Vaccines
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An analysis of the constituents of mRNA vaccines shows that an anaphylactic reaction may be due to several factors which cannot be determined in clinical practice (see Risma 2021). A recent study of three individuals with a history of PEG allergy and three healthy controls found that the BioNTech/Pfizer vaccine induced positive skin tests in PEG allergic patients, whereas traditional PEG skin testing was negative in two of three patients. As an effect could be induced by PEGylated liposomal doxorubicin, the authors suggest that PEGlyated lipids within nanoparticles, and not PEG in its native state, could be a potential trigger of anaphylaxis to the BioNTech/Pfizer vaccine (Troelnikov 2021). However, it may still be possible to safely vaccinate people with allergies to vaccine components after assessing patients who report allergy to a vaccine, injectable medication, or PEG. Consult an allergist who might triage patients into those able to go ahead with vaccination with the routine 15 minutes of observation, those requiring 30 minutes of observation, and those who require skin testing to PEG and polysorbate before vaccination (Glover 2021, Mustafa 2021). The CDC recommends that appropriate medical treatment for severe allergic reactions be immediately available in the event that an acute anaphylactic reaction occurs following administration of an mRNA COVID-19 vaccine (CDC 20201231, CDC 20210303). In particular, persons without contraindications to vaccination who receive an mRNA COVID-19 vaccine should be observed after vaccination for the following time periods: •
30 minutes: Persons with a history of an immediate allergic reaction of any severity to a vaccine or injectable therapy and persons with a history of anaphylaxis due to any cause.
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15 minutes: Everyone else
Special Topics Post-exposure SARS-CoV-2 vaccination Could post-exposure vaccination with SARS-CoV-2 vaccines be able to mitigate COVID-19 disease? Claude Muller of the Luxembourg Institute of Health argues that there might be enough time for protective vaccine effects to set in (Muller 2021):
COVID Reference ENG 006.9
