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. 2022 Jul;77(7):2200-2210.
doi: 10.1111/all.15183. Epub 2021 Dec 4.

Experience with polyethylene glycol allergy-guided risk management for COVID-19 vaccine anaphylaxis

Knut Brockow  1 , Sonja Mathes  1 , Jörg Fischer  2   3 , Sebastian Volc  2 , Ulf Darsow  1 , Bernadette Eberlein  1 , Tilo Biedermann  1
Affiliations

Experience with polyethylene glycol allergy-guided risk management for COVID-19 vaccine anaphylaxis

Knut Brockow et al. Allergy. 2022 Jul.

Abstract

Background: Polyethylene glycol (PEG) may elicit anaphylaxis to COVID-19 mRNA vaccines, and guidance for patients at risk is needed.

Methods: In retrospective patients with PEG allergy collected from 2006 till 2019, clinical, skin, and basophil activation test (BAT) characteristics discriminative for PEG allergy were analyzed and compared with the literature. In 421 prospective real-life patients asking for allergy workup for COVID-19 vaccine hypersensitivity in 2020/2021, risk assessment was performed and tolerance of the recommended vaccination approach was assessed.

Results: Ten patients with PEG allergy were found in the retrospective cohort. Patients reacted with immediate anaphylaxis (100%) not only to PEG-based laxatives/bowel preparations or injections, but also to cold medication, antiseptics, analgetics, or antibiotics. Skin tests ± BAT with PEG ± elicitors were positive in 10/10. Provocation tests were positive in 7/9 patients. From the prospective cohort, 370/421 patients self-reporting increased risk for vaccine allergy lacked criteria necessitating allergy workup and were recommended for routine vaccination. A total of 51/421 patients were tested, and three (6%) with PEG allergy were identified, whereas 48 patients remained negative in skin tests. Vaccination was recommended in all those patients. No hypersensitivity reactions were reported to vaccination including six PEG-allergic patients tolerating COVID-19 vaccination.

Conclusions: Taking a detailed history excluded PEG allergy in most referred patients and enabled direct safe vaccination. Immediate urticaria/anaphylaxis to typical elicitors identified patients requiring PEG allergy workup. Skin tests ± BAT identified PEG allergy and helped to select the vaccine and the vaccination approach. Even PEG-allergic patients can tolerate COVID-19 vaccines.

Keywords: COVID-19; allergy; allergy testing; hypersensitivity; polyethylene glycol.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow chart of patients evaluated requesting allergy diagnostics regarding vaccination against COVID‐19 and tolerating vaccination. # Patients with immediate urticaria or anaphylaxis‐like reaction as a precaution for safety in case of non‐allergic hypersensitivity; *patients who did not want to be vaccinated; §patients not reporting despite call to report any hypersensitivity reaction
FIGURE 2
FIGURE 2
Skin test and basophil test results (A: Comirnaty® diluted 1:5, B: Moderna diluted 1:5, C: Vaxzevria® diluted 1%) in a patient with skin test‐confirmed PEG allergy who was successfully vaccinated with Vaxzevria®
See this image and copyright information in PMC

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