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Intradermal Testing With COVID-19 mRNA Vaccines Predicts Tolerance
Florian Stehlin1, Rima Mahdi-Aljedani1, Loris Canton1
1Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland.
Frontiers in Allergy
|October 14, 2022
Summary
mRNA COVID-19 vaccines can cause anaphylaxis, potentially due to polyethylene glycol (PEG). A two-step vaccination protocol is safe for individuals with negative skin tests, even those with a history of allergic reactions.
Area of Science:
- Immunology
- Vaccinology
- Allergy and Immunology
Background:
- mRNA COVID-19 vaccines may cause anaphylaxis, with polyethylene glycol (PEG) as a suspected trigger.
- Management strategies for individuals with PEG allergy or post-vaccination reactions are not well-defined.
Purpose of the Study:
- To investigate the safety and efficacy of a two-step mRNA COVID-19 vaccination protocol in high-risk individuals.
- To evaluate diagnostic methods for identifying vaccine-induced allergic reactions.
Main Methods:
- Real-life study involving pre-vaccination (n=187) and post-vaccination (n=87) cohorts.
- Skin testing with mRNA vaccines, followed by a two-step (10-90%) vaccination protocol for those with negative tests.
- Basophil activation test (BAT) to confirm positive skin tests; analysis of CD63 and CD203c expression.
Main Results:
- Out of 604,267 vaccine doses, 87 suspected allergic reactions were reported.
- 18 reactions were consistent with anaphylaxis; 90% of affected individuals were female.
- A two-step vaccination protocol was tolerated by 98% of individuals with negative skin tests.
Conclusions:
- Intradermal testing can detect sensitization to mRNA vaccines.
- A two-step vaccination protocol is safe for individuals with negative skin tests.
- The findings suggest an IgE-dependent mechanism in vaccine-induced allergic reactions.
