Department of Clinical Immunology and Allergy, Auckland Hospital, Auckland, New Zealand.
Starship Blood and Cancer Centre, Starship Children's Hospital, Auckland, New Zealand.
Intern Med J. 2022 Oct;52(10):1818-1820. doi: 10.1111/imj.15821. Epub 2022 Oct 6.
Previous anaphylaxis or immediate allergic reaction to polyethylene glycol (PEG; also known as macrogol) is considered a contraindication to the BNT162b2 mRNA COVID-19 vaccine, which contains 50 ug of PEG at a molecular weight of 2000, and this component is thought to account for the higher rate of anaphylaxis seen with this vaccine (4.7 per million doses) than with other non-mRNA vaccines. However, there is evidence that both anaphylaxis to PEG and anaphylaxis to the Pfizer COVID-19 reaction may not be IgE-mediated, with patients with anaphylaxis to first dose of the Pfizer COVID-19 vaccine receiving their second dose of vaccine without no or milder reactions in a high-risk clinic setting. In New Zealand, non-PEG-containing COVID-19 vaccines were not available until late 2021. Therefore, we offered patients with known or suspected PEG anaphylaxis their first dose of Pfizer COVID-19 vaccine in a high-risk hospital clinic. Eleven patients with previous hypersensitivity to PEG (including eight with anaphylaxis) successfully received their first dose with mild or no reactions; all have now had their second doses in the community without significant reaction. Record review also showed that most patients with previous hypersensitivity reactions to pegylated asparaginase have also been successfully vaccinated. This demonstrates that previous PEG hypersensitivity, including anaphylaxis, does not exclude immunisation with the Pfizer COVID-19 vaccine.
先前对聚乙二醇(PEG;也称为聚乙二醇)的过敏反应或即刻过敏反应被认为是 BNT162b2 mRNA COVID-19 疫苗的禁忌症,该疫苗含有 50μg 的 PEG,分子量为 2000,该成分被认为是导致这种疫苗过敏反应率更高(每百万剂 4.7 例)的原因,而非 mRNA 疫苗。然而,有证据表明,对 PEG 的过敏反应和对辉瑞 COVID-19 反应的过敏反应可能不是 IgE 介导的,在高风险诊所环境中,对第一剂辉瑞 COVID-19 疫苗过敏的患者接受第二剂疫苗时,没有或仅有轻度反应。在新西兰,直到 2021 年末才提供不含 PEG 的 COVID-19 疫苗。因此,我们在高危医院诊所为已知或疑似对 PEG 过敏的患者提供第一剂辉瑞 COVID-19 疫苗。11 名先前对 PEG 过敏的患者(包括 8 名过敏反应患者)成功接受了第一剂疫苗,仅有轻度或无反应;所有患者现在都已在社区中接种了第二剂疫苗,没有明显反应。病历回顾还显示,大多数先前对聚乙二醇化天冬酰胺酶过敏反应的患者也已成功接种疫苗。这表明先前的 PEG 过敏反应,包括过敏反应,并不排除接种辉瑞 COVID-19 疫苗。
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