Administration of a Second Dose of the Moderna COVID-19 Vaccine After an Immediate Hypersensitivity Reaction With the First Dose: Two Case Reports

Mustafa, S. Shahzad; Ramsey, Allison; Staicu, Mary L.

doi:10.7326/l21-0104

Cited by 38 publications

(47 citation statements)

References 3 publications

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“…Table 2. Protocol for graded administration of second dose of CoronaVac 21,27 Step* Dose and Concentration 1 0.05 mL of 1:10 vaccine dilution** 2 0.05 mL of full-strength vaccine 3 0.1 mL of full-strength vaccine 4 0.15 mL of full-strength vaccine 5 0.2 mL of full-strength vaccine…”

Section: Resultsmentioning

confidence: 99%

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Immediate-Type Systemic Hypersensitivity Reactions After the Inactivated SARS-CoV-2 Vaccine in Healthcare Workers

Çerçi

Uçan

2021

Osmangazi̇ Journal of Medicine

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The vaccines developed for Coronavirus disease 2019 (COVID-19) not only brought hope to the struggle against the pandemic but also raised questions about hypersensitivity reactions that might occur. Although some studies regarding these concerns with mRNA COVID-19 vaccines have been published, these data on inactivated Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccine are not available. The objective of this study was to determine the safety of the inactivated SARS-CoV-2 vaccine manufactured by Sinovac by evaluating the reported systemic immediate hypersensitivity reactions (IHRs) after the administration of the vaccine to healthcare workers (HCWs). This was a retrospective analysis of inactivated SARS-CoV-2 vaccine recipients in all HCWs vaccinated at our center. Relevant data of all patients who received the vaccine were collected from the electronic medical records available at our center's database. A statistical analysis of subjects who reported acute adverse reactions was conducted. Of the 3354 HCWs vaccinated with the first dose (female 59.9%, pre-existing allergic disorder 2.4%), four acute adverse reactions (0.12%) met the definition of a systemic IHRs were reported, and only one was confirmed to be anaphylaxis. One out of these four cases received her second dose through graded administration. For the second dose, no systemic reaction was reported in our study population. Inactivated SARS-CoV-2 vaccine appears to be well tolerated in HCWs without any pre-existing allergic disorders.

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Section: Resultsmentioning

confidence: 99%

“…Our graded dosing protocol has been adapted from the practice parameter about adverse reactions to vaccines which was published in 2012 (21). In a recent report, a similar protocol was safely used on two patients who experienced an IHR with the first dose of the Moderna COVID-19 vaccine (27).…”

Section: Discussionmentioning

confidence: 99%

Immediate-Type Systemic Hypersensitivity Reactions After the Inactivated SARS-CoV-2 Vaccine in Healthcare Workers

Çerçi

Uçan

2021

Osmangazi̇ Journal of Medicine

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“…Ainsi, notre protocole d’induction de tolérance au vaccin COMIRNATY®, est une version inspirée à la fois du protocole de Kelso et al pour les vaccins classiques [5] , de celui de Mustapha pour le vaccin Moderna [6] et de celui d’Erdeljic Turk et al pour les vaccins à ARN [11] , adapté pour une dose vaccinale de 0,3 mL. Le Tableau 2 permet une comparaison de notre protocole à ceux de Kelso et al et Erdeljic Turk et al…”

Section: Discussionunclassified

“…En termes d’efficacité vaccinale, le fractionnement des doses a démontré, comme dans l’étude de Mustafa et al pour le vaccin Moderna [6] , une élévation des IgG anti-spike chez notre patient. À l’instar des administrations monodoses de vaccin, cette séroconversion présage d’une efficacité vaccinale, néanmoins sans certitude démontrable en l’état actuel des connaissances.…”

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Induction de tolérance au vaccin à ARN COMIRNATY chez un patient avec une hypersensibilité allergique sévère au PEG

Huynh

Janßen

Beaumier

2022

Revue Française d'Allergologie

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La campagne vaccinale contre la Covid-19 a été marquée par une grande appréhension vis-à-vis du risque allergique, en particulier vis-à-vis des excipients vaccinaux : polyéthylène glycol (PEG), polysorbate ou encore trométamol. Une allergie confirmée à ces derniers ou après la première dose de vaccin constitue une contre-indication vaccinale. Nous rapportons le cas d’un patient présentant une allergie avérée au PEG et une sensibilisation cutanée au vaccin COMIRNATY® (PEG dans sa composition). Il a pu bénéficier de ce vaccin dans le cadre d’un protocole d’induction de tolérance en 5 étapes. Conclusions : une prise en charge allergologique spécifique doit être proposée aux patients suspects d’hypersensibilité sévère au PEG ou à d’autres excipients vaccinaux. Nous proposons ici un protocole ayant permis, sur un cas d’allergie avérée au PEG, d’administrer le vaccin COMIRNATY® sans réaction secondaire.

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Risk of Second Allergic Reaction to SARS-CoV-2 Vaccines

et al. 2022

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IMPORTANCEVaccination against SARS-CoV-2 is a highly effective strategy to prevent infection and severe COVID-19 outcomes. The best strategy for a second dose of vaccine among persons who had an immediate allergic reaction to their first SARS CoV-2 vaccination is unclear.OBJECTIVE To assess the risk of severe immediate allergic reactions (eg, anaphylaxis) to a second dose of SARS-CoV-2 mRNA vaccine among persons with immediate allergic reactions to their first vaccine dose.DATA SOURCES MEDLINE, Embase, Web of Science, and the World Health Organization Global Coronavirus database were searched from inception through October 4, 2021.STUDY SELECTION Included studies addressed immediate allergic reactions of any severity to a second SARS-CoV-2 vaccine dose in persons with a known or suspected immediate allergic reaction (<4 hours after vaccination) after their first SARS-CoV-2 vaccine dose. Studies describing a second vaccine dose among persons reporting delayed reactions (>4 hours after vaccination) were excluded.DATA EXTRACTION AND SYNTHESIS Paired reviewers independently selected studies, extracted data, and assessed risk of bias. Random-effects models were used for meta-analysis. The GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach evaluated certainty of the evidence. MAIN OUTCOMES AND MEASURESRisk of severe immediate allergic reaction and repeated severe immediate allergic reactions with a second vaccine dose. Reaction severity was defined by the reporting investigator, using Brighton Collaboration Criteria, Ring and Messmer criteria, World Allergy Organization criteria, or National Institute of Allergy and Infectious Diseases criteria. RESULTS Among 22 studies of SARS-CoV-2 mRNA vaccines, 1366 individuals (87.8% women; mean age, 46.1 years) had immediate allergic reactions to their first vaccination. Analysis using the pooled random-effects model found that 6 patients developed severe immediate allergic reactions after their second vaccination (absolute risk, 0.16% [95% CI, 0.01%-2.94%]), 232 developed mild symptoms (13.65% [95% CI, 7.76%-22.9%]), and, conversely, 1360 tolerated the dose (99.84% [95% CI, 97.09%-99.99%]). Among 78 persons with severe immediate allergic reactions to their first SARS-CoV-2 mRNA vaccination, 4 people (4.94% [95% CI, 0.93%-22.28%]) had a second severe immediate reaction, and 15 had nonsevere symptoms (9.54% [95% CI, 2.18%-33.34%]). There were no deaths. Graded vaccine dosing, skin testing, and premedication as risk-stratification strategies did not alter the findings. Certainty of evidence was moderate for those with any allergic reaction to the first dose and low for those with severe allergic reactions to the first dose. CONCLUSIONS AND RELEVANCEIn this systematic review and meta-analysis of case studies and case reports, the risk of immediate allergic reactions and severe immediate reactions or anaphylaxis associated with a second dose of an SARS-CoV-2 mRNA vaccine was low among persons who experienced an immediate allergic reaction to their fir...

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Administration of a Second Dose of the Moderna COVID-19 Vaccine After an Immediate Hypersensitivity Reaction With the First Dose: Two Case Reports

Cited by 38 publications

References 3 publications

Immediate-Type Systemic Hypersensitivity Reactions After the Inactivated SARS-CoV-2 Vaccine in Healthcare Workers

Immediate-Type Systemic Hypersensitivity Reactions After the Inactivated SARS-CoV-2 Vaccine in Healthcare Workers

Induction de tolérance au vaccin à ARN COMIRNATY chez un patient avec une hypersensibilité allergique sévère au PEG

Risk of Second Allergic Reaction to SARS-CoV-2 Vaccines

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