Adverse reactions to COVID‐19 vaccines: A practical approach

Rutkowski, Krzysztof; Mirakian, Rita; Till, Stephen J.; Rutkowski, Ryszard; Wagner, Annette

doi:10.1111/cea.13880

Cited by 38 publications

(50 citation statements)

References 30 publications

(57 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Consistent with previous studies, our review found that foods, drugs or therapeutic agents, contrast media, stinging insects or jellyfish, cosmetics, detergents, household products, and latex are the most common triggers of anaphylactic and nonanaphylactic reactions induced by mRNA COVID-19 vaccines [ 21 – 23 , 38 , 46 ]. Previous history of anaphylaxis; and comorbidities such as asthma, allergic rhinitis, atopic and contact eczema/dermatitis and psoriasis and cholinergic urticaria were also described by other investigators as elicitors for anaphylactic and nonanaphylactic reactions to mRNA COVID-19 vaccines [ 47 , 48 ].…”

Section: Discussionsupporting

confidence: 89%

Anaphylactic and nonanaphylactic reactions to SARS-CoV-2 vaccines: a systematic review and meta-analysis

Alhumaid

Mutair

Alawi

et al. 2021

Allergy Asthma Clin Immunol

View full text Add to dashboard Cite

Background Currently there is no systematic review and meta-analysis of the global incidence rates of anaphylactic and nonanaphylactic reactions to SARS-CoV-2 vaccines in the general adult population. Objectives To estimate the incidence rates of anaphylactic and nonanaphylactic reactions after COVID-19 vaccines and describe the demographic and clinical characteristics, triggers, presenting signs and symptoms, treatment and clinical course of confirmed cases. Design A systematic review and meta-analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] statement was followed. Methods Electronic databases (Proquest, Medline, Embase, Pubmed, CINAHL, Wiley online library, and Nature) were searched from 1 December 2020 to 31 May 2021 in the English language using the following keywords alone or in combination: anaphylaxis, non-anaphylaxis, anaphylactic reaction, nonanaphylactic reaction, anaphylactic/anaphylactoid shock, hypersensitivity, allergy reaction, allergic reaction, immunology reaction, immunologic reaction, angioedema, loss of consciousness, generalized erythema, urticaria, urticarial rash, cyanosis, grunting, stridor, tachypnoea, wheezing, tachycardia, abdominal pain, diarrhea, nausea, vomiting and tryptase. We included studies in adults of all ages in all healthcare settings. Effect sizes of prevalence were pooled with 95% confidence intervals (CIs). To minimize heterogeneity, we performed sub-group analyses. Results Of the 1,734 papers that were identified, 26 articles were included in the systematic review (8 case report, 5 cohort, 4 case series, 2 randomized controlled trial and 1 randomized cross-sectional studies) and 14 articles (1 cohort, 2 case series, 1 randomized controlled trial and 1 randomized cross-sectional studies) were included in meta-analysis. Studies involving 26,337,421 vaccine recipients [Pfizer-BioNTech (n = 14,505,399) and Moderna (n = 11,831,488)] were analyzed. The overall pooled prevalence estimate of anaphylaxis to both vaccines was 5.0 (95% CI 2.9 to 7.2, I2 = 81%, p = < 0.0001), while the overall pooled prevalence estimate of nonanaphylactic reactions to both vaccines was 53.9 (95% CI 0.0 to 116.1, I2 = 99%, p = < 0.0001). Vaccination with Pfizer-BioNTech resulted in higher anaphylactic reactions compared to Moderna (8.0, 95% CI 0.0 to 11.3, I2 = 85% versus 2.8, 95% CI 0.0 to 5.7, I2 = 59%). However, lower incidence of nonanaphylactic reactions was associated with Pfizer-BioNTech compared to Moderna (43.9, 95% CI 0.0 to 131.9, I2 = 99% versus 63.8, 95% CI 0.0 to 151.8, I2 = 98%). The funnel plots for possible publication bias for the pooled effect sizes to determine the incidence of anaphylaxis and nonanaphylactic reactions associated with mRNA COVID-19 immunization based on mRNA vaccine type appeared asymmetrical on visual inspection, and Egger’s tests confirmed asymmetry by producing p values < 0.05. Across the included studies, the most commonly identified risk factors for anaphylactic and nonanaphylactic reactions to SARS-CoV-2 vaccines were female sex and personal history of atopy. The key triggers to anaphylactic and nonanaphylactic reactions identified in these studies included foods, medications, stinging insects or jellyfish, contrast media, cosmetics and detergents, household products, and latex. Previous history of anaphylaxis; and comorbidities such as asthma, allergic rhinitis, atopic and contact eczema/dermatitis and psoriasis and cholinergic urticaria were also found to be important. Conclusion The prevalence of COVID-19 mRNA vaccine-associated anaphylaxis is very low; and nonanaphylactic reactions occur at higher rate, however, cutaneous reactions are largely self-limited. Both anaphylactic and nonanaphylactic reactions should not discourage vaccination.

show abstract

Section: Discussionsupporting

confidence: 89%

Anaphylactic and nonanaphylactic reactions to SARS-CoV-2 vaccines: a systematic review and meta-analysis

Alhumaid

Mutair

Alawi

et al. 2021

Allergy Asthma Clin Immunol

View full text Add to dashboard Cite

show abstract

“… 22 , 23 , 29 Additionally, PEG‐ASNase and BNT162b2 contain PEG of differing molecular weight; allergenicity correlates with molecular weight. 24 , 28 , 29 , 30 To the best of our knowledge, there have been no allergic reactions to BNT162b2 in patients with PEG‐ASNase allergy.…”

Section: Discussionmentioning

confidence: 92%

“…This is because some patients labeled as PEG‐ASNase allergic are sensitized to the asparaginase component and not the PEG‐moiety 22,23,29 . Additionally, PEG‐ASNase and BNT162b2 contain PEG of differing molecular weight; allergenicity correlates with molecular weight 24,28–30 . To the best of our knowledge, there have been no allergic reactions to BNT162b2 in patients with PEG‐ASNase allergy.…”

Section: Discussionmentioning

confidence: 97%

Safety of administration of BNT162b2 mRNA (Pfizer‐BioNTech) COVID‐19 vaccine in youths and young adults with a history of acute lymphoblastic leukemia and allergy to PEG‐asparaginase

Mark

Gupta

Punnett

et al. 2021

Pediatric Blood & Cancer

View full text Add to dashboard Cite

Vaccinationis a critical tool in the prevention of COVID‐19 infection for individuals and for communities. The mRNA vaccines contain polyethylene glycol (PEG) as a stabilizer. Currently, in North America, only the BNT162b2 (Pfizer‐BioNTech ) mRNA vaccine is approved for individuals aged 12–17. Most patients treated with contemporary regimens for acute lymphoblastic leukemia receive PEG‐asparaginase (PEG‐ASNase) and 10%–30% will develop allergic reactions. Optimizing access and safety for vaccine administration for these patients is critical. This report describes a process developed to support COVID vaccination in a cohort of adolescents and young adults with a history of PEG‐ASNase allergy.

show abstract

“…Notably, mRNA and viral vector vaccines activate different TLRs; therefore, immunological differences appear plausible [36,37]. Moreover, vaccines comprise various molecules that potentially act as haptens to elicit type IV allergic reactions [38]. At this point, it is not clear whether specific vaccine types impose a larger risk for severe cutaneous ADRs to specific groups of patients, e.g., psoriatic patients.…”

Section: Discussionmentioning

confidence: 99%

Cutaneous Adverse Reactions to COVID-19 Vaccines: Insights from an Immuno-Dermatological Perspective

et al. 2021

View full text Add to dashboard Cite

(1) Background: Numerous vaccines are under preclinical and clinical development for prevention of severe course and lethal outcome of coronavirus disease 2019 (COVID-19). In light of high efficacy rates and satisfactory safety profiles, some agents have already reached approval and are now distributed worldwide, with varying availability. Real-world data on cutaneous adverse drug reactions (ADRs) remain limited. (2) Methods: We performed a literature research concerning cutaneous ADRs to different COVID-19 vaccines, and incorporated our own experiences. (3) Results: Injection site reactions are the most frequent side effects arising from all vaccine types. Moreover, delayed cutaneous ADRs may occur after several days, either as a primary manifestation or as a flare of a pre-existing inflammatory dermatosis. Cutaneous ADRs may be divided according to their cytokine profile, based on the preponderance of specific T-cell subsets (i.e., Th1, Th2, Th17/22, Tregs). Specific cutaneous ADRs mimic immunogenic reactions to the natural infection with SARS-CoV-2, which is associated with an abundance of type I interferons. (4) Conclusions: Further studies are required in order to determine the best suitable vaccine type for individual groups of patients, including patients suffering from chronic inflammatory dermatoses.

show abstract

Adverse reactions to COVID‐19 vaccines: A practical approach

Cited by 38 publications

References 30 publications

Anaphylactic and nonanaphylactic reactions to SARS-CoV-2 vaccines: a systematic review and meta-analysis

Anaphylactic and nonanaphylactic reactions to SARS-CoV-2 vaccines: a systematic review and meta-analysis

Safety of administration of BNT162b2 mRNA (Pfizer‐BioNTech) COVID‐19 vaccine in youths and young adults with a history of acute lymphoblastic leukemia and allergy to PEG‐asparaginase

Cutaneous Adverse Reactions to COVID-19 Vaccines: Insights from an Immuno-Dermatological Perspective

Contact Info

Product

Resources

About