Anaphylaxis to vaccinations: A review of the literature and evaluation of the COVID-19 mRNA vaccinations

Kuder, Margaret; Lang, David M.; Patadia, Deepa D.

doi:10.3949/ccjm.88a.ccc075

Cited by 10 publications

(9 citation statements)

References 13 publications

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“…Immunologically mediated reactions include IgE-mediated and T-cell mediated reactions as well as other immunologic mechanisms that occur as a result of allergen exposure. These responses, particularly severe anaphylaxis, rarely occur [ 8 , 9 ]. Symptoms can begin within minutes of exposure to the allergen [generally within 30 min and less commonly within several hours]; and range from urticaria, swelling, and gastrointestinal upset, to respiratory distress and cardiovascular collapse associated with severe anaphylaxis [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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

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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.

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Section: Introductionmentioning

confidence: 99%

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

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“… 3 Symptoms can range from cutaneous symptoms to respiratory distress and cardiovascular collapse. 5 Delayed reactions which occur hours to days after exposure, typically manifest as cutaneous reaction. 5 Our patient developed reactions 27 hours after vaccination, had level 1 anaphylaxis as per Brighton Collaboration case definition ( www.brightoncollaboration.us ) as he met all 3 major criteria under dermatologic/mucosal, respiratory, and cardiovascular symptoms.…”

Section: To the Editorsmentioning

confidence: 99%

“…1 In most anaphylactic reactions, symptoms begin within minutes (generally 30 minutes) of exposure to the allergen. 5 In case of vaccines, symptoms onset is 13 minutes on average, and generally, 86% occur within 30 minutes of vaccination. 3 Symptoms can range from cutaneous symptoms to respiratory distress and cardiovascular collapse.…”

Section: Delayed-onset Anaphylaxis After Mrna-based Covid-19 Vaccinat...mentioning

confidence: 99%

Delayed-onset Anaphylaxis After mRNA-Based COVID-19 Vaccination in an Adolescent Male

Shrestha

Bhattarai

Dhungana

et al. 2022

Pediatric Infectious Disease Journal

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“…Such reactions are antibodyindependent, cell-mediated, stemming from over stimulation of T cells and monocytes/macrophages and cytokine's release that further cause inflammation, cell death, and tissue damage [110]. They have been associated with vaccines containing antimicrobial agents and ingredients, such as thimerosal and aluminum [111] and with-Japanese encephalitis and rabies vaccines [112]. A common type of delayed hypersensitivity reaction is the heparin hypersensitivity [113].…”

Section: Covid-19 Vaccine-induced Thrombotic Eventsmentioning

confidence: 99%

COVID-19 Disease, Women’s Predominant Non-Heparin Vaccine-Induced Thrombotic Thrombocytopenia and Kounis Syndrome: A Passepartout Cytokine Storm Interplay

et al. 2021

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Coronavirus disease 2019 (COVID-19) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) constitute one of the deadliest pandemics in modern history demonstrating cardiovascular, gastrointestinal, hematologic, mucocutaneous, respiratory, neurological, renal and testicular manifestations and further complications. COVID-19-induced excessive immune response accompanied with uncontrolled release of cytokines culminating in cytokine storm seem to be the common pathogenetic mechanism of these complications. The aim of this narrative review is to elucidate the relation between anaphylaxis associated with profound hypotension or hypoxemia with pro-inflammatory cytokine release. COVID-19 relation with Kounis syndrome and post-COVID-19 vaccination correlation with heparin-induced thrombocytopenia with thrombosis (HITT), especially serious cerebral venous sinus thrombosis, were also reviewed. Methods: A current literature search in PubMed, Embase and Google databases was performed to reveal the pathophysiology, prevalence, clinical manifestation, correlation and treatment of COVID-19, anaphylaxis with profuse hypotension, Kounis acute coronary syndrome and thrombotic events post vaccination. Results: The same key immunological pathophysiology mechanisms and cells seem to underlie COVID-19 cardiovascular complications and the anaphylaxis-associated Kounis syndrome. The myocardial injury in patients with COVID-19 has been attributed to coronary spasm, plaque rupture and microthrombi formation, hypoxic injury or cytokine storm disposing the same pathophysiology with the three clinical variants of Kounis syndrome. COVID-19-interrelated vaccine excipients as polysorbate, polyethelene glycol (PEG) and trometamol constitute potential allergenic substances. Conclusion: Better acknowledgement of the pathophysiological mechanisms, clinical similarities, multiorgan complications of COVID-19 or other viral infections as dengue and human immunodeficiency viruses along with the action of inflammatory cells inducing the Kounis syndrome could identify better immunological approaches for prevention, treatment of the COVID-19 pandemic as well as post-COVID-19 vaccine adverse reactions.

show abstract

Anaphylaxis to vaccinations: A review of the literature and evaluation of the COVID-19 mRNA vaccinations

Cited by 10 publications

References 13 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

Delayed-onset Anaphylaxis After mRNA-Based COVID-19 Vaccination in an Adolescent Male

COVID-19 Disease, Women’s Predominant Non-Heparin Vaccine-Induced Thrombotic Thrombocytopenia and Kounis Syndrome: A Passepartout Cytokine Storm Interplay

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