Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada; Division of Allergy and Clinical Immunology, Department of Internal Medicine, Security Forces Hospital Program, Riyadh, Saudi Arabia.
Division of Allergy and Clinical Immunology, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada; The Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada.
Ann Allergy Asthma Immunol. 2022 Aug;129(2):182-188.e1. doi: 10.1016/j.anai.2022.05.014. Epub 2022 May 21.
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.
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.
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.
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.
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.
信使 RNA 冠状病毒病 2019（COVID-19）疫苗与过敏反应有关。有人提出过敏反应史是此类反应的危险因素之一。聚乙二醇（PEG）已被提出作为一种可能的过敏原。
调查报告 COVID-19 疫苗或 PEG 过敏反应史的患者中是否存在 PEG 或聚山梨酯过敏，并报告其随后对 COVID-19 疫苗的耐受性。
从 2021 年 1 月 1 日至 2021 年 10 月 31 日，前瞻性招募了因过敏而被认为有发生过敏反应风险的成年患者。入选标准为任何有记录的 COVID-19 疫苗反应史或报告的 PEG 或聚山梨酯过敏史。评估患者接受 PEG 和聚山梨酯的皮肤点刺试验（SPT）。SPT 后，进行安慰剂对照疫苗挑战。
44 名入组患者中，40 名（90.1%）对第一剂疫苗有反应，其中 18 名（45%）发生过敏反应。所有患者均进行 SPT，其中 5 名（11.3%）检测结果阳性。39 名（88.6%）患者在过敏诊所接受 COVID-19 疫苗挑战。大多数患者耐受疫苗，其中 18 名（40.1%）接受单次全剂量，20 名（45.4%）接受 2 次分剂量，6 名（13.6%）接受分级剂量方案。在对第一剂疫苗有反应的 40 名患者中，有 2 名患者对第二剂疫苗出现立即非严重过敏反应。
在这群有过敏反应史和 COVID-19 疫苗过敏反应风险增加的患者中，在过敏科医生评估后，包括 PEG 皮肤测试结果阴性，安全接种疫苗，无严重不良事件。
