AstraZeneca ChAdOx1-S COVID-19 Vaccine Can Be Safely Administered in Patients with EDTA Allergy

2021 ◽  
Author(s):  
Syed Basharat Ali ◽  
Griffith Perkins ◽  
Dongjae Ryoo ◽  
Maverick Lee ◽  
Matthew Tunbridge ◽  
...  
Keyword(s):  
Skin Testing ◽  
Local Anaesthetics ◽  
Intradermal Test ◽  
Disodium Edta ◽  
Immediate Hypersensitivity ◽  
Positive Skin ◽  
Radiocontrast Media ◽  
Oral Medications ◽  
Ethylenediaminetetracetic Acid ◽  
History Of

Abstract Background: Immediate hypersensitivity reactions to COVID-19 vaccines have been postulated to be linked to their excipients, such as polyethylene glycol (PEG) in Pfizer Comirnaty, or polysorbate 80 and ethylenediaminetetracetic acid (EDTA) in AstraZeneca ChAdOx1-S [recombinant] (Vaxzevria). These excipients are potentially found in a range of other products, including injectable and oral medications as well as intravenous radiocontrast media (RCM) and various cosmetic products.Currently patients with proven excipient allergy may be advised to avoid a COVID-19 vaccine containing that excipient and/or potentially cross-reactive excipients. We present two cases of previously confirmed EDTA anaphylaxis, who had negative Vaxzevria vaccine in-vivo testing and subsequently tolerated the vaccine.Case 1: A patient with history of anaphylaxis to RCM and local anaesthetics (LA) had positive intradermal test (IDT) to EDTA nine years earlier. Skin testing to Vaxzeria vaccine (up to 1:10 IDT), Comirnaty vaccine (up to 1:10 IDT) and EDTA 0.3mg/mL IDT were negative. However, following EDTA 3mg/ml IDT, he developed immediate generalised urticaria without anaphylaxis. Basophil activation testing was negative to disodium EDTA, Vaxzevria and Cominarty vaccines. Given the negative in-vitro and in-vivo testing to Vaxzevria vaccine, he proceeded to Vaxzevria immunisation and tolerated both doses.Case 2: A patient with history of anaphylaxis to RCM had positive skin testing to EDTA and RCM containing EDTA six years earlier. Following referral to COVID19 vaccine clinic, Vaxzevria vaccine (1:10 IDT) and Cominarty vaccine (1:10 IDT) were negative whilst EDTA was positive at 0.3mg/mL IDT. He subsequently tolerated both Vaxzevria vaccinations.Conclusion: Excipient allergy does not necessarily preclude a patient from receiving a vaccine containing that excipient. Allergy testing can help identify excipient-allergic patients who may still tolerate vaccination, which is important in situations where COVID-19 vaccination options are limited.

Skin Testing for Penicillin Allergy: Its Limited Value

PEDIATRICS ◽  
1973 ◽  
Vol 52 (2) ◽  
pp. 309-309
Author(s):  
Renee K. Bergner
Keyword(s):  
American Academy ◽  
Skin Testing ◽  
Skin Tests ◽  
Penicillin G ◽  
Study Group ◽  
Immediate Hypersensitivity ◽  
Positive Skin ◽  
American Academy Of Pediatrics ◽  
History Of ◽  
Therapeutic Administration

In its statement, "Anaphylaxis," The American Academy of Pediatrics Committee on Drugs states in part: "If there is a possibility of sensitivity to . . . penicillin, skin testing for immediate hypersensitivity to the agent should be performed prior to its therapeutic administration."1 The Penicillin Study Group of the American Academy of Allergy reported in 1971 that only 17 (30.4%) of 56 patients with a history of immediate (including anaphylactic) reactions to penicillin exhibited positive skin tests to penicillin G.2

THE CUTANEOUS REACTION TO EGGWHITE

PEDIATRICS ◽  
1959 ◽  
Vol 24 (6) ◽  
pp. 1009-1015
Author(s):  
Richard L. London ◽  
Jerome Glaser
Keyword(s):  
Skin Test ◽  
Skin Testing ◽  
Intradermal Test ◽  
Skin Tests ◽  
Etiologic Factor ◽  
Initial Reaction ◽  
Age Group ◽  
Positive Skin ◽  
Clinical Sensitivity ◽  
Number Of Patients

A study of 400 allergic patients of all ages, who were skin tested with eggwhite, is reported. The authors agree with those who believe that a positive reaction in infants who have in no known way been exposed to eggwhite after birth is in all probability due to intrauterine sensitization. There is a possibility, however, that some reactions to eggwhite may be due to a primary histamine or serotonin releasing substance present in the eggwhite which has no relationship to antigen-antibody reaction. The circumstances under which this takes place are not known. In all age groups the family history was positive in about 65% of cases. It was surprising to find, in view of previous opinions, that in the youngest age group (infants up to 2 years of age), the skin test was positive in less than half the patients (42%) in the presence of clinical sensitivity. It was also unexpected to find that the number of patients clinically sensitive to eggwhite but giving negative skin tests increased as age advanced. This justifies the common practice of eliminating egg as a trial measure in the diet of the first age group, regardless of the results of skin testing, and suggests that this should be done in any age group where food is considered a possible etiologic factor. In the youngest age group somewhat more than one-third (34%) of the patients reacted positively to eggwhite but were not clinically sensitive. This finding was completely unexpected as it had been thought that in this age group a positive skin test to eggwhite was practically pathognomonic of clinical sensitivity. In this study more positive reactions in children to eggwhite were obtained (70.5%) than in a somewhat comparable series where the incidence was much less (20%). We attribute this to the fact that in our series both scratch and intradermal tests were made while in the other series only scratch tests were done. This reflects the greater sensitivity of the intradermal test. Only about half the patients of all ages who react to eggwhite are also clinically sensitive. Attention is drawn to a theory which explains why a positive cutaneous test to a food, as eggwhite, may be clinically significant in atopic dermatitis even though the test (wheal reaction) does not reproduce the type of dermatitis being studied. There was no definite evidence, because the number of cases studied is far too small, to indicate that the severity of asthma which may ultimately develop in infants not asthmatic at the time of skin testing is proportional to the strength of the initial reaction to eggwhite.

scholarly journals The intradermal test in whooping cough a review, with a study of 1300 cases

1938 ◽  
Vol 38 (1) ◽  
pp. 104-119 ◽  
Author(s):  
A. R. Thompson
Keyword(s):  
Whooping Cough ◽  
Past History ◽  
Skin Testing ◽  
Intradermal Test ◽  
Causative Organism ◽  
Virus Diseases ◽  
Clear Cut ◽  
History Of ◽  
The Individual ◽  
The Ideal

The literature dealing with the intradermal test in whooping cough has been reviewed, and the claims as to the specific value of the test have been investigated in 1300 cases.A method for the extraction of endotoxin fromHaemophilus pertussishas been described and the intradermal response to this preparation compared with that following whole vaccine.The findings in this investigation do not support the claim that the intradermal response to Sauer's vaccine in the strength commonly employed (10,000 million organisms per c.c.) is of value either in demonstrating immunity to whooping cough or in the early diagnosis of this disease. The bacterial content of this vaccine appears to be too high for skin-testing purposes, giving rise to inflammatory lesions of a non-specific character rather than to allergic reactions of specific value. These reactions are less apparent when the vaccine is employed in a diluted form.The intradermal response to pertussis endotoxin, on the other hand, though not invariably consisting of a clear-cut reaction (and in this respect falling short of the ideal as a reagent) is more consistent with the development of the allergic state towardsH. pertussis, reactions presumably of this nature being present in the skin of approximately 85% of children with a past history of whooping cough. Similar reactions, however, can be elicited in the skin of about 30% of individuals with no history of the disease; but in view of the fact that, unlike the more invasive virus diseases, many individuals never develop whooping cough in spite of almost certain exposure when young, it is suggested that latent immunization or recent contact with the causative organism might account for this phenomenon. Whether these reactions indicate merely sensitization or a definite immunity to pertussis must remain, for the time being,sub judice.The onset of bacterial hypersensitiveness, as judged by the pertussis endotoxin test, appears about the 10th day of whooping cough and becomes heightened during the subsequent course of the disease. Ultimately this cutaneous allergy undergoes a regression, which, however, is not always complete. For this reason the pertussis endotoxin test would appear to be of some value in assessing the immune state of the individual, and also as a diagnostic reaction in early, atypical or late cases of whooping cough where bacteriological findings by the cough plate method have proved disappointing.

scholarly journals Anaphylaxis After the Covid-19 Vaccine in a Patient With Cholinergic Urticaria

2021 ◽  
Author(s):  
Hyun J Park ◽  
Jay R Montgomery ◽  
Nathan A Boggs
Keyword(s):  
Mast Cell ◽  
Standardized Testing ◽  
Medical Center ◽  
Skin Testing ◽  
Vaccine Dose ◽  
Immediate Hypersensitivity ◽  
Patient History ◽  
Cholinergic Urticaria ◽  
History Of ◽  
Hypersensitivity Skin

ABSTRACT Cholinergic urticaria is a common disorder that has been associated with anaphylaxis. We report the events, workup, and eventual second dose vaccination of a patient at the Walter Reed National Military Medical Center, who had immediate anaphylaxis after administration of the first Pfizer-BioNTech Covid-19 (BNT162b2) vaccine dose. During the initial evaluation after anaphylaxis, the patient described a history of symptoms suspicious for cholinergic urticaria but had never had this condition confirmed with standardized testing. After the episode of anaphylaxis, we performed several studies including immediate hypersensitivity skin testing, which did not demonstrate vaccine or component sensitization. We then performed an exercise provocation challenge and confirmed the diagnosis of cholinergic urticaria. These results, combined with the patient history, suggested that the episode of anaphylaxis was most likely driven by a severe flare of cholinergic urticaria. After obtaining the patient’s consent, she received and tolerated her second dose without any objective findings of anaphylaxis. We conclude that patients with mast cell disorders or anaphylaxis after their first Covid-19 immunization will benefit from referral to an allergist since receipt of their second Covid-19 immunization may be possible.

scholarly journals Comparison of Subject-Reported Allergy versus Skin Test Results in a Common Cold Trial

2003 ◽  
Vol 17 (3) ◽  
pp. 159-162
Author(s):  
Jason S. Krahnke ◽  
Deborah A. Gentile ◽  
Kelly M. Cordoro ◽  
Betty L. Angelini ◽  
Sheldon A. Cohen ◽  
...  
Keyword(s):  
Skin Test ◽  
Common Cold ◽  
Skin Testing ◽  
Positive Skin Test ◽  
Poor Correlation ◽  
Test Results ◽  
Positive Skin ◽  
Test Response ◽  
History Of ◽  
Allergy Skin Testing

Background Few studies have examined the relationship between subject-reported allergy and results of allergy skin testing in large unselected or unbiased cohorts. The objective of this study was to compare the results of self-reported allergy via verbal questioning with the results of allergy skin testing by the puncture method in 237 healthy adult subjects enrolled in a common cold study. Methods On enrollment, all subjects were verbally asked if they had a history of allergy and then underwent puncture skin testing to 19 relevant aeroallergens, as well as appropriate positive and negative controls. A skin test was considered positive if its wheal diameter was at least 3 mm larger than that obtained with the negative control. Results Forty-eight (20%) subjects reported a history of allergy and 124 (52%) subjects had at least one positive skin test response. A history of allergy was reported in 40 (32%) of the skin test-positive subjects and 8 (7%) of the skin test-negative subjects. At least one positive skin test response was found in 40 (83%) of those subjects reporting a history of allergy and 84 (44%) of those subjects denying a history of allergy. Conclusion These data indicate that there is a relatively poor correlation between self-reported history of allergy and skin test results in subjects enrolled in a common cold study. These results have implications in both clinical practice and research settings.

scholarly journals Sodium metabisulfite hypersensitivity in urticaria

2021 ◽  
Vol 12 (2) ◽  
pp. 106-112
Author(s):  
Beata Sadowska ◽  
Marlena Sztormowska ◽  
Marika Gawinowska ◽  
Marta Chelminska
Keyword(s):  
Skin Testing ◽  
Food Additives ◽  
Oral Challenge ◽  
Skin Tests ◽  
Sodium Metabisulfite ◽  
Positive Skin ◽  
Patch Tests ◽  
Detailed Medical History ◽  
History Of ◽  
Skin Prick Tests

Background: Sodium metabisulfite is a recognized, but rare, trigger of urticaria, wherein the IgE mechanism has been sporadically proven. The aim of this study was to identify the potential reaction to sodium metabisulfite (MBS) based on a placebo-controlled oral challenge in patients with urticaria and suspected hypersensitivity to food additives. Materials and Methods: A total of 110 adult patients (76 females and 34 males with a mean age of 46 years) were included in the study between 2017 and 2019. All subjects underwent MBS skin prick tests (SPT) and patch tests (PT). Patients with a positive skin test or suspected MBS hypersensitivity were qualified for a placebo-controlled oral challenge (OC). Results: Skin testing was positive in 24 patients: SPT in 20% (n = 22), PT in 5% (n = 6). Out of 64 oral challenges, 13 positive results were obtained. Patients with a positive challenge typed sulfite foods twice as often as a culprit compared to those with a negative OC. Conclusions: In patients with urticaria, both the IgE and non-IgE mechanism of MBS hypersensitivity has been demonstrated. Skin tests with a detailed medical history of potentially guilty foods may be helpful in determining sulfite hypersensitivity.

scholarly journals Etiology and immediate drug hypersensitivity in acute urticaria: a retrospective study

2019 ◽  
Vol 5 (2) ◽  
pp. 314
Author(s):  
Priya Prabhakaran Nair
Keyword(s):  
Drug Hypersensitivity ◽  
Physical Contact ◽  
Intradermal Test ◽  
Immediate Hypersensitivity ◽  
Test Report ◽  
Dermatology Department ◽  
Acute Urticaria ◽  
Drug Test ◽  
Immune Mediated ◽  
History Of

<p class="abstract"><strong>Background:</strong> Acute urticaria is an immune mediated or non-immune reaction lasting for less than 6 weeks. This can be caused by food, drugs, infections, physical contact, insect bite but majority are reported to be idiopathic. Theoretically, almost any drug can cause urticaria especially antibiotics like penicillin. We carried out this study to assess the various etiologial factors and to assess the immediate hypersensitivity reaction to various drugs in acute urticaria.</p><p class="abstract"><strong>Methods:</strong> We reviewed the medical records of patients with acute urticaria in dermatology department from 2016 to 2018 (2 years) and recorded the demographic details, history of suspected cause, medications and intradermal drug test report in a standard proforma.<strong></strong></p><p class="abstract"><strong>Results:</strong> There were 154 cases of acute urticaria. Mean age of these cases were 36.48±11.37 years. 13.6% had associated angioedema. Mean duration of urticaria was 21.74±7.92 days. 40.9% cases were labelled idiopathic. Food accounted for 29.2% of the cases, drugs for 23.4% and infection for 5.2%. The rest 1.3% were due to insect bite. Intradermal drug test report showed the following frequency of positive reaction: diclofenac&gt;ciprofloxacin= piroxicam&gt;paracetamol=ketamine=diazepam&gt;promethazine=atracurium.</p><p class="abstract"><strong>Conclusions:</strong> Most cases of acute urticaria were idiopathic whereas food, drugs, infections and insect bite were the specific causes. Fish among food, acetaminophen among drugs and streptococci among infections were most responsible agents. Immediate hypersensitivity to drugs in intradermal test were maximum for NSAIDs especially diclofenac and piroxicam followed by antibiotic namely ciprofloxacin in patients with acute urticaria.</p>

scholarly journals Management and outcome of suspected and confirmed COVID-19 (SARS-CoV-2) vaccine hypersensitivity.

2021 ◽  
Author(s):  
Margitta Worm ◽  
A. Alexiou ◽  
Andrea Bauer ◽  
Regina Treudler ◽  
Gerda Wurpts ◽  
...  
Keyword(s):  
Gastrointestinal Symptoms ◽  
Female Gender ◽  
Immediate Hypersensitivity ◽  
Positive Skin ◽  
Vector Vaccine ◽  
Skin Symptoms ◽  
Cutaneous Symptom ◽  
History Of ◽  
Ige Mediated ◽  
Definition Of

Systemic allergic reactions to vaccines are very rare. In this study we assessed the management and outcome suspected SARS-CoV-2 vaccine hypersensitivity. We present data of 219 individuals, who experienced symptoms suspicious for an allergic reaction after the first (n=214) or the second vaccination (n=5). 195 reactions occurred after the first application of mRNA-based vaccines (157 Comirnaty®, and 38 Spikevax®) and eighteen reactions were reported after first application of a vector vaccine (Vaxzevria®). Of these 162 experienced immediate symptoms. Skin symptoms occurred in 91 cases. The most frequent cutaneous symptom was angioedema (n=45), followed by generalized urticaria (n=36) and generalized erythema/flush (n=20). 70 patients had cardiovascular symptoms, 45 showed respiratory symptoms and gastrointestinal symptoms were recorded in 14 patients. The allergological assessment of 334 individuals (219 with reactions after COVID vaccination and 115 with a history of vaccine related reactions) showed in 17% a suspicion of sensitization against the SARS-CoV-2 vaccine and/or their ingredients defined as one positive skin test and/or BAT. The majority of the SPT/IDT with the vaccines were negative. Of the 214 patients with suspected allergic symptoms after the first vaccination, 67/67 patients tolerated the re-vaccination. In this study, 334 individuals of a cohort resembling >2000 persons presenting for an allergy workup regarding SARS-CoV-2 vaccination only 45 were diagnosed in concordance with the anaphylaxis definition of the Brighton collaboration with anaphylactic immediate hypersensitivity reaction after SARS-CoV-2 vaccination. Identifiable characteristics of these patients with suspected, but also diagnosed SARS-CoV-2 vaccine hypersensitivity were female gender and the symptom angioedema. Overall, IgE-mediated hypersensitivity towards SARS-CoV-2 vaccines is extremely low and not increased in comparison to the reported hypersensitivity for other vaccines.

scholarly journals The Role of Skin Tests and Premedication in Radiocontrast Media Hypersensitivity: A Clinical Dilemma

2021 ◽  
Vol 19 (2) ◽  
pp. 78-83
Author(s):  
Özge Can Bostan ◽  
Mehmet Erdem Çakmak ◽  
Saltuk Buğra Kaya ◽  
Ebru Damadoğlu ◽  
Gül Karakaya ◽  
...  
Keyword(s):  
Skin Testing ◽  
Intradermal Test ◽  
Skin Tests ◽  
Clinical Value ◽  
Radiocontrast Media ◽  
Iodinated Contrast ◽  
Culprit Drug ◽  
Keywords Allergy ◽  
Clinical Dilemma

ABSTRACT Objective: Controversies continue over the diagnostic approach, prediction, and premedication in radiocontrast media (RCM) hypersensitivity. One of the most important problems encountered in daily clinical practice is that patients do not recall which contrast agent has been used in previous exposures. Also, in most cases, the details of the reaction have not been recorded. Therefore, difficulties are experienced in decision-making about skin testing and premedication in patients who are suspected of RCM hypersensitivity. To assess the clinical value of skin tests and premedication in RCM hypersensitivity. Materials and Methods: A retrospective evaluation was made of the medical records of patients between October 2014 and December 2019. The skin tests were performed with the culprit agent if it was known, otherwise, with iohexol, one of the most commonly used RCM in Turkey. As premedication, oral methylprednisolone 40 mg 13-7-1 hours before the procedure and oral pheniramine 22.7 mg 1 hour before the procedure were prescribed. Results: A total of 41 patients were evaluated (32 females and 9 males). Of the reactions, 35 (85.4%) were immediate and 6 (14.6%) were non-immediate. Three (7.3%) had a positive intradermal test result. It was determined that 20 patients (17 immediate, 3 non- immediate), required imaging with RCM again. Of these, 18 received premedication and two did not, although it was recommended. Of the patients who received premedication, one (5.5%) had an urticarial reaction of the same grade, while both patients (100%) who did not receive premedication developed an immediate allergic reaction that was of a similar grade to that of the previous reaction. Conclusion: Skin test positivity for RCM was observed at low rates. In cases with negative skin tests and when the culprit drug cannot be identified, re-exposure to alternative RCM under premedication may reduce the risk of the reaction. Keywords: Allergy, iodinated contrast media, iobitridol, iohexol, premedication

scholarly journals Pre-vaccination allergy testing with COVID-19 mRNA vaccines predicts tolerance

2021 ◽  
Author(s):  
Florian Stehlin ◽  
Rima Mahdi-Aljedani ◽  
Loris Canton ◽  
Véronique Monzambani-Banderet ◽  
Alix Miauton ◽  
...  
Keyword(s):  
Acute Asthma ◽  
Skin Testing ◽  
Skin Tests ◽  
Positive Skin ◽  
Post Vaccination ◽  
Vaccination Protocol ◽  
Acute Asthma Exacerbation ◽  
History Of ◽  
Negative Skin Test ◽  
Dependent Mechanism

Background: The newly developed mRNA-based COVID-19 vaccines can provoke anaphylaxis, possibly induced by polyethylene glycol (PEG) contained in the vaccine. The management of persons with a history of PEG allergy, or with an allergic-like reaction after the first dose remains to be defined.  Methods: We studied two cohorts of individuals: one pre-vaccination, the second post-vaccination. Skin testing was performed with COVID-19 mRNA vaccines. Upon negative skin test, a two-step (10%-90%) vaccination protocol was performed. Positive skin tests were confirmed with basophil activation tests (BAT). Vaccine-sensitized patients were offered a five-step induction protocol. Results: We identified 187 patients with high-risk profiles for developing anaphylaxis. In parallel, among 385’926 doses of vaccine, 87 allergic-like reactions were reported to our division for further investigations: 18/87 (21%) were consistent with anaphylaxis, 78/87 (90%) were female, and 47/87 (54%) received the BNT162b2 mRNA vaccine. Vaccine skin tests were negative in 96% and 76% in the pre- and post-vaccination cohorts, respectively. A two-step vaccination was tolerated in 232/236 (98%) of individuals with negative tests. Four individuals experienced acute asthma exacerbation during the two-step challenge. Vaccine-positive skin tests were consistently confirmed by BAT; CD63 and CD203c expression was selectively inhibited with ibrutinib, suggesting an IgE-dependent mechanism. Finally, 13 sensitized patients were successfully vaccinated with a five-step vaccination protocol. Conclusion: A two-step 10%-90%-vaccination protocol can be safely administered upon negative skin testing. Yet, it should be delayed in individuals with poorly controlled asthma. Importantly, mRNA vaccine sensitized individuals may receive a five-step vaccination protocol.

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