Utility and futility of skin testing to address concerns surrounding messenger RNA coronavirus disease 2019 vaccine reactions

Pitlick, Mitchell M.; Sitek, Andrea; D'Netto, Michael; Dages, Kelley N.; Chiarella, Sergio E.; Gonzalez‐Estrada, Alexei; Joshi, Avni Y.; Park, Miguel A.

doi:10.1016/j.anai.2021.11.006

Cited by 15 publications

(20 citation statements)

References 36 publications

(42 reference statements)

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“…Other than a definite allergy to polyethylene glycol, there are no other contraindications to mRNA vaccinations 22,23 . Increasing evidence shows that non‐IgE‐mediated mechanisms, e.g., IgG‐mediated anaphylaxis and complement activation‐related pseudoallergy (CARPA), may be involved in some of these cases who develop anaphylaxis reactions, 24 limiting the role of skin tests and other in vitro diagnostic tests 25 . Some patients with previous immediate reactions to mRNA vaccinations are able to tolerate subsequent doses without recurrence of a similar reaction 3 following specialist allergy evaluation and risk stratification 26 .…”

Section: Discussionmentioning

confidence: 99%

“…22,23 Increasing evidence shows that non-IgE-mediated mechanisms, e.g., IgG-mediated anaphylaxis and complement activation-related pseudoallergy (CARPA), may be involved in some of these cases who develop anaphylaxis reactions, 24 limiting the role of skin tests and other in vitro diagnostic tests. 25 Some patients with previous immediate reactions to mRNA vaccinations are able to tolerate subsequent doses without recurrence of a similar reaction 3 following specialist allergy evaluation and risk stratification. 26 Finally, some of these reactions may have been immunization stress-related responses (ISRRs) due to vaccination-related psychologic reactions which occur due to anxiety or stress mimicking acute allergic reactions.…”

Section: Discussionmentioning

confidence: 99%

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Asia Pacific perspectives on the second year of the COVID‐19 pandemic: A follow‐up survey

Pawankar

Thong

Tiongco‐Recto

et al. 2022

Clin Experimental Allergy

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BackgroundThe Coronavirus disease 2019 (COVID‐19) pandemic is currently in its third year. This follow‐up survey was commissioned by the Asia Pacific Association of Allergy Asthma and Clinical Immunology (APAAACI) Task Force on COVID‐19 to compare and contrast changes in the epidemiology, clinical profile, therapeutics and public health measures of the pandemic in the Asia Pacific region.MethodsA questionnaire‐based survey comprising 32 questions was electronically sent out to all 15 member countries of APAAACI using Survey Monkey® from 1 December 2021 to 28 February 2022.ResultsSeventeen responses were received from 14/15 (93.4%) member countries and 3 individual members. Mild‐to‐moderate COVID‐19 predominated over severe infection, largely contributed by COVID‐19 vaccination programmes in the region. The incidence of vaccine adverse reactions in particular anaphylaxis from messenger ribonucleic acid (mRNA) vaccines was no longer as high as initially anticipated, although perimyocarditis remains a concern in younger males. Novel therapeutics for mild‐to‐moderate disease including neutralizing antibodies casirivimab/imdevimab (REGEN‐COV®) and sotrovimab (Xevudy®), anti‐virals Paxlovid® (nirmatrelvir and ritonavir) and Molnupiravir pre‐exposure prophylaxis for high‐risk persons with Tixagevimab and Cilgavimab (Evusheld) are now also available to complement established therapeutics (e.g., remdesivir, dexamethasone and baricitinib) for severe disease. In the transition to endemicity, public health measures are also evolving away from containment/elimination strategies.ConclusionsWith access to internationally recommended standards of care including public health preventive measures, therapeutics and vaccines among most APAAACI member countries, much progress has been made over the 2‐year period in minimizing the morbidity and mortality from COVID‐19 disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Asia Pacific perspectives on the second year of the COVID‐19 pandemic: A follow‐up survey

Pawankar

Thong

Tiongco‐Recto

et al. 2022

Clin Experimental Allergy

View full text Add to dashboard Cite

show abstract

“…Other studies also provide additional data showing that excipient skin testing with PEG and polysorbate is of little utility in the assessment of suspected allergic reactions to SARS-CoV-2 vaccines [ 14 ]. Pitlick et al demonstrated that despite having adverse reactions after the first dose of an mRNA vaccine and having a history of PEG allergies, the majority of patients had negative skin testing results, and 89.1% of them were able to tolerate subsequent vaccinations with no allergic symptoms, including 83% of those who had positive skin test results [ 15 , 16 ]. Similarly, Wolfson et al reported that most individuals are able to receive the second dose of an mRNA COVID-19 vaccine after a reported allergic reaction to the first dose, regardless of skin test results [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Patients with Vaccine Allergies Prior to mRNA-Based COVID-19 Vaccination

et al. 2022

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During the initial rollout of coronavirus disease 2019 (COVID-19) vaccination in Singapore, the Ministry of Health (MOH) issued a recommendation that patients with a history of any previous vaccine allergy be referred to an allergist for further review of their suitability to proceed with mRNA-based COVID-19 vaccines. Patients fulfilling the above criterion were divided into three groups: immediate reaction (Group A), delayed reaction (Group B) and no/irrelevant reaction (Group C). They were subjected to either a skin prick test (SPT) and intradermal test (IDT) with polyethylene glycol (PEG) or polysorbate-containing products; direct injection with the Pfizer BNT162b2 vaccine in the allergy clinic; or injection at community vaccination centres, respectively. Groups A and B were also invited to complete a questionnaire survey on post-vaccination reactions, and blood sampling pre-vaccination and 1 h after the first dose of the BNT162b2 vaccine to measure immunoglobulin (Ig) G, IgM and IgE antibodies to the Pfizer BNT162b2 vaccine via ELISA assays immobilised with the BNT162b2 vaccine, as well as levels of allergic cytokines interleukin (IL)-4 and IL-33, complement C5a and the endothelial activation marker intercellular adhesion molecule-1 (ICAM-1). Groups A and B comprised 62 (20.5%) patients each. In Group A, two subjects (3.2%) with equivocal IDT results tolerated both doses of the BNT162b2 vaccine without major allergic reactions. The remaining 60 (96.8%) in Group A and 62 (100%) in Group B completed both doses of BNT162b2 vaccination without major adverse reactions. Among the 99 who completed the questionnaire survey, 13 (13%) patients reported mild allergic reactions after the first dose of the vaccine. Immunoglobulin (Ig) G and M antibodies, but not IgE antibodies to the Pfizer BNT162b2 vaccine were detected in 67 subjects prior to vaccination. The presence of anti-Pfizer BNT162b2 IgG and IgM prior to vaccination did not result in major allergic reactions nor increases in Th2-related cytokines (IL-4, IL-33), complement activation products (C5a) or endothelial activation (ICAM-1). The majority of those with suspected reactions to non-COVID-19 polysorbate-containing vaccines tolerated the BNT162b2 vaccine. Excipient skin tests for PEG and polysorbate prior to vaccination are unnecessary.

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“…these concerns was previously outlined, but subsequent studies showed limited utility in its use. [1][2][3] Emphasis has now shifted towards methods of safe vaccine administration in patients with concern for vaccine allergy in a model consistent with existing vaccine allergy practice parameters. [4][5] There is minimal reported experience using graded dosing protocols for COVID-19 vaccine administration.…”

mentioning

confidence: 99%

Graded coronavirus disease 2019 vaccine administration

Pitlick

Gonzalez‐Estrada

Park

2022

Annals of Allergy, Asthma & Immunology

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Utility and futility of skin testing to address concerns surrounding messenger RNA coronavirus disease 2019 vaccine reactions

Cited by 15 publications

References 36 publications

Asia Pacific perspectives on the second year of the COVID‐19 pandemic: A follow‐up survey

Asia Pacific perspectives on the second year of the COVID‐19 pandemic: A follow‐up survey

Evaluation of Patients with Vaccine Allergies Prior to mRNA-Based COVID-19 Vaccination

Graded coronavirus disease 2019 vaccine administration

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