Tolerance to SARS-CoV-2 mRNA Vaccination in a Patient With Challenge-Confirmed PEG 2000 Allergy

Faihs, Valentina; Bent, Rebekka; Darsow, Ulf; Biedermann, Tilo; Brockow, Knut

doi:10.18176/jiaci.0829

Cited by 4 publications

(8 citation statements)

References 10 publications

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“…Even this patient was vaccinated under safety precautions in the clinic without any/serious problems, also reported by others. 21,22,24 Revaccination was done by 65 patients (95.6%) in this group within 60 days after testing, which was tolerated well, with significantly fewer symptoms than before and without any serious reactions. This is in line with the literature reporting a reduction of adverse reactions after revaccination.…”

Section: Discussionmentioning

confidence: 97%

“…However, even in case of a positive provocation test, vaccination could still be performed at the hospital with safety precautions and has been well tolerated in selected patients. [22][23][24] The study was approved by the local medical ethics committee. All participants provided written informed consent.…”

Section: Methodsmentioning

confidence: 99%

“…Depending on this allergological assessment, 12 patients were either advised to get vaccinated or to perform PEG provocation test, if an allergy could not be reliably excluded. However, even in case of a positive provocation test, vaccination could still be performed at the hospital with safety precautions and has been well tolerated in selected patients 22–24 . The study was approved by the local medical ethics committee.…”

Section: Methodsmentioning

confidence: 99%

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Increasing the COVID‐19 immunization rate through allergy testing

Bent

Weinbrenner

Faihs

et al. 2023

Acad Dermatol Venereol

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Background Vaccination of the population is required to combat the COVID‐19 pandemic. Allergy testing could reduce anxiety towards COVID‐19 vaccination and thereby may increase vaccination rate, however, its effectiveness remains unclear. Methods One hundred and thirty prospective real‐life patients in need of but not daring to get vaccinated asked for allergy workup for COVID‐19 vaccine hypersensitivity in 2021/2022. Characterization of patients, identification of anxieties, decrease of patient's anxiety levels, overall vaccination rate and adverse reactions after vaccination were assessed. Results Tested patients were characterized by being female (91.5%) and having a high rate of previous allergies (e.g. to food 55.4%, drugs 54.6%, or previous vaccinations 50%) and dermatological disease (29.2%) but not always had medical contraindications for COVID‐19 vaccination. Sixty one patients (49.6%) were highly concerned (4‐6, Likert scale 0‐6) about vaccination and 47 (37.6%) expressed resolving thoughts about vaccinaion anaphylaxis (3‐6, Likert scale 0‐6). However only 35 patients (28.5%) were scared of getting COVID‐19 within 2 months (4–6, Likert scale 0–6) and only 11 (9%) patients had high expectations of getting COVID‐19 (4–6, Likert scale 0–6). Allergy testing significantly (p < 0.01 to p < 0.05 respectively) reduced the median anxiety of allergic symptoms following vaccination: dyspnoea (4.2–3.1), to faint (3.7–2.7), long‐term consequences (3.6–2.2), pruritus (3.4–2.6), skin rash (3.3–2.6) and death (3.2–2.6). After allergy testing, most patients (108/122, 88.5%) let themselves be vaccinated within 60 days. Revaccinated patients with previous symptoms experienced a reduction of symptoms (p < 0.05) upon revaccination. Conclusions Patients not daring to get vaccinated have more anxiety towards vaccination than to acquire COVID‐19. For those, allergy testing excludes vaccine allergy, and is a tool to increase vaccination willingness and thereby helps to combat vaccination hesitancy.

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Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Increasing the COVID‐19 immunization rate through allergy testing

Bent

Weinbrenner

Faihs

et al. 2023

Acad Dermatol Venereol

View full text Add to dashboard Cite

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“…In a patient population of 12 PEG-allergic patients, in whom PEG allergy was detected in 6 patients by positive skin or oral challenge test, no reaction occurred after vaccination with mRNA SARS-CoV-2 vaccine [ 39 ]. Furthermore, there are several case reports of patients with immediate-type PEG allergy who tolerated their vaccination [ 40 ]. These reports could mean that the small amount of PEG 2000 in vaccines is not sufficient to trigger symptoms in some PEG-allergic patients.…”

Section: Tolerance Despite Reaction To the First Vaccine Dosementioning

confidence: 99%

SARS-CoV-2 and allergy – what have we learned after two and a half years?

Brockow¹,

Wang²,

Mathes³

et al. 2023

ALS

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Background: Coronavirus disease-2019 (COVID-19) has significantly hampered the regular workflow for allergists and allergy departments. Materials and methods: The purpose of this review is to highlight our own experiences on SARS-CoV-2 and allergy as well as to discuss findings from the literature. Results: Vaccination against SARS-CoV-2 is needed for protection against severe infection. Skin reactions may arise with SARS-CoV-2 infections. Short-term general immune reactions and skin reactions are also possible upon SARS-CoV-2 vaccination; however, they recur in only a proportion of patients during follow-up vaccinations. Initial reports of anaphylaxis after vaccination fueled public fear. On the other hand, more recent epidemiologic data do not show a substantially increased anaphylaxis risk compared with other vaccines. Fear-related reactions may be essential for many “anaphylaxis” reports. In Germany, the flow chart developed by Paul-Ehrlich-Institut (PEI) and Robert-Koch-Institut (RKI) together with the allergological societies helps to care for patients with suspected “allergy history” safely and effectively. Through this, patients with increased risk of anaphylaxis to SARS-CoV-2 vaccines and their ingredients (e.g., polyethylene glycol (PEG), polysorbate 80) are identified. However, since only small amounts of these excipients are contained in mRNA vaccines, even some PEG-allergic patients can tolerate the vaccination. In Germany, an allergy test-guided procedure is recommended for high-risk patients, including an allergy history, prick tests, intradermal and basophil activation tests, and, if necessary, provocation tests. This also appears effective for anxiety reduction in patients with vaccination skepticism. To date, all of our patients have been able to be vaccinated with SARS-CoV-2 vaccines without the occurrence of significant reactions. Conclusion: Many initial concerns about unexpected side effects of SARS-CoV-2 vaccination have not been confirmed. The flowchart and, in the case of suspicion of hypersensitivity, an allergy test-guided risk assessment helps to reduce patients’ fear of vaccination and enables safe vaccination.

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“…Furthermore, Brockow et al 9 published two patients diagnosed with PEG allergy who were ignorant of the potential risk and tolerated vaccination with Comirnaty ® . Li et al 10 Faihs et al 13 described one patient with a challenge verified PEG allergy receiving fractionated immunization with Spikewax R (five doses given with 30-60 min intervals) without allergic reaction. A single case of oral desensitization with a two-days, 23 step protocol using serial 10-fold dilution of PEG 3350 has been published to successfully mRNA COVID-19 vaccinate a patient.…”

mentioning

confidence: 99%