Khokhar Dilawar, O'Shea Kelly M, Akin Cem, Baldwin James L, Benjamin Mariel R, Ravikumar Rajan, Hosler Mirie, McMorris Marc S, Sanders Georgiana M, Troost Jonathan P, Baptist Alan P, Oberdoerster Deborah T, Kovalszki Anna
Department of Internal Medicine, Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich.
Michigan Institute for Clinical and Health Research, Michigan Medicine, Ann Arbor, Mich.
J Allergy Clin Immunol Glob. 2022 Nov;1(4):209-216. doi: 10.1016/j.jacig.2022.05.012. Epub 2022 Aug 13.
Allergic reactions have been reported with mRNA vaccines for COVID-19 prevention. Patients perceived to be at higher risk for a reaction may be referred to an allergist, although evaluation strategies may differ between allergists.
Our aim was to determine outcomes of COVID-19 vaccinations in patients evaluated by an allergist using different approaches.
We conducted a retrospective case series evaluation of 98 patients seen at the University of Michigan Allergy Clinic for concerns regarding COVID-19 vaccination. Of these 98 patients, 34 underwent skin testing with polyethylene glycol (PEG) 2000 with or without PEG 3350/polysorbate 80 testing.
Of the 34 patients on whom skin testing was performed, 16 underwent testing before vaccination and 18 underwent testing after a reported vaccine-related event. One patient had a positive skin testing result in response to PEG 3350 following a vaccination reaction and natural infection and was advised against a second dose. One patient with a significant history concerning of anaphylaxis in response to PEG had positive results of testing to identify allergy to PEG 2000, PEG 3350, and polysorbate 80 and was advised against vaccination. Of the 98 patients, 63 (64%) tolerated COVID-19 vaccination without complication after evaluation by an allergist.
No significant differences were found between vaccination counseling with and without skin testing to excipients. Patients who presented before the first dose of vaccination were more likely to proceed with COVID-19 vaccination and tolerate vaccination without complication.
已有关于用于预防新冠病毒病的信使核糖核酸（mRNA）疫苗引发过敏反应的报道。被认为发生反应风险较高的患者可能会被转诊至过敏症专科医生处，不过不同过敏症专科医生的评估策略可能有所不同。
我们的目的是确定由过敏症专科医生采用不同方法评估的新冠病毒病疫苗接种患者的结局。
我们对在密歇根大学过敏症诊所就诊的98例担心新冠病毒病疫苗接种的患者进行了一项回顾性病例系列评估。在这98例患者中，34例接受了聚乙二醇（PEG）2000皮肤试验，部分还进行了PEG 3350/聚山梨酯80试验。
在接受皮肤试验的34例患者中，16例在接种疫苗前进行了试验，18例在报告了与疫苗相关的事件后进行了试验。1例患者在接种疫苗反应和自然感染后，对PEG 3350的皮肤试验结果呈阳性，被建议不要接种第二剂疫苗。1例有明确的对PEG过敏反应史的患者，对PEG 2000、PEG 3350和聚山梨酯80的过敏试验结果呈阳性，被建议不要接种疫苗。在这98例患者中，63例（64%）在经过敏症专科医生评估后耐受了新冠病毒病疫苗接种，未出现并发症。
对接种辅料进行皮肤试验与不进行皮肤试验的疫苗接种咨询之间未发现显著差异。在第一剂疫苗接种前就诊的患者更有可能继续接种新冠病毒病疫苗并耐受接种，且无并发症。
