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Safety of mRNA-based COVID-19 vaccination in paediatric patients with a PEG-asparaginase allergy
Nancy Broos1, Leiah J Brigitha2, Annemieke Schuurhof1
1Paediatric Allergology, Wilhelmina Children's Hospital Utrecht, the Netherlands.
Insights
Children with pegaspargase allergy can safely receive mRNA COVID-19 vaccines containing polyethylene glycol (PEG). Pre-existing antibodies to PEG do not prevent safe vaccination, and skin prick testing may not be necessary.
Area of Science:
- Pediatric Oncology
- Immunology
- Vaccinology
Background:
- Children undergoing malignancy treatment face severe COVID-19 risks.
- Pegaspargase, a leukemia treatment, commonly causes allergies to asparaginase and polyethylene glycol (PEG).
- mRNA COVID-19 vaccines utilize PEG, posing a potential risk for allergic individuals.
Purpose of the Study:
- To establish a safe vaccination protocol for children with pegaspargase allergy.
- To assess the safety of mRNA COVID-19 vaccination in this vulnerable pediatric population.
Main Methods:
- A protocol was developed for safely vaccinating children with a history of pegaspargase allergy.
- Included patients underwent skin prick testing for various PEGs prior to mRNA COVID-19 vaccination.
Main Results:
- Twelve children (ages 6-16) were vaccinated without allergic reactions.
- No patients tested positive via skin prick tests for PEG.
- Ten patients had pre-existing IgG or IgM antibodies against PEG.
Conclusions:
- mRNA COVID-19 vaccines containing PEG are safe for children with pegaspargase allergy, regardless of pre-existing PEG antibodies.
- Routine skin prick testing appears to have limited added value in this patient group.
Background:
Children treated for a malignancy are at risk to develop serious illness from a COVID-19 infection. Pegylated E. coli asparaginase (PEG-asparaginase) is used in the treatment of acute lymphoblastic leukemia. Allergy to this drug is common and both asparaginase and polyethylene glycol (PEG) are identified as possible antigens. The mRNA-based vaccines against COVID-19 contain PEG as a stabilizing component.
Methods:
We developed a protocol to be able to safely vaccinate children with a PEG-asparaginase allergy. All patients with a history of allergy to PEG-asparaginase have been included and skin prick testing for various PEGs was performed before vaccination with the mRNA Pfizer-BioNTech COVID-19 vaccine.
Results:
Twelve children between six and 16 years old were vaccinated, without allergic reaction. None of them got a positive skin prick test for PEG. Ten patients had pre-existing IgG or IgM antibodies against PEG.
Conclusion:
Children with a PEG-asparaginase allergy can be safely vaccinated against COVID-19 with mRNA vaccines containing PEG irrespective of IgG/IgM antibodies to PEG-asparaginase. Routine skin prick testing in patients with PEG-asparaginase allergy does not seem to be of added value.
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