Vaccines and allergic reactions: The past, the current COVID‐19 pandemic, and future perspectives

Sampath, Vanitha; Rabinowitz, Grace; Shah, Mihir; Jain, Suruchi; Diamant, Zuzana; Jeseňák, Miloš; Rabin, Ronald L.; Vieths, Stefan; Agache, Ioana; Akdiş, Mübeccel; Barber, Domingo; Breiteneder, Heimo; Chinthrajah, R. Sharon; Chivato, Tomás; Collins, William J.; Eiwegger, Thomas; Fast, Katharine; Fokkens, Wytske J.; O’Hehir, Robyn E; Ollert, Markus; O’Mahony, Liam; Palomares, Óscar; Pfaar, Oliver; Riggioni, Carmen; Shamji, Mohamed H.; Sokołowska, Milena; Torres, Maria J; Traidl‐Hoffmann, Claudia; Zelm, Menno C. van; Wang, De Yun; Zhang, Luo; Akdiş, Cezmi A.; Nadeau, Kari

doi:10.1111/all.14840

Cited by 92 publications

(142 citation statements)

References 139 publications

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“…The mechanism of delayed onset reactions in vaccines are poorly described, and most often, there is no recurrence of symptoms at revaccination. [19][20][21] Fifty-five patients had an adverse reaction to first COVID-19 vaccine. After testing, we were able to revaccinate all but three patients (one patient with positive skin tests to all excipients and two abstaining from revaccination), either with the culprit vaccine, or in the case of reactions to the AZ-vaccine, which was withdrawn from the Danish market due to side effects, with PB-or M-vaccine instead.…”

Section: Past Medical Historymentioning

confidence: 99%

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Patients with suspected allergic reactions to COVID‐19 vaccines can be safely revaccinated after diagnostic work‐up

Rasmussen

Mørtz

Georgsen

et al. 2021

Clinical & Translational All

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Background: When initiating the Danish vaccination program against COVID-19, the incidence of anaphylaxis was estimated to be 10 times higher compared to other virus-based vaccines. In this study, we present data on patients referred with suspected allergic reactions to COVID-19 vaccines. The main purpose of the study is to investigate the incidence and severity of the allergic reactions, and to evaluate the safety of revaccination. Methods: All patients in the region of Southern Denmark with case histories of allergic reactions to COVID-19 vaccines in a defined period are included in this study. Diagnostic work up consisted of a detailed case history, evaluation of Brighton level of diagnostic certainty and World Allergy Organization grade of anaphylaxis and skin prick testing-and basophil histamine release testing with COVID-19 vaccines and relevant drug excipients. Patients were revaccinated at the Allergy Center when possible.Results: Sixty-one patients are included in this study. In 199,377 doses administered, nine patients fulfilled the criteria of anaphylaxis when using the Brighton Criteria (incidence being 45 per million). Of 55 patients with reactions to the first dose, 52 patients were revaccinated without adverse reactions. We found no proven cases of immediate anaphylaxis due to COVID-19 vaccines. By skin prick test, we diagnosed three patients with drug excipient allergy and further a patient with mastocytosis was found.Conclusions: Anaphylactic reactions to COVID-19 vaccines are rare and the incidence is similar to what is seen with other virus-based vaccines. Revaccination is safe in the majority of patients; however, allergological evaluation is important since some prove to have drug excipient allergy.

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Section: Past Medical Historymentioning

confidence: 99%

“…Drug excipients are thought to be the major cause of anaphylaxis to vaccines. [19][20][21] Only six patients were positive in SPT or BaHR testing to the COVID-19 vaccines and/or drug excipients: T A B L E 4 (Continued) Abbreviations: BaHR, basophil histamine release; PEG, polyethylene glycols; SPT, skin prick testing.…”

Section: Past Medical Historymentioning

confidence: 99%

Patients with suspected allergic reactions to COVID‐19 vaccines can be safely revaccinated after diagnostic work‐up

Rasmussen

Mørtz

Georgsen

et al. 2021

Clinical & Translational All

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show abstract

“…Indeed, serious allergic reactions to anti‐COVID‐19 vaccines are infrequent events that are likely to primarily occur in subjects with history of allergic reaction to vaccine components. 133 …”

Section: Strategies For Dc‐based Therapies Against Sars‐cov‐2 Infectionmentioning

confidence: 99%

A bird's eye view on the role of dendritic cells in SARS‐CoV‐2 infection: Perspectives for immune‐based vaccines

Galati

Zanotta

Capitelli

et al. 2021

Allergy

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Coronavirus disease‐19 (COVID‐19) is a complex disorder caused by the pandemic diffusion of a novel coronavirus named SARS‐CoV‐2. Clinical manifestations vary from silent infection to severe pneumonia, disseminated thrombosis, multi‐organ failure, and death. COVID‐19 pathogenesis is still not fully elucidated, while increasing evidence suggests that disease phenotypes are strongly related to the virus‐induced immune system's dysregulation. Indeed, when the virus‐host cross talk is out of control, the occurrence of an aberrant systemic inflammatory reaction, named “cytokine storm,” leads to a detrimental impairment of the adaptive immune response. Dendritic cells (DCs) are the most potent antigen‐presenting cells able to support innate immune and promote adaptive responses. Besides, DCs play a key role in the anti‐viral defense. The aim of this review is to focus on DC involvement in SARS‐CoV‐2 infection to better understand pathogenesis and clinical behavior of COVID‐19 and explore potential implications for immune‐based therapy strategies.

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“…Therefore, we hypothesized that life-threatening reactions to the vaccine are extremely rare and that most allergic reactions to vaccines are due to non–immunoglobulin (Ig) E–mediated pathways. 3 …”

Section: Introductionmentioning

confidence: 99%

Assessment of Allergic and Anaphylactic Reactions to mRNA COVID-19 Vaccines With Confirmatory Testing in a US Regional Health System

et al. 2021

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Key Points Question What risk factors and mechanisms can help explain documented allergic reactions to Food and Drug Administration–authorized mRNA COVID-19 vaccines? Findings In this case series of 22 patients with suspected vaccine allergy receiving clinical skin prick testing (SPT) and basophil activation testing (BAT) to the whole vaccine and key components (ie, polyethylene glycol [PEG] and polysorbate 80), none exhibited immunoglobulin (Ig) E–mediated allergy to components via SPT. However, most had positive BAT results to PEG, and all had positive BAT results to their administered mRNA vaccine, with no patient sample having detectable PEG IgE. Meaning These findings suggest that non–IgE-mediated allergic reactions to PEG may be responsible for many documented cases of allergy to mRNA vaccines.

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Vaccines and allergic reactions: The past, the current COVID‐19 pandemic, and future perspectives

Cited by 92 publications

References 139 publications

Patients with suspected allergic reactions to COVID‐19 vaccines can be safely revaccinated after diagnostic work‐up

Patients with suspected allergic reactions to COVID‐19 vaccines can be safely revaccinated after diagnostic work‐up

A bird's eye view on the role of dendritic cells in SARS‐CoV‐2 infection: Perspectives for immune‐based vaccines

Assessment of Allergic and Anaphylactic Reactions to mRNA COVID-19 Vaccines With Confirmatory Testing in a US Regional Health System

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