Department of Pediatric Allergy and Immunology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Department of Pediatric Hematology and Oncology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey.
Allergol Immunopathol (Madr). 2023 May 1;51(3):174-180. doi: 10.15586/aei.v51i3.800. eCollection 2023.
mRNA vaccines, particularly, have been associated with an increased risk of allergic reactions and rarely anaphylaxis. Although rare, vaccine reactions can cause significant anxiety and fear in the population, leading to indecision and vaccine refusal. This study aimed to retrospectively evaluate the role of polyethylene glycol (PEG) sensitivity in vaccination decision-making in pediatric patients at high risk of allergy or with suspected allergic reactions to the first dose of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) vaccine. Seventeen enrolled patients were found to have decreased readiness to receive the Coronavirus Disease 2019 (COVID-19) vaccine after developing hypersensitivity to multiple and/or injectable drugs. Skin testing was performed. A basophil activation test with PEG-2000 and 4000 was performed on three patients who were ineligible for skin prick tests. Nine patients with negative tests received the vaccine without complications. One patient had urticarial angioedema despite negative tests. Three patients with positive tests did not agree to desensitization with the mRNA vaccine, and one of them was vaccinated with the inactivated COVID-19 vaccine. Four patients recurred despite negative tests. The general recommendation for patients describing severe reactions to drugs, foods, and allergens, such as toxins that do not contain the adjuvants of the SARS-CoV-2 vaccines, is to be routinely vaccinated with safety precautions. Excipients such as PEG and polysorbate-80 used in COVID-19 vaccines could be potential allergens, but this hypothesis is unclear. The predictive values of these adjuvants for skin testing and in vitro testing are controversial. Further research is needed on the hypersensitivity reactions of adjuvants, the predictive values of skin tests, and etiopathogenesis.
mRNA 疫苗，特别是，与过敏反应风险增加有关，很少发生过敏反应。尽管罕见，但疫苗反应会在人群中引起明显的焦虑和恐惧，导致犹豫不决和拒绝接种疫苗。本研究旨在回顾性评估聚乙二醇（PEG）敏感性在高过敏风险或对首剂严重急性呼吸综合征冠状病毒 2（SARS-CoV2）疫苗有疑似过敏反应的儿科患者接种决策中的作用。研究发现，17 名入组患者在对多种和/或注射药物产生过敏后，对接种冠状病毒病 2019（COVID-19）疫苗的准备程度降低。进行了皮肤测试。对三名因无法进行皮肤点刺试验而不适合进行 PEG-2000 和 4000 嗜碱性粒细胞激活试验的患者进行了试验。9 名检测结果为阴性的患者接受了疫苗接种，没有出现并发症。一名患者尽管检测结果为阴性，但仍出现荨麻疹性血管性水肿。3 名检测结果为阳性的患者不同意用 mRNA 疫苗进行脱敏治疗，其中 1 名患者接种了灭活 COVID-19 疫苗。4 名患者尽管检测结果为阴性，但仍复发。对于描述对药物、食物和过敏原（如不含 SARS-CoV-2 疫苗佐剂的毒素）严重反应的患者，一般建议常规接种疫苗并采取安全预防措施。聚乙二醇和泊洛沙姆-80 等 COVID-19 疫苗中使用的赋形剂可能是潜在的过敏原，但这种假设尚不清楚。这些佐剂的皮肤试验和体外试验的预测值存在争议。需要进一步研究佐剂的过敏反应、皮肤试验的预测值和病因发病机制。
