COVID-19 vaccines: anaphylaxis and anxiety : A case study from an allergy unit

Abstract

Background: Vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) was one crucial element to overcome the coronavirus disease 2019 (COVID-19) pandemic. Even though anaphylaxis to vaccines is rare, 47 patients came to the Allergy Unit at the University Hospital Graz, Austria, reporting immediate anaphylactoid symptoms after administration of COVID-19 vaccines. In addition, 29 patients with known drug-induced anaphylaxis wanted to be tested for a possible sensitization against COVID-19 vaccines or excipients, such as polyethylene glycol (PEG) or polysorbate 80 (PS80) before the first COVID-19 vaccination. Skin prick tests and intradermal tests were performed in all 76 patients, mostly using PEG 2000, and/or PS80. Skin prick tests with COVID-19 vaccines were performed depending on availability.

Objective: Our aim was to characterize this patient cohort in terms of patients' anaphylactoid responses, their willingness to future vaccinations against SARS-Cov‑2, and reasons for their decision.

Methods: We developed a questionnaire and analyzed 34 completed copies.

Results: Of the 47 patients with anaphylactoid reactions to COVID-19 vaccination, most were female (40 female/7 male). The skin tests, even when performed with the respective COVID-19 vaccine, were negative in all but one patient. Most patients who experienced anaphylactoid reactions after a COVID-19 vaccination, did not want another COVID-19 vaccination at the time of answering the questionnaire because of anxiety for another anaphylactoid response at the next shot. Premedication with antihistamines significantly lowered (n = 74 vaccinations) the severity of anaphylactoid responses after COVID-19 vaccinations.

Conclusion: Anxiety about another anaphylactoid episode hinders patients to be vaccinated against SARS-CoV‑2 again. Premedication with antihistamines and collaboration of allergologists with psychologists might lower the risk of an anaphylactic/anaphylactoid response as well anxiety in drug-induced anaphylactic patients.

Keywords: Anaphylactoid; Antihistamine; Intradermal test; Polyethylene glycol; Questionnaire.

Fig. 1

Overview of the study and general participant characteristics. a Study layout, b sex distribution and c age distribution of the 34 study participants. COVID-19 coronavirus disease 2019

Fig. 2

Anaphylactoid reactions after coronavirus disease 2019 (COVID-19) vaccinations. a Anaphylactoid reactions to COVID-19 vaccination and premedication before and after consultation, b comparison of doctor’s and patient’s anaphylaxis grading for COVID-19 vaccinations before consultation, c severity of self-reported anaphylactic reactions to COVID-19 vaccines of all vaccinations received by the study participants, without versus with AH premedication. Group comparison was performed using non-parametric Mann-Whitney test; the P-value is indicated, d data of c broken down per vaccine brand. ana. Anaphylaxis or anaphylactoid reaction, AH antihistamine

Fig. 3

Potential sensitizations to polyethylene glycol (PEG), polysorbate 80 (PS80) or other triggers. a Evaluation of pre-exposures and additional anaphylactoid experience, b radar graph indicating study participants with possible polysensitization, c additional triggers of anaphylactoid reactions reported by the study participants. ana. anaphylaxis or anaphylactoid reaction, COVID-19 coronavirus disease 2019

Fig. 4

Anxiety and willingness concerning future coronavirus disease 2019 (COVID-19) vaccination (vacc). a Anxiety to experience an anaphylaxis in general, before they had their reaction to COVID-19 vaccination, since their reaction to COVID-19 vaccination and whether anxiety is strong, b correlation of anxiety to experience another anaphylactic or anaphylactoid episode and willingness to vaccinate against COVID-19 in the future