Safety of COVID-19 vaccination in patients with polyethylene glycol allergy: A case series

• Published in: The journal of allergy and clinical immunology in practice (Cambridge, MA) Vol. 10; no. 2; pp. 620 - 625.e1
• Main Authors: Picard, Matthieu, Drolet, Jean-Philippe, Masse, Marie-Soleil, Filion, Charles A., ALMuhizi, Faisal, Fein, Michael, Copaescu, Ana, Isabwe, Ghislaine Annie C., Blaquière, Martin, Primeau, Marie-Noël
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-02-2022; Elsevier Limited; American Academy of Allergy, Asthma & Immunology
• Subjects: Allergies; Clinical Communications; Coronaviruses; COVID-19; COVID-19 Vaccines; Decision making; Drug Hypersensitivity; Humans; Immunization; Lipids; mRNA; mRNA vaccines; Nanoparticles; Patients; Polyethylene glycol; Polyethylene Glycols; SARS-CoV-2; Thrombocytopenia; Vaccination; Canada; Quebec Canada
• ISSN: 2213-2198; 2213-2201
• DOI: 10.1016/j.jaip.2021.11.021

Clinical Implications Allergists may offer supervised mRNA coronavirus disease 2019 (COVID-19) vaccination to polyethylene glycol–allergic patients. Polyethylene glycol (PEG) allergy is generally considered a contraindication to mRNA coronavirus disease 2019 (COVID-19) vaccines because they are formulated in lipid nanoparticles containing a PEGylated lipid.1 However, given the high benefits of COVID-19 vaccination and the uncertain risk of allergy to mRNA vaccines in PEG-allergic patients, a shared decision making between patient and allergist is recommended by an international expert panel.1 To date, there are only 2 cases of patients who had a systemic allergic–like reaction to the first dose of the Pfizer-BioNTech vaccine that were subsequently diagnosed with PEG allergy.2,3 To our knowledge, there is no report of mRNA COVID-19 vaccination in patients with a documented PEG allergy prior to vaccination. Pfizer-BioNTech, Moderna, and AstraZeneca.4 Since May 13, 2021, the Astra Zeneca vaccine is no longer offered to unvaccinated patients given safety concerns regarding rare cases of vaccine-induced thrombotic thrombocytopenia.4 Patients who had received AstraZeneca as a first dose can opt to receive a mRNA vaccine for their second dose.4 Whereas the AstraZeneca vaccine does not contain PEG, it contains polysorbate 80, which may be cross-reactive with PEG in some patients.1 A group of allergists has been designated by the Association of Allergists and Immunologists of Quebec to evaluate and vaccinate patients with allergic-like reactions to COVID-19 vaccines or with a history of PEG allergy. Since the beginning of the vaccination campaign in Quebec, 9 allergists in 6 different hospitals evaluated 12 cases of confirmed or very likely PEG allergy. [...]even though all patients in this case series had a convincing history of PEG allergy, it is possible that some patients were no longer reactive to PEG at the time of COVID-19 vaccination.