Potential mechanisms of anaphylaxis to COVID-19 mRNA vaccines.
Potential mechanisms of anaphylaxis to COVID-19 mRNA vaccines.
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DOI：
10.1016/j.jaci.2021.04.002
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发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
Milner JD
中科院分区：
文献类型：
--
作者：
Risma KA;Edwards KM;Hummell DS;Little FF;Norton AE;Stallings A;Wood RA;Milner JD
对疫苗的过敏反应在历史上是罕见的事件。2019年冠状病毒病大流行推动了应用新型抗原递送系统快速生产疫苗的需求：包装在脂质纳米颗粒中的信使RNA疫苗。出乎意料的是，公共疫苗接种导致了少数严重的过敏反应，从而引起了大量的公众关注，特别是在特应性个体中。我们回顾了信使RNA脂质纳米颗粒疫苗的成分，并考虑了这些反应的几个贡献者：（1）通过核酸的接触系统活化，（2）疫苗活化的过敏效应细胞的补体识别，（3）聚乙二醇（脂质纳米颗粒表面亲水性聚合物）的预先存在的抗体识别，和（4）直接肥大细胞活化，再加上潜在的遗传或环境易感性过敏。不幸的是，体外抗聚乙二醇抗体的测量在临床上不可用，并且皮肤测试对聚乙二醇组分作为冠状病毒疾病2019信使RNA疫苗特异性过敏反应标志物的预测价值尚不清楚。关于疫苗用于试验（体外/体内）以确定发病机理或预测反应性风险的适用性，我们所知什少。在公共卫生危机期间，需要对发生过敏性疫苗反应的患者进行便捷和彻底的基于研究的评估，并在假定的高危人群中进行前瞻性临床试验，以解决这些问题。
Anaphylaxis to vaccines is historically a rare event. The coronavirus disease 2019 pandemic drove the need for rapid vaccine production applying a novel antigen delivery system: messenger RNA vaccines packaged in lipid nanoparticles. Unexpectedly, public vaccine administration led to a small number of severe allergic reactions, with resultant substantial public concern, especially within atopic individuals. We reviewed the constituents of the messenger RNA lipid nanoparticle vaccine and considered several contributors to these reactions: (1) contact system activation by nucleic acid, (2) complement recognition of the vaccine-activating allergic effector cells, (3) preexisting antibody recognition of polyethylene glycol, a lipid nanoparticle surface hydrophilic polymer, and (4) direct mast cell activation, coupled with potential genetic or environmental predispositions to hypersensitivity. Unfortunately, measurement of anti–polyethylene glycol antibodies in vitro is not clinically available, and the predictive value of skin testing to polyethylene glycol components as a coronavirus disease 2019 messenger RNA vaccine-specific anaphylaxis marker is unknown. Even less is known regarding the applicability of vaccine use for testing (in vitro/vivo) to ascertain pathogenesis or predict reactivity risk. Expedient and thorough research-based evaluation of patients who have suffered anaphylactic vaccine reactions and prospective clinical trials in putative at-risk individuals are needed to address these concerns during a public health crisis.
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影响因子：
15.9
作者：
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通讯作者：
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20.3
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DOI：
10.1056/nejmoa2035389
发表时间：
2021-02-04
期刊：
The New England journal of medicine
影响因子：
--
作者：
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通讯作者：
COVE Study Group
DOI：
10.1016/j.jaci.2018.01.043
发表时间：
2018-08
期刊：
The Journal of allergy and clinical immunology
影响因子：
--
作者：
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通讯作者：
Bulfone-Paus S
影响因子：
4.9
作者：
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通讯作者：
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