First-Dose mRNA COVID-19 Vaccine Allergic Reactions: Limited Role for Excipient Skin Testing.
First-Dose mRNA COVID-19 Vaccine Allergic Reactions: Limited Role for Excipient Skin Testing.
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DOI：
10.1016/j.jaip.2021.06.010
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发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
Banerji A
中科院分区：
文献类型：
--
作者：
Wolfson AR;Robinson LB;Li L;McMahon AE;Cogan AS;Fu X;Wickner P;Samarakoon U;Saff RR;Blumenthal KG;Banerji A
美国疾病控制与预防中心表示，对第一剂 mRNA COVID-19 疫苗出现严重或立即过敏反应是第二剂的禁忌症。评估第一剂 mRNA COVID-19 疫苗出现过敏反应后与赋形剂皮试相关的结果。我们确定了在第一剂 mRNA COVID-19 疫苗后报告有过敏反应的患者的连续样本，这些患者接受了聚乙二醇 (PEG) 和适当时的聚山梨酯 80 皮肤测试的过敏评估。皮肤测试结果与第一剂 mRNA COVID-19 疫苗反应的临床表型相结合，指导了第二剂疫苗接种建议。评估了第二剂 mRNA COVID-19 疫苗反应。 80 名报告首剂 mRNA COVID-19 疫苗过敏反应的患者（n = 65；81% 立即发病）接受了赋形剂皮肤测试。其中，14 名 (18%) 的 PEG (n = 5) 和/或聚山梨醇酯 80 (n = 12) 皮肤测试呈阳性。皮试结果不影响立即或延迟反应患者对第二剂的耐受性。在接受第二剂 mRNA COVID-19 疫苗的 70 名患者中 (88%)，62 名患者没有反应或使用抗组胺药治疗后出现轻微反应 (89%)，但 2 名患者需要肾上腺素治疗。三名 PEG-3350 皮内（甲基泼尼松龙）检测呈阳性的患者耐受第二剂 mRNA COVID-19 疫苗接种。刷新眼泪会引起非特异性皮肤刺激。大多数对第一剂 mRNA COVID-19 疫苗有过敏反应的人，无论皮试结果如何，都安全地接受了第二剂。需要更多数据来了解 PEG (MiraLAX) 皮肤点刺测试在评估 mRNA COVID-19 疫苗过敏反应患者中的价值。 Refresh Tears 不应用于皮肤测试。
The Centers for Disease Control and Prevention state that a severe or immediate allergic reaction to the first dose of an mRNA COVID-19 vaccine is a contraindication for the second dose. To assess outcomes associated with excipient skin testing after a reported allergic reaction to the first dose of mRNA COVID-19 vaccine. We identified a consecutive sample of patients with reported allergic reactions after the first dose of mRNA COVID-19 vaccine who underwent allergy assessment with skin testing to polyethylene glycol (PEG) and, when appropriate, polysorbate 80. Skin testing results in conjunction with clinical phenotyping of the first-dose mRNA COVID-19 vaccine reaction guided second-dose vaccination recommendation. Second-dose mRNA COVID-19 vaccine reactions were assessed. Eighty patients with reported first-dose mRNA COVID-19 vaccine allergic reactions (n = 65; 81% immediate onset) underwent excipient skin testing. Of those, 14 (18%) had positive skin tests to PEG (n = 5) and/or polysorbate 80 (n = 12). Skin testing result did not affect tolerance of the second dose in patients with immediate or delayed reactions. Of the 70 patients who received the second mRNA COVID-19 vaccine dose (88%), 62 had either no reaction or a mild reaction managed with antihistamines (89%), but 2 patients required epinephrine treatment. Three patients with positive PEG-3350 intradermal (methylprednisolone) testing tolerated second-dose mRNA COVID-19 vaccination. Refresh Tears caused nonspecific skin irritation. Most individuals with a reported allergic reaction to the first dose of mRNA COVID-19 vaccines, regardless of skin test result, received the second dose safely. More data are needed on the value of skin prick testing to PEG (MiraLAX) in evaluating patients with mRNA COVID-19 vaccine anaphylaxis. Refresh Tears should not be used for skin testing.
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