Graded-dosing immunization in adults at risk for immediate-type reactions to mRNA SARS-CoV-2 vaccines

Stehlin, Florian; Tommasini, Francesco; Monzambani-Banderet, Véronique; Girard, Cedric; Yerly, Daniel; Ribi, Camillo; Müller, Yannick D.

doi:10.1016/j.alit.2022.10.001

Cited by 4 publications

(1 citation statement)

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“…At this stage, this remains speculative as it has been repeatedly shown that the majority of sensitized patients can tolerate the vaccine (18). Thus, there is growing evidence showing that immediate reactions are primarily non-IgE dependent, due to complement activation (21), and that C5a could be a relevant biomarker of anaphylaxis (22). In conclusion, IgE against PEG molecules on lipid nanoparticles (LNP) are frequently produced after multiple exposures to mRNA-based vaccines.…”

Section: Discussionmentioning

confidence: 99%

Features of chronic urticaria after COVID-19 mRNA vaccine, a real-life cohort study

Muller,

Foglierini,

Pescosolido

et al. 2024

Preprint

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Background New onsets of chronic urticaria (CU) have been reported after repeated immunizations, mainly with the Moderna mRNA-1273 vaccine (Spikevax) Objective This study aims to evaluate patients with CU after COVID-19 mRNA vaccination. The contribution of SARS-Cov2 infection, atopy and IgE against the vaccine was analyzed. Methods We monitored the features of patients who developed CU after vaccination in the Canton of Vaud through two surveys conducted in 2022 and 2023. Fifty individuals with CU underwent blood tests, and their results were compared with individuals without a history of urticaria (N=135). The presence of anti-vaccine IgE was detected with basophil activation tests (BAT). We assessed anti-SARS-Cov2 humoral response, and the presence of IgEs against common respiratory allergens (Phadiatop) as a surrogate for atopy. Results Post-vaccination CU occurred after a median interval of 10 days and significantly more after the Spikevax booster, affecting middle-aged individuals (median 41, 66% females). In 2023, CU was still active in 53% of the cases. Inducible forms of CU, primarily dermographism, were reported in 54% (2022) and 61% (2023) of the cases. BAT positivity was not specific to CU, anti-nucleocapsid positivity, or atopy but was significantly associated with higher anti-spike neutralizing activities and younger age. Four CU patients tolerated an additional dose of mRNA vaccine with no disease exacerbation/recurrence. Conclusion The Spikevax booster induced anti-vaccine IgE independently of CU, the latter being not directly associated with COVID-19 infection nor atopy. The tolerance to a new booster in 4/4 patients suggests that the Spikevax vaccine indirectly triggered CU in predisposed individuals.

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Section: Discussionmentioning

confidence: 99%