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mRNA Vaccines to Prevent COVID-19 Disease and Reported Allergic Reactions: Current Evidence and Suggested Approach

2020; Elsevier BV; Volume: 9; Issue: 4 Linguagem: Inglês

10.1016/j.jaip.2020.12.047

2213-2201

Aleena Banerji, Paige G. Wickner, Rebecca R. Saff, Cosby A. Stone, Lacey B. Robinson, Aidan A. Long, Anna R. Wolfson, Paul V. Williams, David A. Khan, Elizabeth Phillips, Kimberly G. Blumenthal,

RNA Interference and Gene Delivery

To date, allergic reactions to vaccines have been rare and often attributed to various vaccine components. Current reports from the CDC suggest that anaphylactic reactions to the Pfizer-BioNTech mRNA vaccine may occur more frequently than seen with other vaccines. Therefore, to support large-scale COVID-19 vaccine rollout programs, allergists can offer clinical phenotyping, risk stratification, and clear recommendations based on the best available information to date. At this point in time, the etiology of reactions to the Pfizer-BioNTech and Moderna mRNA vaccines is not clear. Avoidance of both mRNA COVID-19 vaccines in individuals with a history of anaphylaxis to PEG, PEG derivatives or polysorbate is recommended by the CDC. However, understanding the negative and positive predictive value of skin testing to PEG and polysorbate may play an important role in future risk stratification as many vaccines contain these excipients. Although these challenges require attention immediately during the current vaccination process, it is of equal importance that we must also design and conduct adequately powered studies to investigate the potential mechanistic etiology of these reactions. We need to understand the safety issues surrounding these vaccines, because the success of this mRNA vaccine platform is foundational to the flexibility of the COVID-19 response and our response to other viruses with similar vaccines in phase I and II trials. We must also remain vigilant to the rare potential for PEG sensitization to occur as individuals are receiving 2 doses of vaccine with PEG2000 in close succession and the mechanism for PEG sensitization leading to PEG allergy has not been determined.