Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel.
Clinical Immunology, Angioedema and Allergy Unit, Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Allergy Clin Immunol Pract. 2022 Oct;10(10):2677-2684. doi: 10.1016/j.jaip.2022.08.010. Epub 2022 Aug 13.
Allergic reactions to the coronavirus disease 2019 (COVID-19) vaccines have raised concerns, particularly as repeated doses are required. Skin tests with the vaccines excipient were found to be of low value, whereas the utility of skin tests with the whole vaccine is yet to be determined.
To evaluate a panel of skin tests and the outcomes of subsequent doses of immunization among subjects who suffered an immediate allergic reaction to the BioNTech (BNT162b2) COVID-19 vaccine.
Between March and December 2021, patients who experienced symptoms consistent with immediate allergic reactions to the BNT162b2 vaccine and were referred to the Sheba Medical Center underwent skin testing with polyethylene glyol (PEG)-containing medicines, Pfizer-BNT162b2, and Oxford-AstraZeneca vaccine (AZD1222). Further immunization was performed accordingly and under medical observation.
A total of 51 patients underwent skin testing for suspected allergy to the COVID vaccines, of which 38 of 51 (74.5%) were nonreactive, 7 of 51(13.7%) had no skin sensitization but suffered a clinical reaction during skin testing (mainly cough), and 6 of 51 (11.7%) exhibited immediate skin sensitization. Both skin sensitization and cough during testing were related to a higher use of adrenaline following immunization (P = .08 and P = .024, respectively). Further immunization with the BNT162b2 vaccine was recommended unless sensitization or severe reaction to previous immunization was evident. The latter were referred to be tested/receive the alternative AZD1222 vaccine. Ten patients underwent skin testing with AZD1222: 2 of 10 (20%) demonstrated skin sensitization to both vaccines; thus, 8 of 10 were immunized with the AZD1222, of which 2 of 8 (25%) had allergic reactions.
Immediate allergic reactions to COVID-19 vaccines are rare but can be severe and reoccur. Intradermal testing with the whole vaccine may discriminate sensitized subjects, detect cross-sensitization between vaccines, and enable estimation of patients at higher risk.
人们对新冠病毒疾病 2019（COVID-19）疫苗的过敏反应感到担忧，尤其是因为需要多次接种。人们发现，使用疫苗赋形剂进行皮肤测试价值不高，而使用整个疫苗进行皮肤测试的效用尚待确定。
评估一组皮肤测试和随后免疫接种剂量在对 BioNTech（BNT162b2）COVID-19 疫苗发生即刻过敏反应的受试者中的结果。
2021 年 3 月至 12 月期间，Sheba 医疗中心对出现与 BNT162b2 疫苗即刻过敏反应一致症状并被转介至该中心的患者进行了含有聚乙二醇（PEG）的药物、辉瑞-BNT162b2 和牛津-阿斯利康疫苗（AZD1222）的皮肤测试。根据测试结果，相应地进行了进一步的免疫接种并在医疗观察下进行。
共有 51 名患者因疑似对 COVID 疫苗过敏而接受了皮肤测试，其中 51 名中的 38 名（74.5%）无反应，51 名中的 7 名（13.7%）无皮肤致敏，但在皮肤测试期间出现临床反应（主要为咳嗽），51 名中的 6 名（11.7%）表现出即刻皮肤致敏。皮肤致敏和测试期间的咳嗽均与免疫接种后肾上腺素的使用增加有关（分别为 P=0.08 和 P=0.024）。除非之前的免疫接种有明显的致敏或严重反应，否则建议进行 BNT162b2 疫苗的进一步免疫接种。对于后者，建议他们进行测试/接种替代的 AZD1222 疫苗。10 名患者接受了 AZD1222 皮肤测试：10 名中的 2 名（20%）对两种疫苗均有皮肤致敏；因此，8 名中的 8 名（100%）接种了 AZD1222，其中 2 名（25%）出现过敏反应。
对 COVID-19 疫苗的即刻过敏反应很少见，但可能很严重且会再次发生。使用整个疫苗进行皮内测试可能会区分致敏患者，检测疫苗之间的交叉致敏，并估计患者的风险更高。
