Anaphylaxis to the first COVID-19 vaccine: is polyethylene glycol (PEG) the culprit?

Garvey, Lene Heise; Nasser, Shuaib

doi:10.1016/j.bja.2020.12.020

Cited by 139 publications

(154 citation statements)

References 10 publications

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“…The cause of these vaccine anaphylaxis cases is unclear, but polyethylene glycol (PEG) is a candidate allergen. 3,4 Here, we demonstrate for the first time that allergy to PEG can cause anaphylaxis to the Pfizer/BioNTech vaccine.…”

Section: Polyethylene Glycol (Peg) Is a Cause Of Anaphylaxis To The Pfizer/biontech Mrna Covid-19 Vaccinementioning

confidence: 74%

Polyethylene glycol (PEG) is a cause of anaphylaxis to the Pfizer/BioNTech mRNA COVID‐19 vaccine

Sellaturay

Nasser

Islam

et al. 2021

Clin Experimental Allergy

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210

248

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Common drugsCommon drugs containing PEG: laxatives, Gaviscon double action, depotcorticosteroids, for example methylprednisolone, Depo Provera, penicillin Importance of brand Depends on brand (checklist of excipients 6.1 on SmPC or contents 6 on PIL). PEG is also called macrogol PEG Molecular Weight Higher PEG MWs appear more allergenic, and molecular weight and amount of PEG determines whether an allergic reaction occurs Topical products Mild usually cutaneous reactions (pruritus, rhino-conjunctivitis) to cosmetics, toothpaste, mouthwashes, shower gels, moisturizers, hand sanitizers and soaps often with lower PEG molecular weights. Vaccine reaction Immediate-onset (minutes) severe systemic allergic reaction to an mRNA COVID−19 vaccine Abbreviations: MW, molecular weight; PEG, polyethylene glycol; SmPC, summary of product characteristics. TA B L E 1 The clinical features of a PEG-allergic patient may help identify at-risk patients before vaccination or if a COVID-19 vaccine reaction was likely due to PEG Key messages 1. The Pfizer/BioNTech COVID-19 vaccine can cause severe anaphylaxis of unknown cause 2. Here, we show polyethylene glycol allergy caused one of the first cases of anaphylaxis to the Pfizer/BioNTech COVID-19 vaccine 3. Allergy skin prick testing with polyethylene glycol triggered anaphylaxis, highlighting the importance of safety procedures during investigation | 863 RESEARCH LETTER

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Section: Polyethylene Glycol (Peg) Is a Cause Of Anaphylaxis To The Pfizer/biontech Mrna Covid-19 Vaccinementioning

confidence: 74%

Polyethylene glycol (PEG) is a cause of anaphylaxis to the Pfizer/BioNTech mRNA COVID‐19 vaccine

Sellaturay

Nasser

Islam

et al. 2021

Clin Experimental Allergy

Self Cite

210

248

View full text Add to dashboard Cite

show abstract

“…However, it is possible to consider resuming vaccination using other types of vaccine. Especially in case of a severe anaphylactic reaction, it is preferable not to administer the second dose of the same vaccine and consider the possibility of restarting the vaccination from scratch using other types of vaccine (with different excipients, after carrying out skin tests) [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Allergy to Polyethilenglicole of Anti-SARS CoV2 Vaccine Recipient: A Case Report of Young Adult Recipient and the Management of Future Exposure to SARS-CoV2

et al. 2021

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The main contraindication to the anti-SARS CoV2 vaccine is an anaphylactic reaction to a vaccine component. The need to vaccinate allergic people who are at higher risk can be of public health interest and this report shows a case of an allergic reaction to PEG of a HCW who had received the first dose of anti-SARS CoV2 vaccine. For 5 h after the administration of the vaccine, she had the appearance of erythematous spots on the face and neck, and a feeling of a slurred mouth and hoarseness. In order to treat the event, she was administered 8 mg intravenous dexamethasone, 1 vial intravenous chlorphenamine maleate, 250 mL intravenous 0.9% NaCl, and conventional oxygen therapy (2 L/min) with complete resolution of the suspected adverse drug reaction. According to the contraindication to the cutaneous test for this patient, BAT was used for further investigations. The patient who suffered the adverse reaction to the COVID-19 vaccine and other five allergic patients who did not report any adverse reaction after the vaccination were tested. There was a significant activation of the vaccine-reactive patient’s basophils with 14.79 CD203chigh% at the concentration of 0.2 mg/mL, while other patients were negative. People who have a confirmed reaction to a vaccine component should undergo further investigation to discover other possible cross-reactions and select the right vaccine to immunize them.

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“…The recent introduction of the mRNA based COVID-19 vaccines has led to an increased focus on PEG as a possible culprit of allergic reactions to the vaccine. 5 PEGs are difficult to avoid due to the widespread use, and patients with PEG allergy are at particular risk of re-exposure due to the lack of a standardized nomenclature and insufficient product labelling. 1,2,6 PEGs are polymers of ethylene oxide.…”

Section: Introductionmentioning

confidence: 99%

Clinical manifestations and impact on daily life of allergy to polyethylene glycol (PEG) in ten patients

Bruusgaard‐Mouritsen

Johansen

Garvey

2021

Clin Experimental Allergy

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Background Polyethylene glycols (PEGs) are widely used as excipients in drugs, cosmetics and household products. Immediate‐type allergy to PEGs including anaphylaxis is rare. The recent introduction of the mRNA‐based COVID‐19 vaccines has led to an increased focus on PEG as a possible culprit of allergic reactions to the vaccines. A low awareness of the allergenic potential of PEG among consumers, manufacturers and doctors leads to under‐diagnosis and under‐reporting of allergy to PEGs, putting patients at risk of repeated severe reactions. Objectives To investigate clinical manifestations, time to diagnosis and impact of a PEG allergy diagnosis on the daily life of patients diagnosed with allergy to PEG from 2010 to 2019. Method Ten patients diagnosed with allergy to PEG were included. Detailed clinical history was obtained, and allergy investigations had been performed at the time of diagnosis. All patients were contacted and asked to retrospectively complete a questionnaire about causes and impact on daily life of an allergy to PEG, scored on a likert scale (0–10) before and after diagnosis. Results Eight patients had experienced at least one anaphylactic reaction requiring adrenaline treatment. Anaphylaxis was primarily caused by antibiotic/analgesic tablets, depot‐steroids, antacids and laxatives. Seven patients reported repeated reactions before diagnosis (median 3, range 2–6). Median time from first reaction to diagnosis was 20 months (range 2–120). None of the patients experienced severe allergic reactions after the diagnosis. Median likert score of the impact on daily life before diagnosis was 7 compared with 4 after diagnosis. Conclusion and clinical relevance The clinical manifestations of PEG allergy are often dramatic. Improved awareness about the clinical presentation and common culprits, clear product labelling and a standardized nomenclature is needed to ensure the timely diagnosis of PEG allergy to prevent repeated anaphylactic reactions with severe impact on patients’ lives.

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Anaphylaxis to the first COVID-19 vaccine: is polyethylene glycol (PEG) the culprit?

Cited by 139 publications

References 10 publications

Polyethylene glycol (PEG) is a cause of anaphylaxis to the Pfizer/BioNTech mRNA COVID‐19 vaccine

Polyethylene glycol (PEG) is a cause of anaphylaxis to the Pfizer/BioNTech mRNA COVID‐19 vaccine

Allergy to Polyethilenglicole of Anti-SARS CoV2 Vaccine Recipient: A Case Report of Young Adult Recipient and the Management of Future Exposure to SARS-CoV2

Clinical manifestations and impact on daily life of allergy to polyethylene glycol (PEG) in ten patients

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