Although allergic responses to the mRNA COVID-19 vaccines are rare, recent reports have suggested that a small number of individuals with allergy to polyethylene glycol (PEG), a component of the mRNA lipid nanoshell, may be at increased risk of anaphylaxis following vaccination. In this report, we describe a case of a patient who received an mRNA COVID-19 vaccine, experienced anaphylaxis, and was subsequently confirmed to have anti-PEG allergy by skin prick testing. The patient had previously noticed urticaria after handling PEG powder for their occupation and had a history of severe allergic response to multiple other allergens. Importantly, as many as 70% of people possess detectable levels of anti-PEG antibodies, indicating that the detection of such antibodies does not imply high risk for an anaphylactic response to vaccination. However, in people with pre-existing anti-PEG antibodies, the administration of PEGylated liposomes may induce higher levels of antibodies, which may cause accelerated clearance of other PEGylated therapeutics a patient may be receiving. It is important to improve awareness of PEG allergy among patients and clinicians.
Diabetic ketoacidosis in pregnancy (DKP) is a serious complication that poses several challenges with respect to diagnosis, management and prevention. This article covers the precipitating factors for DKP in pregnancy as well as diagnosis, management and prevention of the complication.
Learning objectivesTo manage the acute crisis of DKP. To increase awareness of DKP. To reduce the perinatal morbidity and mortality associated with DKP.
Ethical issuesDespite adequate knowledge and care of patients with diabetes, is DKA a major cause for concern? To increase awareness, and reduce the perinatal morbidity and mortality associated with DKP.
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