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Evaluation of Patients with Vaccine Allergies Prior to mRNA-Based COVID-19 Vaccination

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posted on 09.07.2022, 01:38 authored by Xin Rong Lim, Justina Wei Lynn Tan, Grace Yin Lai Chan, Jinfeng Hou, Linlin Xie, Vivian Hui Li Goh, Joewee Boon, Samuel Shang Ming Lee, Claire Min-Li Teo, Sze Chin Tan, Khai Pang Leong, Bernard Yu Hor Thong, Pui Lam Bernard LeungPui Lam Bernard Leung

During the initial rollout of coronavirus disease 2019 (COVID-19) vaccination in Singapore, the Ministry of Health (MOH) issued a recommendation that patients with a history of any previous vaccine allergy be referred to an allergist for further review of their suitability to proceed with mRNAbased COVID-19 vaccines. Patients fulfilling the above criterion were divided into three groups: immediate reaction (Group A), delayed reaction (Group B) and no/irrelevant reaction (Group C). They were subjected to either a skin prick test (SPT) and intradermal test (IDT) with polyethylene glycol (PEG) or polysorbate-containing products; direct injection with the Pfizer BNT162b2 vaccine in the allergy clinic; or injection at community vaccination centres, respectively. Groups A and B were also invited to complete a questionnaire survey on post-vaccination reactions, and blood sampling pre-vaccination and 1 h after the first dose of the BNT162b2 vaccine to measure immunoglobulin (Ig) G, IgM and IgE antibodies to the Pfizer BNT162b2 vaccine via ELISA assays immobilised with the BNT162b2 vaccine, as well as levels of allergic cytokines interleukin (IL)-4 and IL-33, complement C5a and the endothelial activation marker intercellular adhesion molecule-1 (ICAM-1). Groups A and B comprised 62 (20.5%) patients each. In Group A, two subjects (3.2%) with equivocal IDT results tolerated both doses of the BNT162b2 vaccine without major allergic reactions. The remaining 60 (96.8%) in Group A and 62 (100%) in Group B completed both doses of BNT162b2 vaccination without major adverse reactions. Among the 99 who completed the questionnaire survey, 13 (13%) patients reported mild allergic reactions after the first dose of the vaccine. Immunoglobulin (Ig) G and M antibodies, but not IgE antibodies to the Pfizer BNT162b2 vaccine were detected in 67 subjects prior to vaccination. The presence of anti-Pfizer BNT162b2 IgG and IgM prior to vaccination did not result in major allergic reactions nor increases in Th2-related cytokines (IL-4, IL-33), complement activation products (C5a) or endothelial activation (ICAM-1). The majority of those with suspected reactions to non-COVID-19 polysorbate-containing vaccines tolerated the BNT162b2 vaccine. Excipient skin tests for PEG and polysorbate prior to vaccination are unnecessary.


This work is supported by the research fund of the Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, and a research grant from the National Centre for Infectious Diseases, Singapore, Catalyst Grant #FY2021LXR.


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This is the publisher's PDF version of: Lim, X. R., J. W. L. Tan, G. Y. L. Chan, J. F. Hou, L. L. Xie, V. H. L. Goh, J. Boon, S. S. M. Lee, C. M.-L. Teo, S. C. Tan, K. P. Leong, B. Y. H. Thong, and B. P. L. Leung. 2022. Evaluation of Patients with Vaccine Allergies Prior to mRNA-Based COVID-19 Vaccination. Vaccines 10: 1025. https://doi.org/10.3390/vaccines10071025.

Corresponding author

Lim Xin Rong, xin_rong_lim@ttsh.com.sg

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