Keywords
Anaphylaxis
Pfizer-BioNTech
Skin testing
Polyethylene glycol
Abstract
Background: The Pfizer-BioNTech BNT162b2 vaccine, provides 95% effectiveness from the second dose onwards. The reported rate of anaphylaxis to COVID-19 vaccines is 4.7 cases/million doses administered. Case presentation: 30-year-old female, health professional, history of allergic rhinitis, asthma, reaction to eye cosmetics and adhesive tape: erythema, edema and local pruritus. Immediately after application of the first dose of Pfizer-BioNTech vaccine, she presented grade III anaphylaxis. The patient was stratified, phenotyped and skin tests with PEG 3350 were positive. A recommendation was issued not to reapply vaccine containing polyethylene glycol and alternatives were offered. Discussion: An adequate risk stratification should be performed before applying mRNA-based COVID-19 vaccines for the first time in at-risk groups. In case of anaphylaxis at the first dose, phenotyping and further study with PEG skin tests should be performed and vaccination alternatives should be offered.
References
World Health Organization. WHO Coronavirus (COVID-19) Dashboard [Internet]. 2022 [citado el 20 de enero de 2022]. Disponible en: https://covid19.who.int/info/
Polack FP, Thomas SJ, Kitchin N, et al. Safety and Efficacy of the BNT162b2 mRNA COVID-19 Vaccine. N Engl J Med 2020;383(27):2603-2615. DOI: 10.1056/NEJMoa2034577.
Oliver S. Updates to the Evidence to Recommendation Framework: Pfizer-BioNTech and Moderna COVID-19 vaccine booster doses. Disponible en: https://www.cdc.gov/vaccines/acip/meetings/slides-2021-09-22-23.html
Shimabukuro T, Nair N. Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine. J Am Med Assoc 2021;325(8):780-781. Disponible en: https://jamanetwork.com/journals/jama/fullarticle/2775646
Rutkowski K, Mirakian R, Till S, et al. Adverse reactions to COVID-19 vaccines: A practical approach. Clin Exp Allergy. John Wiley and Sons Inc 2021; Vol. 51:770–777. DOI: 10.1111/cea.13880.
Turner PJ, Ansotegui IJ, Campbell DE, et al. COVID-19 vaccine-associated anaphylaxis: A statement of the World Allergy Organization Anaphylaxis Committee. World Allergy Organ J. Elsevier Inc 2021;Vol. 14(2): 100517. DOI: 10.1016/j.waojou.2021.100517
Moghimi SM. Allergic Reactions and Anaphylaxis to LNP-Based COVID-19 Vaccines., Mol Ther. Cell Press 2021;Vol. 29:898–900. DOI: 10.1016/j.ymthe.2021.01.030
Stone CA, Liu Y, Relling MV, et al. Immediate Hypersensitivity to Polyethylene Glycols and Polysorbates: More Common Than We Have Recognized. J Allergy Clin Immunol: In Practice 2019;7(5):1533-1540.e8. DOI: 10.1016/j.jaip.2018.12.003
Banerji A, Wickner PG, Saff R, et al. mRNA Vaccines to Prevent COVID-19 Disease and Reported Allergic Reactions: Current Evidence and Suggested Approach. J Allergy Clin Immunol Pract. American Academy of Allergy, Asthma and Immunology 2021;Vol. 9:1423–1437. DOI: 10.1016/j.jaip.2020.12.047
Kelso JM. Misdiagnosis of systemic allergic reactions to mRNA COVID-19 vaccines. Ann Allergy Asthma Immunol 2021;127(1):133–134. Disponible en: http://www.annallergy.org/article/S108112062100257X/fulltext
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright (c) 2023 Revista Alergia México