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

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...

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Autores principales: Lim, Xin Rong, Tan, Justina Wei Lynn, Chan, Grace Yin Lai, Hou, Jinfeng, Xie, Linlin, Goh, Vivian Hui Li, Boon, Joewee, Lee, Samuel Shang Ming, Teo, Claire Min-Li, Tan, Sze Chin, Leong, Khai Pang, Thong, Bernard Yu Hor, Leung, Bernard Pui Lam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9319755/
https://www.ncbi.nlm.nih.gov/pubmed/35891189
http://dx.doi.org/10.3390/vaccines10071025
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author Lim, Xin Rong
Tan, Justina Wei Lynn
Chan, Grace Yin Lai
Hou, Jinfeng
Xie, Linlin
Goh, Vivian Hui Li
Boon, Joewee
Lee, Samuel Shang Ming
Teo, Claire Min-Li
Tan, Sze Chin
Leong, Khai Pang
Thong, Bernard Yu Hor
Leung, Bernard Pui Lam
author_facet Lim, Xin Rong
Tan, Justina Wei Lynn
Chan, Grace Yin Lai
Hou, Jinfeng
Xie, Linlin
Goh, Vivian Hui Li
Boon, Joewee
Lee, Samuel Shang Ming
Teo, Claire Min-Li
Tan, Sze Chin
Leong, Khai Pang
Thong, Bernard Yu Hor
Leung, Bernard Pui Lam
author_sort Lim, Xin Rong
collection PubMed
description 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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spelling pubmed-93197552022-07-27 Evaluation of Patients with Vaccine Allergies Prior to mRNA-Based COVID-19 Vaccination Lim, Xin Rong Tan, Justina Wei Lynn Chan, Grace Yin Lai Hou, Jinfeng Xie, Linlin Goh, Vivian Hui Li Boon, Joewee Lee, Samuel Shang Ming Teo, Claire Min-Li Tan, Sze Chin Leong, Khai Pang Thong, Bernard Yu Hor Leung, Bernard Pui Lam Vaccines (Basel) Article 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. MDPI 2022-06-27 /pmc/articles/PMC9319755/ /pubmed/35891189 http://dx.doi.org/10.3390/vaccines10071025 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Lim, Xin Rong
Tan, Justina Wei Lynn
Chan, Grace Yin Lai
Hou, Jinfeng
Xie, Linlin
Goh, Vivian Hui Li
Boon, Joewee
Lee, Samuel Shang Ming
Teo, Claire Min-Li
Tan, Sze Chin
Leong, Khai Pang
Thong, Bernard Yu Hor
Leung, Bernard Pui Lam
Evaluation of Patients with Vaccine Allergies Prior to mRNA-Based COVID-19 Vaccination
title Evaluation of Patients with Vaccine Allergies Prior to mRNA-Based COVID-19 Vaccination
title_full Evaluation of Patients with Vaccine Allergies Prior to mRNA-Based COVID-19 Vaccination
title_fullStr Evaluation of Patients with Vaccine Allergies Prior to mRNA-Based COVID-19 Vaccination
title_full_unstemmed Evaluation of Patients with Vaccine Allergies Prior to mRNA-Based COVID-19 Vaccination
title_short Evaluation of Patients with Vaccine Allergies Prior to mRNA-Based COVID-19 Vaccination
title_sort evaluation of patients with vaccine allergies prior to mrna-based covid-19 vaccination
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9319755/
https://www.ncbi.nlm.nih.gov/pubmed/35891189
http://dx.doi.org/10.3390/vaccines10071025
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