had either no reaction or a mild reaction managed with antihistamines (89%), but 2 patients required epinephrine treatment. Three patients with positive PEG-3350 intradermal (methylprednisolone) testing tolerated second-dose mRNA COVID-19 vaccination. Refresh Tears caused nonspecific skin irritation.
Most individuals with a reported allergic reaction to the first dose of mRNA COVID-19 vaccines, regardless of skin test result, received the second dose safely. More data are needed on the value of skin prick testing to PEG (MiraLAX) in evaluating patients with mRNA COVID-19 vaccine anaphylaxis. Refresh Tears should not be used for skin testing.
美国疾病控制与预防中心表示，对 mRNA COVID-19 疫苗第一针的严重或即刻过敏反应是第二针的禁忌症。
评估在报告对 mRNA COVID-19 疫苗第一针过敏反应后，进行辅料皮肤试验的结果。
我们确定了一个连续的样本，这些患者在接种 mRNA COVID-19 疫苗第一针后出现了报告的过敏反应，并进行了过敏评估，包括聚乙二醇（PEG）和（如有必要）聚山梨酯 80 的皮肤试验。皮肤试验结果结合第一针 mRNA COVID-19 疫苗反应的临床表型，指导第二针疫苗接种建议。评估第二针 mRNA COVID-19 疫苗的反应。
80 例报告对 mRNA COVID-19 疫苗第一针过敏的患者（n=65；81%为即刻发作）进行了辅料皮肤试验。其中，14 例（18%）对 PEG（n=5）和/或聚山梨酯 80（n=12）的皮肤试验呈阳性。即刻或迟发性反应患者的皮肤试验结果不影响对第二针的耐受性。在接受第二针 mRNA COVID-19 疫苗的 70 例患者中（88%），62 例无反应或用抗组胺药治疗轻度反应（89%），但 2 例需要肾上腺素治疗。3 例对 PEG-3350 皮内（甲泼尼龙）试验呈阳性的患者耐受了第二针 mRNA COVID-19 疫苗接种。Refresh Tears 引起非特异性皮肤刺激。
大多数报告对 mRNA COVID-19 疫苗第一针过敏的个体，无论皮肤试验结果如何，都安全地接种了第二针。需要更多的数据来评估 PEG（MiraLAX）皮肤点刺试验在评估 mRNA COVID-19 疫苗过敏反应中的价值。Refresh Tears 不应用于皮肤试验。
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