Allergic Reactions to Current Available COVID-19 Vaccinations: Pathophysiology, Causality, and Therapeutic Considerations.
Allergic Reactions to Current Available COVID-19 Vaccinations: Pathophysiology, Causality, and Therapeutic Considerations.
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DOI：
10.3390/vaccines9030221
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发表时间：
2021-03-05
期刊：
影响因子：
7.8
通讯作者：
Hung MY
中科院分区：
文献类型：
--
作者：
Kounis NG;Koniari I;de Gregorio C;Velissaris D;Petalas K;Brinia A;Assimakopoulos SF;Gogos C;Kouni SN;Kounis GN;Calogiuri G;Hung MY
疫苗是公共卫生领域最有效的药物，因为它们控制和预防传染病的传播并降低死亡率。与其他药物类似，在接种疫苗期间可能发生过敏反应。虽然大多数反应既不频繁也不严重，但过敏性反应是潜在的危及生命的过敏反应，很少遇到，但会引起严重的并发症。疫苗引起的过敏反应可通过fce1受体1型反应激活肥大细胞，由针对特定疫苗的免疫球蛋白E （IgE）抗体之间的相互作用介导，并在几分钟或长达四小时内发生。IV型过敏反应在接种后48 h开始，72 ~ 96 h达到高峰。非ige介导的通过激活补体系统和激活mass相关G蛋白偶联受体X2的肥大细胞脱颗粒也可诱导过敏反应。反应通常是由惰性物质引起的，称为赋形剂，它们被添加到疫苗中以改善稳定性和吸收，增加溶解度，影响适口性，或产生独特的外观，而不是由活性疫苗本身引起的。目前可用的辉瑞- biontech和Moderna COVID-19 mRNA疫苗中的聚乙二醇，也称为大醇，以及阿斯利康和强生COVID-19疫苗中的聚山梨酸酯80，也称为Tween 80，是主要与过敏反应有关的辅料。本综述将总结当前可用的COVID-19疫苗中即时和延迟性过敏反应的知识现状，以及一般和特定的治疗考虑。这些考虑因素包括：使用现有疫苗进行调查的过敏反应发生率和死亡人数、肥大细胞疾病患者接种疫苗的情况、首次接种时出现过敏的患者、伪装成过敏反应的血管迷走神经症状、妊娠期接种COVID-19疫苗、与COVID-19疫苗接种相关的死亡以及在处理当前这一问题时出现的问题。长期进行仔细的疫苗安全性监测，并结合阐明不同COVID-19疫苗平台不良事件的机制，将有助于制定安全疫苗战略。过敏症专家在正确诊断和治疗过敏反应方面的专业知识对于筛选高危人群至关重要。
Vaccines constitute the most effective medications in public health as they control and prevent the spread of infectious diseases and reduce mortality. Similar to other medications, allergic reactions can occur during vaccination. While most reactions are neither frequent nor serious, anaphylactic reactions are potentially life-threatening allergic reactions that are encountered rarely, but can cause serious complications. The allergic responses caused by vaccines can stem from activation of mast cells via Fcε receptor-1 type I reaction, mediated by the interaction between immunoglobulin E (IgE) antibodies against a particular vaccine, and occur within minutes or up to four hours. The type IV allergic reactions initiate 48 h after vaccination and demonstrate their peak between 72 and 96 h. Non-IgE-mediated mast cell degranulation via activation of the complement system and via activation of the Mas-related G protein-coupled receptor X2 can also induce allergic reactions. Reactions are more often caused by inert substances, called excipients, which are added to vaccines to improve stability and absorption, increase solubility, influence palatability, or create a distinctive appearance, and not by the active vaccine itself. Polyethylene glycol, also known as macrogol, in the currently available Pfizer-BioNTech and Moderna COVID-19 mRNA vaccines, and polysorbate 80, also known as Tween 80, in AstraZeneca and Johnson & Johnson COVID-19 vaccines, are excipients mostly incriminated for allergic reactions. This review will summarize the current state of knowledge of immediate and delayed allergic reactions in the currently available vaccines against COVID-19, together with the general and specific therapeutic considerations. These considerations include: The incidence of allergic reactions and deaths under investigation with the available vaccines, application of vaccination in patients with mast cell disease, patients who developed an allergy during the first dose, vasovagal symptoms masquerading as allergic reactions, the COVID-19 vaccination in pregnancy, deaths associated with COVID-19 vaccination, and questions arising in managing of this current ordeal. Careful vaccine-safety surveillance over time, in conjunction with the elucidation of mechanisms of adverse events across different COVID-19 vaccine platforms, will contribute to the development of a safe vaccine strategy. Allergists’ expertise in proper diagnosis and treatment of allergic reactions is vital for the screening of high-risk individuals.
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DOI：
10.5414/alx02215e
发表时间：
2021
期刊：
Allergologie select
影响因子：
--
作者：
Kleine-Tebbe J;Klimek L;Hamelmann E;Pfaar O;Taube C;Wagenmann M;Werfel T;Worm M
通讯作者：
Worm M
影响因子：
5.9
作者：
Coors, EA;Seybold, H;Mahler, V
通讯作者：
Mahler, V
影响因子：
2.8
作者：
Demir, Semra;Erdenen, Fusun;Buyukozturk, Suna
通讯作者：
Buyukozturk, Suna
影响因子：
2.6
作者：
Caubet, Jean-Christoph;Ponvert, Claude
通讯作者：
Ponvert, Claude
影响因子：
3.7
作者：
Hawe, Andrea;Filipe, Vasco;Jiskoot, Wim
通讯作者：
Jiskoot, Wim