Increasing the COVID‐19 immunization rate through allergy testing

Abstract

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.

Predictive value of skin testing with excipients for COVID-19 vaccines

“…Isolated PS allergy is rare. Korean authors [64] performed an oral desensitization protocol to PEG using the PEG formulation for bowel preparation before administering the vaccine. Their 13-step desensitization schedule takes two days to be performed [64].…”

Value of vaccine and vaccine excipient skin testing to COVID‐19 vaccines

“…4 In addition, we identified and analysed fears in vaccination-hesitant patients. 3 The anxiety was even more pronounced in unvaccinated hesitant patients than in those who had reported a previous reaction to a COVID-19 mRNA vaccine. Strikingly, patients were more fearful of vaccination than of COVID-19 infection itself.…”

“…We believe that rather an anxiety(stress)-induced reaction may be relevant as non-allergic mechanism. 3 At the onset of the pandemic, widespread media coverage of hypersensitivity reactions to COVID-19 mRNA vaccines and discussion of PEG as a culprit generated enormous interest in the population as evidenced by the exponential increase of Google search volumes for related search terms. 4 This contrasted with a barely increased number of new cases with PEG allergy in publications.…”

“…This contrasted with a barely increased number of new cases with PEG allergy in publications 4 . In addition, we identified and analysed fears in vaccination‐hesitant patients 3 . The anxiety was even more pronounced in unvaccinated hesitant patients than in those who had reported a previous reaction to a COVID‐19 mRNA vaccine.…”

“…Complement activation‐related pseudoallergy (CARPA) has been proposed as a non‐allergic mechanism, but evidence is not yet convincing. We believe that rather an anxiety(stress)‐induced reaction may be relevant as non‐allergic mechanism 3 . At the onset of the pandemic, widespread media coverage of hypersensitivity reactions to COVID‐19 mRNA vaccines and discussion of PEG as a culprit generated enormous interest in the population as evidenced by the exponential increase of Google search volumes for related search terms 4 .…”