Pseudo-Anaphylactic Reactions to Pfizer BNT162b2 Vaccine: Report of 3 Cases of Anaphylaxis Post Pfizer BNT162b2 Vaccination.
Pseudo-Anaphylactic Reactions to Pfizer BNT162b2 Vaccine: Report of 3 Cases of Anaphylaxis Post Pfizer BNT162b2 Vaccination.
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DOI：
10.3390/vaccines9090974
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发表时间：
2021-08-31
期刊：
影响因子：
7.8
通讯作者：
Leong KP
中科院分区：
文献类型：
--
作者：
Lim XR;Leung BP;Ng CYL;Tan JWL;Chan GYL;Loh CM;Tan GLX;Goh VHH;Wong LT;Chua CR;Tan SC;Lee SSM;Howe HS;Thong BYH;Leong KP
新加坡2019年全国冠状病毒病（COVID-19）疫苗接种计划于2020年12月开始后，观察到过敏反应。我们报告了本机构3例接受Pifzer BNT 162 b2疫苗后发生过敏反应的患者的临床和实验室特征。在所有受试者中均检测到辉瑞BNT 162 b2疫苗的IgM和IgG抗体，但未检测到IgE抗体。类似地，通过商业ELISA在三名患者中的两名中检测到轻度至高度升高水平的抗聚乙二醇（PEG）IgG（1035-19709 U/mL，相对于未接种疫苗的< 265 U/mL，疫苗耐受的< 785 U/mL）和IgM（1682-5310 U/mL，相对于未接种疫苗的< 1011 U/mL，疫苗耐受的< 1007 U/mL）。在反应的急性期，在所有三名患者中观察到高水平的血清过敏毒素C3 a（79.0 ± 6.3 μg/mL，平均值± SD，与正常值< 10 μg/mL），而类胰蛋白酶水平（肥大细胞活化的标志物）未升高。最后，具有最高水平的抗PEG IgG、IgM和抗Pfizer BNT 162 b2 IgG和IgM的一名患者在急性反应期间表现出增强的Th 2细胞因子血清谱，具有高水平的IL-4（45.7 pg/mL，vs.疫苗初治/耐受< 2.30 pg/mL），IL-33在皮质类固醇治疗后，IL-10（86.4pg/mL，相对于未接种疫苗/耐受性<5.51pg/mL）和IL-10（22.9pg/mL，相对于未接种疫苗/耐受性<12.49pg/mL）随时间减少。综上所述，我们认为这些过敏反应的病例是由补体激活相关的假变态反应（CAPRA）驱动的，而不是经典的IgE介导的机制。
Anaphylactic reactions were observed after Singapore’s national coronavirus disease 2019 (COVID-19) vaccination programme started in December 2020. We report the clinical and laboratory features of three patients in our institution who developed anaphylactic reactions after receiving the Pifzer BNT162b2 vaccine. IgM and IgG antibodies, but not IgE antibodies to the Pfizer BNT162b2 vaccine, were detected in all subjects. Similarly, mild to high elevated levels of anti-polyethylene glycol (PEG) IgG (1035–19709 U/mL, vs. vaccine-naive < 265 U/mL, vaccine-tolerant < 785 U/mL) and IgM (1682–5310 U/mL, vs. vaccine-naive < 1011 U/mL, vaccine-tolerant < 1007 U/mL) were detected in two out of three patients via commercial ELISA. High levels of serum anaphylatoxin C3a (79.0 ± 6.3 μg/mL, mean ± SD, vs. normal < 10 μg/mL) were observed in all three patients during the acute phase of the reaction, while tryptase levels, a marker of mast cell activation, were not elevated. Finally, one patient with the highest levels of anti-PEG IgG, IgM, and anti-Pfizer BNT162b2 IgG and IgM exhibited an enhanced Th2 cytokine serum profile during an acute reaction, with high levels of IL-4 (45.7 pg/mL, vs. vaccine-naive/tolerant < 2.30 pg/mL), IL-33 (86.4 pg/mL, vs. vaccine-naive/tolerant < 5.51 pg/mL) and IL-10 (22.9 pg/mL, vs. vaccine-naive/tolerant < 12.49 pg/mL) diminishing over time following corticosteroid treatment. Taken together, we propose these cases of anaphylaxis described are driven by a complement activation-related pseudoallergy (CAPRA), rather than classical IgE-mediated mechanisms.
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