The conundrum of COVID-19 mRNA vaccine-induced anaphylaxis

被引:14
作者
Khalid, Muhammad Bilal [1 ]
Frischmeyer-Guerrerio, Pamela A. [1 ]
机构
[1] NIAID, Lab Allerg Dis, Food Allergy Res Sect, NIH, MSC 1881,10 Ctr Dr, Bethesda, MD 20892 USA
基金
美国国家卫生研究院;
关键词
COVID-19; mRNA; vaccine; anaphylaxis; immunization stress-related response; ISRR; allergy; allergic reaction; polyeth-ylene glycol; PEG; IMMEDIATE-TYPE HYPERSENSITIVITY; PRACTICE PARAMETER UPDATE; POLYETHYLENE-GLYCOL; MECHANISMS; MASTOCYTOSIS; ANTIBODIES; SYMPTOMS; ALLERGY; UTILITY; SAFETY;
D O I
10.1016/j.jacig.2022.10.003
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
Novel messenger RNA (mRNA) vaccines have proven to be effective tools against coronavirus disease 2019, and they have changed the course of the pandemic. However, early reports of mRNA vaccine-induced anaphylaxis resulted in public alarm, contributing toward vaccine hesitancy. Although initial reports were concerning for an unusually high rate of anaphylaxis to the mRNA vaccines, the true incidence is likely comparable with other vaccines. These reactions occurred predominantly in young to middle-aged females, and many had a history of allergies. Although initially thought to be triggered by polyethylene glycol (PEG), lack of reproducibility of these reactions with subsequent dosing and absent PEG sensitization point away from an IgE-mediated PEG allergy in most. PEG skin testing has poor posttest probability and should be reserved for evaluating non-vaccine-related PEG allergy without influencing decisions for subsequent mRNA vaccination. Immunization stress-related response can closely mimic vaccine-induced anaphylaxis and warrants consideration as a potential etiology. Current evidence suggests that many individuals who developed anaphylaxis to the first dose of an mRNA vaccine can likely receive a subsequent dose after careful evaluation. The need to understand these reactions mechanistically remains critical because the mRNA platform is rapidly finding its way into other vaccinations and therapeutics. (J Clin Immunol Global 2023;2:1-13.)
引用
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页码:1 / 13
页数:13
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