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Review
. 2022 Jul;129(1):40-51.
doi: 10.1016/j.anai.2022.03.030. Epub 2022 Apr 4.

What have we learned about the allergenicity and adverse reactions associated with the severe acute respiratory syndrome coronavirus 2 vaccines: One year later

Ana M Copaescu  1 , Jaime S Rosa Duque  2 , Elizabeth Jane Phillips  3
Affiliations
Review

What have we learned about the allergenicity and adverse reactions associated with the severe acute respiratory syndrome coronavirus 2 vaccines: One year later

Ana M Copaescu et al. Ann Allergy Asthma Immunol. 2022 Jul.

Abstract

Objective: The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to the most rapid response and scale-up in vaccine and therapeutic development in history. We highlight the history of these amazing achievements with a focus on the description of the classification and mechanisms of allergic reactions and adverse events relevant to the allergist and immunologist that have been associated with the SARS-CoV-2 vaccines. Finally, we offer a detailed management approach in the context of a possible allergic reaction.

Data sources: Using defined search strategy, we identified peer-reviewed articles within PubMed that were published between January 1, 2019, and December 4, 2021.

Study selections: All recent articles on COVID-19 published in English were reviewed with focus on the immunogenicity and allergenicity of the current existing COVID-19 vaccines.

Results: Following a detailed literature review, we discuss the evolution and development of the new vaccines for SARS-CoV-2. Furthermore, we provide evidence regarding the significance and mechanisms of allergic reactions associated with the vaccines and offer a management approach for those with an increased risk of presenting an allergic or other relevant vaccine reaction.

Conclusion: The international rollout of COVID-19 vaccination started with reports of immediate allergic reactions. Although we still need to understand the mechanisms of these reactions, we can be reassured that patients with underlying allergic disease will not need to avoid SARS-CoV-2 vaccination. In addition, the vast majority of those with a first-dose reaction will tolerate subsequent doses.

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Figures

Figure 1
Figure 1
Timeline of COVID-19 vaccines and therapeutics. COVID-19, coronavirus disease 2019; EUA, emergency use authorization; FDA, Food and Drug Administration; PEG, polyethylene glycol; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; WHO, World Health Organization.
Figure 2
Figure 2
Classification of COVID-19 vaccine reactions. CARPA, complement activation-related pseudoallergy; COVID-19, coronavirus disease 2019; MRGPRX2, Mas-related G protein-coupled receptor-X2; mRNA, messenger ribonucleic acid; PEG, polyethylene glycol; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.
Figure 3
Figure 3
. Management approach.
See this image and copyright information in PMC

References

    1. World Health Organization. WHO coronavirus (COVID-19). 2021. Available at: https://covid19.who.int/2021. Accessed January 15, 2022.
    1. Copaescu A, Smibert O, Gibson A, Phillips EJ, Trubiano JA. The role of IL-6 and other mediators in the cytokine storm associated with SARS-CoV-2 infection. J Allergy Clin Immunol. 2020;146(3):518–534. e1. - PMC - PubMed
    1. Hou H, Zhang Y, Tang G, Luo Y, Liu W, Cheng C, et al. Immunologic memory to SARS-CoV-2 in convalescent COVID-19 patients at 1 year postinfection. J Allergy Clin Immunol. 2021;148(6):1481–1492. e2. - PMC - PubMed
    1. Stone CA, Jr, Rukasin CRF, Beachkofsky TM, Phillips EJ. Immune-mediated adverse reactions to vaccines. Br J Clin Pharmacol. 2019;85(12):2694–2706. - PMC - PubMed
    1. Castells MC, Phillips EJ. Maintaining safety with SARS-CoV-2 vaccines. N Engl J Med. 2021;384(7):643–649. - PMC - PubMed

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