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Perkins GB, Tunbridge MJ, Hurtado PR, Zuiani J, Mhatre S, Yip KH, Le TTA, Yuson C, Kette F, Hissaria P. PEGylated liposomes for diagnosis of polyethylene glycol allergy. J Allergy Clin Immunol 2024:S0091-6749(24)00456-1. [PMID: 38718949 DOI: 10.1016/j.jaci.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/28/2024] [Accepted: 03/15/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Polyethylene glycol (PEG) is a nonprotein polymer that is present in its native (unbound) form as an excipient in a range of products. It is increasingly being utilized clinically in the form of PEGylated liposomal medications and vaccines. PEG is the cause of anaphylaxis in a small percentage of drug reactions; however, diagnosis of PEG allergy is complicated by the variable and poor diagnostic performance of current skin testing protocols. OBJECTIVE We assessed the diagnostic performance of PEGylated lipid medications as an alternative to currently described tests that use medications containing PEG excipients. METHODS Nine patients with a strong history of PEG allergy were evaluated by skin testing with a panel of PEG-containing medications and with a PEGylated lipid nanoparticle vaccine (BNT162b2). Reactivity of basophils to unbound and liposomal PEG was assessed ex vivo, and specificity of basophil responses to PEGylated liposomes was investigated with a competitive inhibition assay. More detailed information is provided in this article's Methods section in the Online Repository available at www.jacionline.org. RESULTS Despite compelling histories of anaphylaxis to PEG-containing medications, only 2 (22%) of 9 patients were skin test positive for purified PEG or their index reaction-indicated PEG-containing compound. Conversely, all 9 patients were skin test positive or basophil activation test positive to PEGylated liposomal BNT162b2 vaccine. Concordantly, PEGylated liposomal drugs (BNT162b2 vaccine and PEGylated liposomal doxorubicin), but not purified PEG2000, consistently induced basophil activation ex vivo in patients with PEG allergy but not in nonallergic controls. Basophil reactivity to PEGylated nanoparticles competitively inhibited by preincubation of basophils with native PEG2000. CONCLUSION Presentation of PEG on the surface of a lipid nanoparticle increases its in vivo and ex vivo allergenicity, and improves diagnosis of PEG allergy.
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Affiliation(s)
- Griffith B Perkins
- Adelaide Medical School, University of Adelaide, Adelaide, Australia; Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia; Immunology Directorate, SA Pathology, Adelaide, Australia
| | - Matthew J Tunbridge
- Adelaide Medical School, University of Adelaide, Adelaide, Australia; Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
| | - Plinio R Hurtado
- Adelaide Medical School, University of Adelaide, Adelaide, Australia; Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia
| | - James Zuiani
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Shweta Mhatre
- Adelaide Medical School, University of Adelaide, Adelaide, Australia; Immunology Directorate, SA Pathology, Adelaide, Australia
| | - Kwok Ho Yip
- Centre for Cancer Biology, University of South Australia and SA Pathology, Adelaide, Australia
| | | | - Carlo Yuson
- Department of Allergy and Immunology, Royal Adelaide Hospital, Adelaide, Australia
| | - Frank Kette
- Department of Allergy and Immunology, Royal Adelaide Hospital, Adelaide, Australia
| | - Pravin Hissaria
- Adelaide Medical School, University of Adelaide, Adelaide, Australia; Immunology Directorate, SA Pathology, Adelaide, Australia; Department of Allergy and Immunology, Royal Adelaide Hospital, Adelaide, Australia.
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2
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Baig M, Nanjappa NC, Perkins GB, Di Lernia R, Thiruvenkatarajan V, Hissaria P. Basophil activation test in the diagnostic workup of perioperative anaphylaxis due to neuromuscular blocking agents: A case series and implications for practice. Anaesth Intensive Care 2024:310057X241232420. [PMID: 38649299 DOI: 10.1177/0310057x241232420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
In Australia, neuromuscular blocking agents are the leading cause of perioperative anaphylaxis. Current investigation of suspected anaphylaxis includes tryptase levels, serum immunoglobulin E (IgE) levels, and skin testing, including intradermal testing and skin prick testing. The gold standard for the diagnosis of a hypersensitivity reaction is a challenge test, but this poses a risk to patient safety. An alternative test, known as the basophil activation test (BAT) is a form of cellular in vitro testing using flow cytometry to measure the degree of basophil degranulation within a sample of blood following exposure to an allergen. This acts as a surrogate marker for mast cell and basophil activation, thereby identifying IgE-mediated allergy. It is most commonly used to supplement equivocal findings from initial in vitro testing to assist in confirming the diagnosis of a hypersensitivity reaction and identify the causative agent. We present a case series in which five patients with suspected anaphylaxis underwent a BAT, demonstrating its role and limitations in allergy testing within Australia.
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Affiliation(s)
- Mahanoor Baig
- Department of Anaesthesia, Queen Elizabeth Hospital, Adelaide, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Australia
| | - Nagesh C Nanjappa
- Department of Anaesthesia, Queen Elizabeth Hospital, Adelaide, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Australia
| | - Griffith B Perkins
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Australia
- SA Pathology, Adelaide, Australi
| | - Rachel Di Lernia
- Department of Anaesthesia, Queen Elizabeth Hospital, Adelaide, Australia
| | - Venkatesan Thiruvenkatarajan
- Department of Anaesthesia, Queen Elizabeth Hospital, Adelaide, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Australia
| | - Pravin Hissaria
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Australia
- SA Pathology, Adelaide, Australi
- Department of Allergy and Immunology, Royal Adelaide Hospital, Adelaide, Australia
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3
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Chen SP, Blakney AK. Immune response to the components of lipid nanoparticles for ribonucleic acid therapeutics. Curr Opin Biotechnol 2024; 85:103049. [PMID: 38118363 DOI: 10.1016/j.copbio.2023.103049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 11/06/2023] [Accepted: 11/26/2023] [Indexed: 12/22/2023]
Abstract
Ribonucleic acid therapeutics have advantages over biologics and small molecules, including lower safety risks, cheaper costs, and extensive targeting flexibility, which is rapidly fueling the expansion of the field. This is made possible by breakthroughs in the field of drug delivery, wherein lipid nanoparticles (LNPs) are one of the most clinically advanced systems. LNP formulations that are currently approved for clinical use typically contain an ionizable cationic lipid, a phospholipid, cholesterol, and a polyethylene glycol-lipid; each contributes to the stability and/or effectiveness of LNPs. In this review, we discuss the immunomodulatory effects associated with each of the lipid components. We highlight several studies in which the components of LNPs have been implicated in cellular sensing and explore the pathways involved.
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Affiliation(s)
- Sunny P Chen
- School of Biomedical Engineering, University of British Columbia, Vancouver V6T 1Z3, Canada; Michael Smith Laboratories, University of British Columbia, Vancouver V6T 1Z4, Canada
| | - Anna K Blakney
- School of Biomedical Engineering, University of British Columbia, Vancouver V6T 1Z3, Canada; Michael Smith Laboratories, University of British Columbia, Vancouver V6T 1Z4, Canada.
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4
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Yang M, Zhang Z, Jin P, Jiang K, Xu Y, Pan F, Tian K, Yuan Z, Liu XE, Fu J, Wang B, Yan H, Zhan C, Zhang Z. Effects of PEG antibodies on in vivo performance of LNP-mRNA vaccines. Int J Pharm 2024; 650:123695. [PMID: 38081560 DOI: 10.1016/j.ijpharm.2023.123695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 12/22/2023]
Abstract
Polyethylene glycol (PEG) plays important roles in stabilizing and lengthening circulation time of lipid nanoparticle (LNP) vaccines. Nowadays various levels of PEG antibodies have been detected in human blood, but the impact and mechanism of PEG antibodies on the in vivo performance of LNP vaccines has not been clarified thoroughly. By illustrating the distribution characteristics of PEG antibodies in human, the present study focused on the influence of PEG antibodies on the safety and efficacy of LNP-mRNA vaccine against COVID-19 in animal models. It was found that PEG antibodies led to shortened blood circulation duration, elevated accumulation and mRNA expression in liver and spleen, enhanced expression in macrophage and dendritic cells, while without affecting the production of anti-Spike protein antibodies of COVID-19 LNP vaccine. Noteworthily, PEG antibodies binding on the LNP vaccine increased probability of complement activation in animal as well as in human serum and led to lethal side effect in large dosage via intravenous injection of mice. Our data suggested that PEG antibodies in human was a risky factor of LNP-based vaccines for biosafety concerns but not efficacy.
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Affiliation(s)
- Min Yang
- Department of Pharmacology, School of Basic Medical Sciences & Department of Pharmacy, Shanghai Pudong Hospital, Pudong Medical Center, Fudan University, Shanghai 200032, PR China
| | - Zengyu Zhang
- Department of Pharmacology, School of Basic Medical Sciences & Department of Pharmacy, Shanghai Pudong Hospital, Pudong Medical Center, Fudan University, Shanghai 200032, PR China
| | - Pengpeng Jin
- Department of Pharmacology, School of Basic Medical Sciences & Department of Pharmacy, Shanghai Pudong Hospital, Pudong Medical Center, Fudan University, Shanghai 200032, PR China; Department of Chronic Disease Management, Shanghai Pudong Hospital, Fudan University, Shanghai 201399, PR China
| | - Kuan Jiang
- Department of Pharmacology, School of Basic Medical Sciences & Department of Pharmacy, Shanghai Pudong Hospital, Pudong Medical Center, Fudan University, Shanghai 200032, PR China; Department of Ophthalmology, Eye and ENT Hospital, Fudan University, Shanghai 200031, PR China
| | - Yifei Xu
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai, 200438 PR China
| | - Feng Pan
- School of Pharmacy, Key Laboratory of Smart Drug Delivery, Ministry of Education, Fudan University, Shanghai 201203, PR China
| | - Kaisong Tian
- Department of Pharmacology, School of Basic Medical Sciences & Department of Pharmacy, Shanghai Pudong Hospital, Pudong Medical Center, Fudan University, Shanghai 200032, PR China
| | - Zhou Yuan
- Department of Pharmacology, School of Basic Medical Sciences & Department of Pharmacy, Shanghai Pudong Hospital, Pudong Medical Center, Fudan University, Shanghai 200032, PR China
| | | | - Jiaru Fu
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai 200032, PR China
| | - Bin Wang
- Department of Pharmacy, Huashan Hospital, Fudan University, Shanghai 200032, PR China
| | - Huafang Yan
- Department of Health Management, Pudong Hospital, Fudan University, Shanghai 201399, PR China
| | - Changyou Zhan
- Department of Pharmacology, School of Basic Medical Sciences & Department of Pharmacy, Shanghai Pudong Hospital, Pudong Medical Center, Fudan University, Shanghai 200032, PR China; State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai, 200438 PR China; Shanghai Engineering Research Center for Synthetic Immunology, Fudan University, Shanghai 200032, PR China.
| | - Zui Zhang
- Department of Pharmacology, School of Basic Medical Sciences & Department of Pharmacy, Shanghai Pudong Hospital, Pudong Medical Center, Fudan University, Shanghai 200032, PR China.
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5
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Tran TT, Roffler SR. Interactions between nanoparticle corona proteins and the immune system. Curr Opin Biotechnol 2023; 84:103010. [PMID: 37852029 DOI: 10.1016/j.copbio.2023.103010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/07/2023] [Accepted: 09/22/2023] [Indexed: 10/20/2023]
Abstract
The corona surrounding nanoparticles (NPs) in serum contains proteins such as complement, immunoglobulins, and apolipoproteins that can interact with the immune system. This review article describes the impact of these interactions on nanomedicine stability, biodistribution, efficacy, and safety. Notably, it highlights the latest findings on the generation of antibody responses to the polyethylene glycol (PEG) component of SARS-CoV-2 mRNA vaccines and possible mechanisms of hypersensitivity reactions induced by antibodies that bind to NPs. Finally, we briefly outline how the NP interactions with immune cells can be harnessed to enhance targeted delivery of nanocargos to disease sites.
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Affiliation(s)
- Trieu Tm Tran
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan
| | - Steve R Roffler
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
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6
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Ieven T, Coorevits L, Vandebotermet M, Tuyls S, Vanneste H, Santy L, Wets D, Proost P, Frans G, Devolder D, Breynaert C, Bullens DMA, Schrijvers R. Endotyping of IgE-Mediated Polyethylene Glycol and/or Polysorbate 80 Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3146-3160. [PMID: 37380070 PMCID: PMC10291891 DOI: 10.1016/j.jaip.2023.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Polyethylene glycol (PEG) and polysorbate 80 (PS80) allergy preclude from SARS-CoV-2 vaccination. The mechanism(s) governing cross-reactivity and PEG molecular weight dependence remain unclear. OBJECTIVES To evaluate PEGylated lipid nanoparticle (LNP) vaccine (BNT162b2) tolerance and explore the mechanism of reactivity in PEG and/or PS80 allergic patients. METHODS PEG/PS80 dual- (n = 3), PEG mono- (n = 7), and PS80 mono-allergic patients (n = 2) were included. Tolerability of graded vaccine challenges was assessed. Basophil activation testing on whole blood (wb-BAT) or passively sensitized donor basophils (allo-BAT) was performed using PEG, PS80, BNT162b2, and PEGylated lipids (ALC-0159). Serum PEG-specific IgE was measured in patients (n = 10) and controls (n = 15). RESULTS Graded BNT162b2 challenge in dual- and PEG mono-allergic patients (n = 3/group) was well tolerated and induced anti-spike IgG seroconversion. PS80 mono-allergic patients (n = 2/2) tolerated single-dose BNT162b2 vaccination. Wb-BAT reactivity to PEG-containing antigens was observed in dual- (n = 3/3) and PEG mono- (n = 2/3), but absent in PS80 mono-allergic patients (n = 0/2). BNT162b2 elicited the highest in vitro reactivity. BNT162b2 reactivity was IgE mediated, complement independent, and inhibited in allo-BAT by preincubation with short PEG motifs, or detergent-induced LNP degradation. PEG-specific IgE was only detectable in dual-allergic (n = 3/3) and PEG mono-allergic (n = 1/6) serum. CONCLUSION PEG and PS80 cross-reactivity is determined by IgE recognizing short PEG motifs, whereas PS80 mono-allergy is PEG-independent. PS80 skin test positivity in PEG allergics was associated with a severe and persistent phenotype, higher serum PEG-specific IgE levels, and enhanced BAT reactivity. Spherical PEG exposure via LNP enhances BAT sensitivity through increased avidity. All PEG and/or PS80 excipient allergic patients can safely receive SARS-CoV-2 vaccines.
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Affiliation(s)
- Toon Ieven
- KU Leuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium; Department of General Internal Medicine, Division of Allergy and Clinical Immunology, University Hospitals Leuven, Leuven, Belgium
| | - Lieve Coorevits
- KU Leuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium; Department of General Internal Medicine, Division of Allergy and Clinical Immunology, University Hospitals Leuven, Leuven, Belgium
| | - Martijn Vandebotermet
- Department of General Internal Medicine, Division of Allergy and Clinical Immunology, University Hospitals Leuven, Leuven, Belgium; Department of Pulmonology, AZ Groeninge Hospital, Kortrijk, Belgium
| | - Sebastiaan Tuyls
- Department of General Internal Medicine, Division of Allergy and Clinical Immunology, University Hospitals Leuven, Leuven, Belgium; Department of Pulmonology, GZA St-Augustinus Hospital, Wilrijk, Belgium
| | - Hélène Vanneste
- Department of General Internal Medicine, Division of Allergy and Clinical Immunology, University Hospitals Leuven, Leuven, Belgium; Department of Pulmonology, AZ Vesalius, Tongeren, Belgium
| | - Lisa Santy
- Department of General Internal Medicine, Division of Allergy and Clinical Immunology, University Hospitals Leuven, Leuven, Belgium; Department of Internal Medicine, Division of Pulmonology, St-Jozefskliniek, Izegem, Belgium
| | - Dries Wets
- Department of General Internal Medicine, Division of Allergy and Clinical Immunology, University Hospitals Leuven, Leuven, Belgium
| | - Paul Proost
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Molecular Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Glynis Frans
- Clinical Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - David Devolder
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
| | - Christine Breynaert
- KU Leuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium; Department of General Internal Medicine, Division of Allergy and Clinical Immunology, University Hospitals Leuven, Leuven, Belgium
| | - Dominique M A Bullens
- KU Leuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium; Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Rik Schrijvers
- KU Leuven Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Group, KU Leuven, Leuven, Belgium; Department of General Internal Medicine, Division of Allergy and Clinical Immunology, University Hospitals Leuven, Leuven, Belgium.
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7
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Guo C, Yuan H, Wang Y, Feng Y, Zhang Y, Yin T, He H, Gou J, Tang X. The interplay between PEGylated nanoparticles and blood immune system. Adv Drug Deliv Rev 2023; 200:115044. [PMID: 37541623 DOI: 10.1016/j.addr.2023.115044] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/11/2023] [Accepted: 07/31/2023] [Indexed: 08/06/2023]
Abstract
During the last two decades, an increasing number of reports have pointed out that the immunogenicity of polyethylene glycol (PEG) may trigger accelerated blood clearance (ABC) and hypersensitivity reaction (HSR) to PEGylated nanoparticles, which could make PEG modification counterproductive. These phenomena would be detrimental to the efficacy of the load and even life-threatening to patients. Consequently, further elucidation of the interplay between PEGylated nanoparticles and the blood immune system will be beneficial to developing and applying related formulations. Many groups have worked to unveil the relevance of structural factors, dosing schedule, and other factors to the ABC phenomenon and hypersensitivity reaction. Interestingly, the results of some reports seem to be difficult to interpret or contradict with other reports. In this review, we summarize the physiological mechanisms of PEG-specific immune response. Moreover, we speculate on the potential relationship between the induction phase and the effectuation phase to explain the divergent results in published reports. In addition, the role of nanoparticle-associated factors is discussed based on the classification of the action phase. This review may help researchers to develop PEGylated nanoparticles to avoid unfavorable immune responses based on the underlying mechanism.
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Affiliation(s)
- Chen Guo
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, Liaoning, PR China
| | - Haoyang Yuan
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, Liaoning, PR China
| | - Yuxiu Wang
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, Liaoning, PR China
| | - Yupeng Feng
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, Liaoning, PR China
| | - Yu Zhang
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, Liaoning, PR China
| | - Tian Yin
- School of Functional Food and Wine, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, Liaoning, PR China
| | - Haibing He
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, Liaoning, PR China
| | - Jingxin Gou
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, Liaoning, PR China.
| | - Xing Tang
- Department of Pharmaceutics, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Road, Shenyang 110016, Liaoning, PR China.
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8
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Greenhawt M, Dribin TE, Abrams EM, Shaker M, Chu DK, Golden DBK, Akin C, Anagnostou A, ALMuhizi F, Alqurashi W, Arkwright P, Baldwin JL, Banerji A, Bégin P, Ben-Shoshan M, Bernstein J, Bingemann TA, Bindslev-Jensen C, Blumenthal K, Byrne A, Cahill J, Cameron S, Campbell D, Campbell R, Cavender M, Chan ES, Chinthrajah S, Comberiati P, Eastman JJ, Ellis AK, Fleischer DM, Fox A, Frischmeyer-Guerrerio PA, Gagnon R, Garvey LH, Grayson MH, Isabwe GAC, Hartog N, Hendron D, Horner CC, Hourihane JO, Iglesia E, Kan M, Kaplan B, Katelaris CH, Kim H, Kelso JM, Khan DA, Lang D, Ledford D, Levin M, Lieberman JA, Loh R, Mack DP, Mazer B, Mody K, Mosnaim G, Munblit D, Mustafa SS, Nanda A, Nathan R, Oppenheimer J, Otani IM, Park M, Pawankar R, Perrett KP, Peter J, Phillips EJ, Picard M, Pitlick M, Ramsey A, Rasmussen TH, Rathkopf MM, Reddy H, Robertson K, Rodriguez Del Rio P, Sample S, Sheshadri A, Sheik J, Sindher SB, Spergel JM, Stone CA, Stukus D, Tang MLK, Tracy JM, Turner PJ, Vander Leek TK, Wallace DV, Wang J, Wasserman S, Weldon D, Wolfson AR, Worm M, Yacoub MR. Updated guidance regarding the risk of allergic reactions to COVID-19 vaccines and recommended evaluation and management: A GRADE assessment and international consensus approach. J Allergy Clin Immunol 2023; 152:309-325. [PMID: 37295474 PMCID: PMC10247143 DOI: 10.1016/j.jaci.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023]
Abstract
This guidance updates 2021 GRADE (Grading of Recommendations Assessment, Development and Evaluation) recommendations regarding immediate allergic reactions following coronavirus disease 2019 (COVID-19) vaccines and addresses revaccinating individuals with first-dose allergic reactions and allergy testing to determine revaccination outcomes. Recent meta-analyses assessed the incidence of severe allergic reactions to initial COVID-19 vaccination, risk of mRNA-COVID-19 revaccination after an initial reaction, and diagnostic accuracy of COVID-19 vaccine and vaccine excipient testing in predicting reactions. GRADE methods informed rating the certainty of evidence and strength of recommendations. A modified Delphi panel consisting of experts in allergy, anaphylaxis, vaccinology, infectious diseases, emergency medicine, and primary care from Australia, Canada, Europe, Japan, South Africa, the United Kingdom, and the United States formed the recommendations. We recommend vaccination for persons without COVID-19 vaccine excipient allergy and revaccination after a prior immediate allergic reaction. We suggest against >15-minute postvaccination observation. We recommend against mRNA vaccine or excipient skin testing to predict outcomes. We suggest revaccination of persons with an immediate allergic reaction to the mRNA vaccine or excipients be performed by a person with vaccine allergy expertise in a properly equipped setting. We suggest against premedication, split-dosing, or special precautions because of a comorbid allergic history.
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Affiliation(s)
- Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
| | - Timothy E Dribin
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Section of Allergy and Immunology, The University of Manitoba, Winnipeg, Canada
| | - Marcus Shaker
- Dartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, NH; Dartmouth Geisel School of Medicine, Hanover, NH
| | - Derek K Chu
- Faculty of Medicine, and the Department of McMaster University, Hamilton, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada; The Research Institute of St. Joe's Hamilton, Hamilton, Canada; Evidence in Allergy Group, McMaster University Medical Centre, Hamilton, Canada
| | - David B K Golden
- Division of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Bethesda
| | - Cem Akin
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan School, Ann Arbor, Mich
| | - Akterini Anagnostou
- Section of Immunology, Allergy, and Retrovirology, Department of Pediatrics, Baylor College of Medicine, Houston, Tex; Section of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Houston, Tex
| | - Faisal ALMuhizi
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Security Forces Hospital Program, Riyadh, Arabia
| | - Waleed Alqurashi
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - Peter Arkwright
- Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, United Kingdom
| | - James L Baldwin
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan School, Ann Arbor, Mich
| | - Aleena Banerji
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Philippe Bégin
- Centre Hospital Universitaire Sainte-Justine, Montreal, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Center-Montreal Children's Hospital, Montreal, Canada
| | - Jonathan Bernstein
- Division of Immunology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Theresa A Bingemann
- Division of Allergy, Immunology, and Rheumatology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Center, Odense Research Centre for Anaphylaxis, Odense, Denmark
| | - Kim Blumenthal
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Aideen Byrne
- Department of Paediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Julia Cahill
- University of Alberta, Faculty of Medicine, Calgary, Canada
| | - Scott Cameron
- Allergy Victoria, Victoria, British Columbia, Canada
| | | | - Ronna Campbell
- Department of Emergency Medicine, Mayo Clinic, Rochester
| | | | - Edmond S Chan
- Division of Allergy and Immunology, BC Children's Hospital, The University of British Columbia, Vancouver, Canada
| | - Sharon Chinthrajah
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, Calif
| | - Pasquale Comberiati
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy
| | - Jacqueline J Eastman
- Corewell Health Allergy and Immunology, Grand Rapids, Mich; Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - Anne K Ellis
- Division of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Canada
| | - David M Fleischer
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - Adam Fox
- Guys's and St Tomas's Hospital National Health Service Foundation Trust, London, Mass
| | - Pamela A Frischmeyer-Guerrerio
- Laboratory of Allergic Diseases, Food Allergy Research Section, National Institutes of Allergy and Infectious Diseases, the National Institutes of Health, Bethesda, Md
| | - Remi Gagnon
- Clinique Spécialisée en Allergie de la Capitale, Québec, Canada
| | - Lene H Garvey
- Allergy Clinic, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mitchell H Grayson
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Ghislaine Annie Clarisse Isabwe
- Division of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Center-Montreal Children's Hospital, Montreal, Canada
| | - Nicholas Hartog
- Corewell Health Allergy and Immunology, Grand Rapids, Mich; Michigan State University College of Human Medicine, Grand Rapids, Mich
| | - David Hendron
- Access Health Care Physicians LLC, New Port Richey, Fla
| | - Caroline C Horner
- Division of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Mo
| | | | - Edward Iglesia
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | | | - Blanka Kaplan
- Division of Allergy and Immunology, Northwell Health, New York, NY
| | | | - Harold Kim
- Faculty of Medicine, and the Department of McMaster University, Hamilton, Canada; Division of Clinical Immunology and Allergy, Department of Medicine, Western University, St Joseph's Health Care, London (Canada), Mass
| | - John M Kelso
- Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif
| | - David A Khan
- Division of Allergy and Immunology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Tex
| | - David Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Dennis Ledford
- Division of Allergy and Immunology, Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Michael Levin
- Division of Paediatric Allergology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jay A Lieberman
- Division of Allergy and Immunology, The University of Tennessee, Memphis, Tenn
| | - Richard Loh
- Immunology Department, Perth Children's Hospital, Perth, Australia
| | - Douglas P Mack
- Department of Pediatrics, McMaster University, Hamilton, Canada; Halton Pediatric Allergy, Burlington, Canada
| | - Bruce Mazer
- Division of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Center-Montreal Children's Hospital, Montreal, Canada
| | - Ketan Mody
- Elite Sports Medicine Institute Ltd, Westmont, Ill
| | - Gisele Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill
| | - Daniel Munblit
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, Mass
| | - S Shahzad Mustafa
- Rochester Regional Health, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Anil Nanda
- Division of Allergy and Immunology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Tex; Asthma and Allergy Center, Lewisville and Flower Mound, Dallas, Tex
| | | | - John Oppenheimer
- University of Medicine and Dentistry of New Jersey, Rutgers University School of Medicine, New Brunswick, NJ
| | - Iris M Otani
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California San Francisco, San Francisco, Calif
| | - Miguel Park
- Division of Allergic Diseases, Mayo Clinic, Rochester
| | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Kirsten P Perrett
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill; Population Allergy Group and the Centre for Food and Allergy Research, Murdoch Children's Research Institute, University of Melbourne, University of Melbourne, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - Jonny Peter
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Cape Town and the Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town
| | - Elizabeth J Phillips
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Center for Drug Safety and Immunology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Matthieu Picard
- Hôspital Maisonneuve-Rosemont, Université de Montréal, Montreal, Canada
| | | | - Allison Ramsey
- Rochester Regional Health, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Trine Holm Rasmussen
- Department of Dermatology and Allergy Center, Odense Research Centre for Anaphylaxis, Odense, Denmark
| | | | - Hari Reddy
- Allergy, Asthma and Immunology Center of Alaska, Anchorage, Alaska; Department of Pediatrics, University of Washington School of Medicine, Seattle, Wash
| | - Kara Robertson
- Division of Clinical Immunology and Allergy, St Joseph's Health Care, London (Canada), Mass; Schulich School of Medicine and Dentistry, Western University, St Joseph's Health Care, London (Canada), Mass
| | | | | | - Ajay Sheshadri
- Department of Pulmonary Medicine, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Javed Sheik
- Kaiser Permanente Los Angeles Medical Center, Los Angeles, Calif
| | - Sayantani B Sindher
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, Calif; Sean N. Parker Center for Allergy and Asthma Research, Stanford University School of Medicine, Palo Alto, Calif
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa
| | - Cosby A Stone
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - David Stukus
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Mimi L K Tang
- Department of Allergy Immunology, Murdoch Children's Research Institute, Melbourne, Parkville, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia
| | - James M Tracy
- Allergy, Asthma, and Immunology Associates PC, Omaha, Neb; Department of Pediatrics, University of Nebraska School of Medicine, Omaha, Neb
| | - Paul J Turner
- Imperial College Healthcare National Health Service Trust, London, Mass; Royal Brompton and Harefield National Health Service Foundation Trust, London, Mass
| | - Timothy K Vander Leek
- Pediatric Allergy and Immunology, Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Dana V Wallace
- Nova Southeastern University College of Allopathic Medicine, Fort Lauderdale, Fla
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY; Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Susan Wasserman
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Canada
| | - David Weldon
- Baylor Scott and White Clinic, College Station, Tex
| | - Anna R Wolfson
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Margitta Worm
- Division of Allergology and Immunology, Department of Dermatology, Venereology and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mona-Rita Yacoub
- Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Hospital, Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Segrate, Milan, Italy
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9
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Subasic CN, Butcher NJ, Minchin RF, Kaminskas LM. Dose-Dependent Production of Anti-PEG IgM after Intramuscular PEGylated-Hydrogenated Soy Phosphatidylcholine Liposomes, but Not Lipid Nanoparticle Formulations of DNA, Correlates with the Plasma Clearance of PEGylated Liposomal Doxorubicin in Rats. Mol Pharm 2023; 20:3494-3504. [PMID: 37256791 DOI: 10.1021/acs.molpharmaceut.3c00104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PEGylated lipid nanoparticle-based Covid-19 vaccines, including Pfizer's BNT162b2 and Moderna's mRNA-1273, have been shown to stimulate variable anti-PEG antibody production in humans. Anti-PEG antibodies have the potential to accelerate the plasma clearance of PEGylated therapeutics, such as PEGylated liposomes and proteins, and compromise their therapeutic efficacy. However, it is not yet clear whether antibody titers produced by PEGylated Covid-19 vaccines significantly affect the clearance of PEGylated therapeutics. This study examined how anti-PEG IgM levels affect the pharmacokinetics of PEGylated liposomal doxorubicin (PLD) and compared the immunogenicity of a lipid nanoparticle formulation of linear DNA (DNA-LNP) to standard PEG-HSPC liposomes. DNA-LNP was prepared using the same composition and approach as Pfizer's BNT162b2, except linear double-stranded DNA was used as the genetic material. PEGylated HSPC-based liposomes were formulated using the lipid rehydration and extrusion method. Nanoparticles were dosed IM to rats at 0.005-0.5 mg lipid/kg body weight 1 week before evaluating the plasma pharmacokinetics of clinically relevant doses of PLD (1 mg/kg, IV) or PEGylated interferon α2a (Pegasys, 5 μg/kg, SC). Plasma PEG IgM was compared between pre- and 1-week post-dose blood samples. The results showed that anti-PEG IgM production increased with increasing PEG-HSPC liposome dose and that IgM significantly correlated with the plasma half-life, clearance, volume of distribution, and area under the curve of a subsequent dose of PLD. The plasma exposure of Pegasys was also significantly reduced after initial delivery of 0.005 mg/ml PEG-HSPC liposome. However, a single 0.05 mg/kg IM dose of DNA-LNP did not significantly elevate PEG IgM and did not alter the IV pharmacokinetics of PLD. These data showed that PEGylated Covid-19 vaccines are less immunogenic compared to standard PEGylated HSPC liposomes and that there is an antibody threshold for accelerating the clearance of PEGylated therapeutics.
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Affiliation(s)
- Christopher N Subasic
- School of Biomedical Sciences, University of Queensland, St Lucia, QLD 4072, Australia
| | - Neville J Butcher
- School of Biomedical Sciences, University of Queensland, St Lucia, QLD 4072, Australia
| | - Rodney F Minchin
- School of Biomedical Sciences, University of Queensland, St Lucia, QLD 4072, Australia
| | - Lisa M Kaminskas
- School of Biomedical Sciences, University of Queensland, St Lucia, QLD 4072, Australia
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10
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Lim XR, Chan GYL, Tan JWL, Ng CYL, Chua CG, Tan GB, Chan SSW, Ong KH, Tan YZ, Tan SHZ, Teo CML, Lee SSM, Thong BYH, Leung BPL. Anaphylatoxin Complement 5a in Pfizer BNT162b2-Induced Immediate-Type Vaccine Hypersensitivity Reactions. Vaccines (Basel) 2023; 11:1020. [PMID: 37376409 DOI: 10.3390/vaccines11061020] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/09/2023] [Accepted: 05/21/2023] [Indexed: 06/29/2023] Open
Abstract
The underlying immunological mechanisms of immediate-type hypersensitivity reactions (HSR) to COVID-19 vaccines are poorly understood. We investigate the mechanisms of immediate-type hypersensitivity reactions to the Pfizer BNT162b2 vaccine and the response of antibodies to the polyethylene glycol (PEG)ylated lipid nanoparticle after two doses of vaccination. Sixty-seven participants, median age 35 and 77.3% females who tolerated two doses of the BNT162b2 vaccine (non-reactors), were subjected to various blood-sampling time points. A separate group of vaccine reactors (10 anaphylaxis and 37 anonymised tryptase samples) were recruited for blood sampling. Immunoglobulin (Ig)G, IgM and IgE antibodies to the BNT162b2 vaccine, biomarkers associated with allergic reaction, including tryptase for anaphylaxis, complement 5a(C5a), intercellular adhesion molecule 1 (ICAM-1) for endothelial activation and Interleukin (IL)-4, IL-10, IL-33, tumour necrosis factor (TNF) and monocyte chemoattractant protein (MCP-1), were measured. Basophil activation test (BAT) was performed in BNT162b2-induced anaphylaxis patients by flow cytometry. The majority of patients with immediate-type BNT162b2 vaccine HSR demonstrated raised C5a and Th2-related cytokines but normal tryptase levels during the acute reaction, together with significantly higher levels of IgM antibodies to the BNT162b2 vaccine (IgM 67.2 (median) vs. 23.9 AU/mL, p < 0.001) and ICAM-1 when compared to non-reactor controls. No detectable IgE antibodies to the BNT162b2 vaccine were found in these patients. The basophil activation tests by flow cytometry to the Pfizer vaccine, 1,2-dimyristoyl-rac-glycero-3-methoxypolyethylene glycol (DMG-PEG) and PEG-2000 were negative in four anaphylaxis patients. Acute hypersensitivity reactions post BNT162b2 vaccination suggest pseudo-allergic reactions via the activation of anaphylatoxins C5a and are independent of IgE-mechanisms. Vaccine reactors have significantly higher levels of anti-BNT162b2 IgM although its precise role remains unclear.
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Affiliation(s)
- Xin Rong Lim
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Grace Yin Lai Chan
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Justina Wei Lynn Tan
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Carol Yee Leng Ng
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Choon Guan Chua
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Guat Bee Tan
- Department of Haematology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | | | - Kiat Hoe Ong
- Department of Haematology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Ying Zhi Tan
- Health and Social Sciences, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Sarah Hui Zhen Tan
- Health and Social Sciences, Singapore Institute of Technology, Singapore 138683, Singapore
| | - Claire Min Li Teo
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Samuel Shang Ming Lee
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Bernard Yu Hor Thong
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Bernard Pui Lam Leung
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Health and Social Sciences, Singapore Institute of Technology, Singapore 138683, Singapore
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11
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Zhou ZH, Cortese MM, Fang JL, Wood R, Hummell DS, Risma KA, Norton AE, KuKuruga M, Kirshner S, Rabin RL, Agarabi C, Staat MA, Halasa N, Ware RE, Stahl A, McMahon M, Browning P, Maniatis P, Bolcen S, Edwards KM, Su JR, Dharmarajan S, Forshee R, Broder KR, Anderson S, Kozlowski S. Evaluation of association of anti-PEG antibodies with anaphylaxis after mRNA COVID-19 vaccination. Vaccine 2023:S0264-410X(23)00568-6. [PMID: 37244808 DOI: 10.1016/j.vaccine.2023.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND The mechanism for anaphylaxis following mRNA COVID-19 vaccination has been widely debated; understanding this serious adverse event is important for future vaccines of similar design. A mechanism proposed is type I hypersensitivity (i.e., IgE-mediated mast cell degranulation) to polyethylene glycol (PEG). Using an assay that, uniquely, had been previously assessed in patients with anaphylaxis to PEG, our objective was to compare anti-PEG IgE in serum from mRNA COVID-19 vaccine anaphylaxis case-patients and persons vaccinated without allergic reactions. Secondarily, we compared anti-PEG IgG and IgM to assess alternative mechanisms. METHODS Selected anaphylaxis case-patients reported to U.S. Vaccine Adverse Event Reporting System December 14, 2020-March 25, 2021 were invited to provide a serum sample. mRNA COVID-19 vaccine study participants with residual serum and no allergic reaction post-vaccination ("controls") were frequency matched to cases 3:1 on vaccine and dose number, sex and 10-year age category. Anti-PEG IgE was measured using a dual cytometric bead assay (DCBA). Anti-PEG IgG and IgM were measured using two different assays: DCBA and a PEGylated-polystyrene bead assay. Laboratorians were blinded to case/control status. RESULTS All 20 case-patients were women; 17 had anaphylaxis after dose 1, 3 after dose 2. Thirteen (65 %) were hospitalized and 7 (35 %) were intubated. Time from vaccination to serum collection was longer for case-patients vs controls (post-dose 1: median 105 vs 21 days). Among Moderna recipients, anti-PEG IgE was detected in 1 of 10 (10 %) case-patients vs 8 of 30 (27 %) controls (p = 0.40); among Pfizer-BioNTech recipients, it was detected in 0 of 10 case-patients (0 %) vs 1 of 30 (3 %) controls (p >n 0.99). Anti-PEG IgE quantitative signals followed this same pattern. Neither anti-PEG IgG nor IgM was associated with case status with both assay formats. CONCLUSION Our results support that anti-PEG IgE is not a predominant mechanism for anaphylaxis post-mRNA COVID-19 vaccination.
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Affiliation(s)
- Zhao-Hua Zhou
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Margaret M Cortese
- Immunization Safety Office, Division of Healthcare Quality and Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jia-Long Fang
- National Center for Toxicological Research, FDA, Jefferson, AR, USA
| | - Robert Wood
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Donna S Hummell
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Kimberly A Risma
- Division of Allergy Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Allison E Norton
- Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Mark KuKuruga
- Center for Biologics Evaluation and Research, Food and Drug Administration, USA
| | - Susan Kirshner
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Ronald L Rabin
- Center for Biologics Evaluation and Research, Food and Drug Administration, USA
| | - Cyrus Agarabi
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Mary A Staat
- Division of Infectious Disease, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Natasha Halasa
- Division of Infectious Diseases, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Russell E Ware
- Division of Hematology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Anna Stahl
- Division of Infectious Diseases, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Maureen McMahon
- Division of Infectious Disease, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Peter Browning
- Microbial Pathogenesis and Immune Response Laboratory, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Panagiotis Maniatis
- Microbial Pathogenesis and Immune Response Laboratory, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shanna Bolcen
- Microbial Pathogenesis and Immune Response Laboratory, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kathryn M Edwards
- Division of Infectious Diseases, Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - John R Su
- Immunization Safety Office, Division of Healthcare Quality and Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sai Dharmarajan
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Richard Forshee
- Center for Biologics Evaluation and Research, Food and Drug Administration, USA
| | - Karen R Broder
- Immunization Safety Office, Division of Healthcare Quality and Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Steven Anderson
- Center for Biologics Evaluation and Research, Food and Drug Administration, USA
| | - Steven Kozlowski
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA.
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12
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Nappi E, Racca F, Piona A, Messina MR, Ferri S, Lamacchia D, Cataldo G, Costanzo G, Del Moro L, Puggioni F, Canonica GW, Heffler E, Paoletti G. Polyethylene Glycol and Polysorbate 80 Skin Tests in the Context of an Allergic Risk Assessment for Hypersensitivity Reactions to Anti-SARS-CoV-2 mRNA Vaccines. Vaccines (Basel) 2023; 11:vaccines11050915. [PMID: 37243019 DOI: 10.3390/vaccines11050915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Concern has arisen about hypersensitivity reactions in patients with allergic reactions to drugs containing polyethylene glycol (PEG) or polysorbate 80 (PS80), excipients of currently available anti-SARS-CoV-2 mRNA vaccines. However, the actual utility of PEG and PS80 skin allergy testing is currently still debated. We retrospectively analyzed all cases of patients on whom we performed allergometric skin tests for PEG and PS80 in the context of a pre-vaccination screening (for patients with multiple hypersensitivity reactions to drugs for which these excipients were among the suspected agents) or following suspected hypersensitivity reactions to anti-SARS-CoV-2 vaccines. A total of 134 tests were performed for PEG and PS80, eight of which produced uninterpretable results (due to dermographism or non-specific reactions). Of the remaining 126 cases (85 pre-vaccinal and 41 post-vaccine reactions), 16 (12.7%) were positive for PEG and/or PS80. Stratifying by clinical indication, there were no statistically significant differences in the proportion of positive tests between patients evaluated in the context of the pre-vaccination screening and those evaluated after a vaccine reaction (10.6% vs. 17.1%, respectively, p = 0.306). Allergometric skin tests for PEG and PS80 in our case series resulted positive in an unexpectedly high proportion of patients, suggesting that testing for allergy to these two excipients should not be ignored in case of reasonable clinical suspicion.
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Affiliation(s)
- Emanuele Nappi
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Francesca Racca
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Alessandra Piona
- Allergy Service, Humanitas San Pio X Hospital, 20159 Milano, Italy
| | - Maria Rita Messina
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Sebastian Ferri
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Donatella Lamacchia
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Giuseppe Cataldo
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Giovanni Costanzo
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Lorenzo Del Moro
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Clinical and Experimental Medicine, University of Florence, 50121 Firenze, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy
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13
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Chen WA, Chang DY, Chen BM, Lin YC, Barenholz Y, Roffler SR. Antibodies against Poly(ethylene glycol) Activate Innate Immune Cells and Induce Hypersensitivity Reactions to PEGylated Nanomedicines. ACS NANO 2023; 17:5757-5772. [PMID: 36926834 PMCID: PMC10062034 DOI: 10.1021/acsnano.2c12193] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/03/2023] [Indexed: 06/09/2023]
Abstract
Nanomedicines and macromolecular drugs can induce hypersensitivity reactions (HSRs) with symptoms ranging from flushing and breathing difficulties to hypothermia, hypotension, and death in the most severe cases. Because many normal individuals have pre-existing antibodies that bind to poly(ethylene glycol) (PEG), which is often present on the surface of nanomedicines and macromolecular drugs, we examined if and how anti-PEG antibodies induce HSRs to PEGylated liposomal doxorubicin (PLD). Anti-PEG IgG but not anti-PEG IgM induced symptoms of HSRs including hypothermia, altered lung function, and hypotension after PLD administration in C57BL/6 and nonobese diabetic/severe combined immunodeficiency (NOD/SCID) mice. Hypothermia was significantly reduced by blocking FcγRII/III, by depleting basophils, monocytes, neutrophils, or mast cells, and by inhibiting secretion of histamine and platelet-activating factor. Anti-PEG IgG also induced hypothermia in mice after administration of other PEGylated liposomes, nanoparticles, or proteins. Humanized anti-PEG IgG promoted binding of PEGylated nanoparticles to human immune cells and induced secretion of histamine from human basophils in the presence of PLD. Anti-PEG IgE could also induce hypersensitivity reactions in mice after administration of PLD. Our results demonstrate an important role for IgG antibodies in induction of HSRs to PEGylated nanomedicines through interaction with Fcγ receptors on innate immune cells and provide a deeper understanding of HSRs to PEGylated nanoparticles and macromolecular drugs that may facilitate development of safer nanomedicines.
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Affiliation(s)
- Wei-An Chen
- Institute
of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan
| | - Deng-Yuan Chang
- Institute
of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan
| | - Bing-Mae Chen
- Institute
of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan
| | - Yi-Chen Lin
- Institute
of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan
- Graduate
Institute of Life Sciences, National Defense
Medical Center, Taipei 11529, Taiwan
| | - Yechezekel Barenholz
- Department
of Biochemistry, Faculty of Medicine, The
Hebrew University, Jerusalem 91120, Israel
| | - Steve R. Roffler
- Institute
of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan
- Graduate
Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
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14
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Hashimoto M, Yonezawa S, Furan S, Nitta C, Maeda N, Tomita K, Yokouchi A, Koide H, Asai T. Increasing the siRNA knockdown efficiency of lipid nanoparticles by morphological transformation with the use of dihydrosphingomyelin as a helper lipid. Biomater Sci 2023; 11:3269-3277. [PMID: 36939181 DOI: 10.1039/d3bm00068k] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
Lipid nanoparticles (LNPs), comprising ionizable lipids, helper lipids, cholesterol, and PEG lipids, can act as delivery carriers for nucleic acids and have achieved clinical success in the delivery of siRNA and mRNA. It has been shown that the morphology of LNPs varies depending on their lipid composition, but the influence of their morphology on nucleic acid efficacy has not been fully elucidated. In this study, we used our previously developed novel lipid, dioleoylglycerophosphate-diethylenediamine conjugate (DOP-DEDA), to create pH-responsive LNPs (DOP-DEDA LNPs). We evaluated the morphology of DOP-DEDA LNPs composed of different helper lipids and the knockdown efficiency of small interfering RNA (siRNA). A distinctive difference in morphology was observed between DOP-DEDA LNPs of different helper lipids. Significant differences were also observed in the apparent pKa of DOP-DEDA LNPs and the knockdown efficiency of siRNA, which may be due to the difference in the localization of DOP-DEDA molecules in DOP-DEDA LNPs. These findings suggest that changing helper lipids alters the morphology of the DOP-DEDA LNP system, which affects the apparent pKa and knockdown efficiency of siRNA.
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Affiliation(s)
- Masahiro Hashimoto
- Department of Medical Biochemistry, University of Shizuoka School of Pharmaceutical Sciences, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan.
| | - Sei Yonezawa
- Department of Medical Biochemistry, University of Shizuoka School of Pharmaceutical Sciences, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan.
| | - Song Furan
- Department of Medical Biochemistry, University of Shizuoka School of Pharmaceutical Sciences, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan.
| | - Chiori Nitta
- Department of Medical Biochemistry, University of Shizuoka School of Pharmaceutical Sciences, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan.
| | - Noriyuki Maeda
- Nippon Fine Chemical Co., Ltd., Takasago, Hyogo 676-0074, Japan
| | - Koji Tomita
- Nippon Fine Chemical Co., Ltd., Takasago, Hyogo 676-0074, Japan
| | - Ayano Yokouchi
- Nippon Fine Chemical Co., Ltd., Takasago, Hyogo 676-0074, Japan
| | - Hiroyuki Koide
- Department of Medical Biochemistry, University of Shizuoka School of Pharmaceutical Sciences, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan.
| | - Tomohiro Asai
- Department of Medical Biochemistry, University of Shizuoka School of Pharmaceutical Sciences, 52-1 Yada, Suruga-ku, Shizuoka 422-8526, Japan.
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15
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Doyle R, Melo M, Teoh C, Wen S, Willcocks S. Safety of mRNA vaccination for COVID-19 in children with polyethylene glycol (PEG)-asparaginase allergy. Pediatr Allergy Immunol 2023; 34:e13939. [PMID: 36974643 DOI: 10.1111/pai.13939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 02/02/2023] [Accepted: 03/05/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Rebecca Doyle
- Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
- University of Queensland, School of Nursing, Midwifery and Social Work, St Lucia, Australia
| | - Mariana Melo
- Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
| | - Cindy Teoh
- Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
| | - Sophie Wen
- Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
- University of Queensland, Centre for Clinical Research, Herston, Australia
| | - Sophie Willcocks
- Children's Health Queensland Hospital and Health Service, South Brisbane, Australia
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16
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Zhang HP, Sun YL, Wang YF, Yazici D, Azkur D, Ogulur I, Azkur AK, Yang ZW, Chen XX, Zhang AZ, Hu JQ, Liu GH, Akdis M, Akdis CA, Gao YD. Recent developments in the immunopathology of COVID-19. Allergy 2023; 78:369-388. [PMID: 36420736 PMCID: PMC10108124 DOI: 10.1111/all.15593] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 11/01/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022]
Abstract
There has been an important change in the clinical characteristics and immune profile of Coronavirus disease 2019 (COVID-19) patients during the pandemic thanks to the extensive vaccination programs. Here, we highlight recent studies on COVID-19, from the clinical and immunological characteristics to the protective and risk factors for severity and mortality of COVID-19. The efficacy of the COVID-19 vaccines and potential allergic reactions after administration are also discussed. The occurrence of new variants of concerns such as Omicron BA.2, BA.4, and BA.5 and the global administration of COVID-19 vaccines have changed the clinical scenario of COVID-19. Multisystem inflammatory syndrome in children (MIS-C) may cause severe and heterogeneous disease but with a lower mortality rate. Perturbations in immunity of T cells, B cells, and mast cells, as well as autoantibodies and metabolic reprogramming may contribute to the long-term symptoms of COVID-19. There is conflicting evidence about whether atopic diseases, such as allergic asthma and rhinitis, are associated with a lower susceptibility and better outcomes of COVID-19. At the beginning of pandemic, the European Academy of Allergy and Clinical Immunology (EAACI) developed guidelines that provided timely information for the management of allergic diseases and preventive measures to reduce transmission in the allergic clinics. The global distribution of COVID-19 vaccines and emerging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with reduced pathogenic potential dramatically decreased the morbidity, severity, and mortality of COVID-19. Nevertheless, breakthrough infection remains a challenge for disease control. Hypersensitivity reactions (HSR) to COVID-19 vaccines are low compared to other vaccines, and these were addressed in EAACI statements that provided indications for the management of allergic reactions, including anaphylaxis to COVID-19 vaccines. We have gained a depth knowledge and experience in the over 2 years since the start of the pandemic, and yet a full eradication of SARS-CoV-2 is not on the horizon. Novel strategies are warranted to prevent severe disease in high-risk groups, the development of MIS-C and long COVID-19.
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Affiliation(s)
- Huan-Ping Zhang
- Department of Allergology, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Yuan-Li Sun
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yan-Fen Wang
- Department of Pediatrics, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Duygu Yazici
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Dilek Azkur
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Faculty of Medicine, University of Kirikkale, Kirikkale, Turkey
| | - Ismail Ogulur
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Ahmet Kursat Azkur
- Department of Virology, Faculty of Veterinary Medicine, University of Kirikkale, Kirikkale, Turkey
| | - Zhao-Wei Yang
- Department of Allergy and Clinical Immunology, State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiao-Xue Chen
- Department of Allergology, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Ai-Zhi Zhang
- Intensive Care Unit, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jia-Qian Hu
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Guang-Hui Liu
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Mübeccel Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Ya-Dong Gao
- Department of Allergology, Zhongnan Hospital of Wuhan University, Wuhan, China
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17
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Skin Testing and Basophil Activation Testing Is Useful for Assessing Immediate Reactions to Polyethylene Glycol-Containing Vaccines. Vaccines (Basel) 2023; 11:vaccines11020252. [PMID: 36851130 PMCID: PMC9968132 DOI: 10.3390/vaccines11020252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The mechanism of immediate reactions to drugs or vaccines containing polyethylene glycol (PEG) and PEG derivatives is not fully elucidated. It is considered in many instances to be IgE-mediated. Diagnosis and management of PEG allergy is topical, as BNT162b and mRNA-1273 contain PEG (2[PEG-2000]-N), and ChAdOx1-S and NVX-CoV2373 contain polysorbate 80. mRNA vaccines contain PEG 2000, which encapsulates the mRNA to impair its degradation. This PEG MW is specific to mRNA vaccines and is not used in other drugs and vaccines. PEG 2000 allergy is not well studied, as higher PEG molecular weights are implicated in most of the PEG allergy published in the literature. METHODS We performed a literature review on PEG allergy and sought to evaluate the safety and effectiveness of our protocol for assessment of PEG 2000 and polysorbate 80 reactions in an outpatient clinic setting. All patients referred to our drug allergy service between 1 July 2021 and 31 December 2021 with suspected immediate allergy to PEG or its derivatives were eligible for the study. Skin testing (ST) and basophil activation testing (BAT) were performed for all patients to multiple PEG molecular weights (MWs). RESULTS We reviewed twenty patients during the study period. Five patients were allergic. Fifteen patients had a masquerade of allergy and were enrolled as control patients. PEG 2000, polysorbate 80, BNT162b, and ChAdOx1-S had excellent performance characteristics on skin testing. BAT showed high specificity for all vaccines and PEG MWs. DISCUSSION In our small study, we found ST and BAT to add useful information, particularly for PEG 2000 allergy. Further study of our protocol in larger patient cohorts will provide more information on its performance characteristics and usefulness.
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18
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Ko HL, Zhuo N, Chang ZW, Santosa A, Kalimuddin S, Lim XR, Tan SY, Lye DC, Toh D, Young BE, Renia L, Lee HY, Ren EC. In vitro vaccine challenge of PBMCs from BNT162b2 anaphylaxis patients reveals HSP90α-NOD2-NLRP3 nexus. Allergy 2023; 78:304-307. [PMID: 36056775 DOI: 10.1111/all.15503] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 12/30/2022]
Affiliation(s)
- Hui Ling Ko
- Singapore Immunology Network, A*STAR, Singapore, Singapore
| | - Nicole Zhuo
- Singapore Immunology Network, A*STAR, Singapore, Singapore
| | - Zi Wei Chang
- A*STAR Infectious Diseases Labs, A*STAR, Singapore, Singapore
| | - Anindita Santosa
- Changi General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Shirin Kalimuddin
- Duke-NUS Medical School, Singapore, Singapore.,Singapore General Hospital, Singapore, Singapore
| | | | | | - David Chien Lye
- Tan Tock Seng Hospital, Singapore, Singapore.,National Centre for Infectious Diseases, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dorothy Toh
- Health Sciences Authority, Singapore, Singapore
| | - Barnaby Edward Young
- Tan Tock Seng Hospital, Singapore, Singapore.,National Centre for Infectious Diseases, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Laurent Renia
- A*STAR Infectious Diseases Labs, A*STAR, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | | | - Ee Chee Ren
- Singapore Immunology Network, A*STAR, Singapore, Singapore.,Department of Microbiology & Immunology, National University of Singapore, Singapore, Singapore
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19
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Zhang D, Tang Q, Chen J, Wei Y, Chen J. Novel Development of Nanoparticles-A Promising Direction for Precise Tumor Management. Pharmaceutics 2022; 15:pharmaceutics15010024. [PMID: 36678653 PMCID: PMC9862928 DOI: 10.3390/pharmaceutics15010024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Although the clinical application of nanoparticles is still limited by biological barriers and distribution, with the deepening of our understanding of nanoparticles over the past decades, people are gradually breaking through the previous limitations in the diagnosis and treatment of tumors, providing novel strategies for clinical decision makers. The transition of nanoparticles from passive targeting to active tumor-targeting by abundant surface-modified nanoparticles is also a development process of precision cancer treatment. Different particles can be used as targeted delivery tools of antitumor drugs. The mechanism of gold nanoparticles inducing apoptosis and cycle arrest of tumor cells has been discovered. Moreover, the unique photothermal effect of gold nanoparticles may be widely used in tumor therapy in the future, with less side effects on surrounding tissues. Lipid-based nanoparticles are expected to overcome the blood-brain barrier due to their special characteristics, while polymer-based nanoparticles show better biocompatibility and lower toxicity. In this paper, we discuss the development of nanoparticles in tumor therapy and the challenges that need to be addressed.
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Affiliation(s)
- Dengke Zhang
- Department of Surgery, The Eighth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510275, China
| | - Qingqing Tang
- Department of Surgery, The Eighth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510275, China
| | - Juan Chen
- Department of Medicine & Rehabilitation, Tung Wah Eastern Hospital, Hong Kong, China
| | - Yanghui Wei
- Department of Surgery, The Eighth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510275, China
- Correspondence: (Y.W.); (J.C.)
| | - Jiawei Chen
- Department of Surgery, The Eighth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510275, China
- Correspondence: (Y.W.); (J.C.)
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20
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Ji C, Li J, Mei J, Su W, Dai H, Li F, Liu P. Advanced Nanomaterials for the Diagnosis and Treatment of Renal Cell Carcinoma. ADVANCED NANOBIOMED RESEARCH 2022. [DOI: 10.1002/anbr.202200079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Chen Ji
- State Key Laboratory of Oncogenes and Related Genes Shanghai Cancer Institute RenJi Hospital School of Medicine Shanghai Jiao Tong University Shanghai 200032 China
- Central Laboratory Renji Hospital School of Medicine Shanghai Jiao Tong University Shanghai 200127 China
- Micro-Nano Research and Diagnosis Center RenJi Hospital School of Medicine Shanghai Jiao Tong University Shanghai 200127 China
| | - Junru Li
- State Key Laboratory of Oncogenes and Related Genes Shanghai Cancer Institute RenJi Hospital School of Medicine Shanghai Jiao Tong University Shanghai 200032 China
- Central Laboratory Renji Hospital School of Medicine Shanghai Jiao Tong University Shanghai 200127 China
- Micro-Nano Research and Diagnosis Center RenJi Hospital School of Medicine Shanghai Jiao Tong University Shanghai 200127 China
| | - Junyang Mei
- State Key Laboratory of Oncogenes and Related Genes Shanghai Cancer Institute RenJi Hospital School of Medicine Shanghai Jiao Tong University Shanghai 200032 China
- Central Laboratory Renji Hospital School of Medicine Shanghai Jiao Tong University Shanghai 200127 China
- Micro-Nano Research and Diagnosis Center RenJi Hospital School of Medicine Shanghai Jiao Tong University Shanghai 200127 China
| | - Weiran Su
- State Key Laboratory of Oncogenes and Related Genes Shanghai Cancer Institute RenJi Hospital School of Medicine Shanghai Jiao Tong University Shanghai 200032 China
- Central Laboratory Renji Hospital School of Medicine Shanghai Jiao Tong University Shanghai 200127 China
- Micro-Nano Research and Diagnosis Center RenJi Hospital School of Medicine Shanghai Jiao Tong University Shanghai 200127 China
| | - Huili Dai
- State Key Laboratory of Oncogenes and Related Genes Shanghai Cancer Institute RenJi Hospital School of Medicine Shanghai Jiao Tong University Shanghai 200032 China
- Central Laboratory Renji Hospital School of Medicine Shanghai Jiao Tong University Shanghai 200127 China
- Micro-Nano Research and Diagnosis Center RenJi Hospital School of Medicine Shanghai Jiao Tong University Shanghai 200127 China
| | - Fengqin Li
- State Key Laboratory of Oncogenes and Related Genes Shanghai Cancer Institute RenJi Hospital School of Medicine Shanghai Jiao Tong University Shanghai 200032 China
- Central Laboratory Renji Hospital School of Medicine Shanghai Jiao Tong University Shanghai 200127 China
- Micro-Nano Research and Diagnosis Center RenJi Hospital School of Medicine Shanghai Jiao Tong University Shanghai 200127 China
| | - Peifeng Liu
- State Key Laboratory of Oncogenes and Related Genes Shanghai Cancer Institute RenJi Hospital School of Medicine Shanghai Jiao Tong University Shanghai 200032 China
- Central Laboratory Renji Hospital School of Medicine Shanghai Jiao Tong University Shanghai 200127 China
- Micro-Nano Research and Diagnosis Center RenJi Hospital School of Medicine Shanghai Jiao Tong University Shanghai 200127 China
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21
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Quan PL, Ollé L, Sabaté-Brescó M, Guo Y, Muñoz-Cano R, Wagner A, Gastaminza G, Martín M. SARS-CoV-2 vaccine excipients polyethylene glycol and trometamol do not induce mast cell degranulation, in an in vitro model for non-IgE-mediated hypersensitivity. FRONTIERS IN ALLERGY 2022; 3:1046545. [PMID: 36606064 PMCID: PMC9807604 DOI: 10.3389/falgy.2022.1046545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022] Open
Abstract
The development of vaccines against SARS-CoV2 brought about several challenges, including the management of hypersensitivity reactions to these formulations. The search for underlying mechanisms involved in these adverse events initially focused on excipients which may trigger mast cell activation responses via non-IgE pathways: polyethylene glycol and trometamol. We sought to determine whether these components, in their pure form, were capable of stimulating mast cells directly. To test this hypothesis, we used an in vitro model for non-IgE-mediated activation that has previously shown degranulation responses induced via MRGPRX2 with known drug agonists of the receptor. Human LAD2 mast cells were incubated with different concentrations (1, 10, 50 mg/ml) of trometamol and of purified polyethylene glycol/Macrogol (molecular weights: 2,000, 3,350, 4,000, and 6,000). Mast cell degranulation was assessed using a beta-hexosaminidase read-out. Interestingly, degranulation responses for all reagents tested showed no significant differences from those obtained from the negative control (basal degranulation). Receptor-silencing assays were therefore not conducted. In summary, purified PEG and trometamol did not induce mast cell degranulation in this in vitro model for the study of non-IgE mechanisms of drug hypersensitivity, previously shown to be useful in the investigation of MRGPRX2 ligands. Studies using complete vaccine formulations, lipid conjugates, and receptor gene variants are needed to further clarify mechanisms of vaccine hypersensitivity.
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Affiliation(s)
- Paola Leonor Quan
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain,Correspondence: Paola Leonor Quan
| | - Laia Ollé
- Laboratory of Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain,Biochemistry Unit, Biomedicine Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Marina Sabaté-Brescó
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain,Research Network on Asthma, Drug Adverse Reactions and Allergy (Red de Investigación en Asma, Reacciones Adversas a Fármacos y Alergia) (ARADyAL), Madrid, Spain,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Yanru Guo
- Laboratory of Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain,Biochemistry Unit, Biomedicine Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Rosa Muñoz-Cano
- Laboratory of Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain,Research Network on Asthma, Drug Adverse Reactions and Allergy (Red de Investigación en Asma, Reacciones Adversas a Fármacos y Alergia) (ARADyAL), Madrid, Spain,Allergy Department, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Annette Wagner
- Department of Adult Allergy, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Gabriel Gastaminza
- Department of Allergy and Clinical Immunology, Clínica Universidad de Navarra, Pamplona, Spain,Research Network on Asthma, Drug Adverse Reactions and Allergy (Red de Investigación en Asma, Reacciones Adversas a Fármacos y Alergia) (ARADyAL), Madrid, Spain,Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Margarita Martín
- Laboratory of Clinical and Experimental Respiratory Immunoallergy, IDIBAPS, Barcelona, Spain,Biochemistry Unit, Biomedicine Department, Faculty of Medicine, University of Barcelona, Barcelona, Spain,Research Network on Asthma, Drug Adverse Reactions and Allergy (Red de Investigación en Asma, Reacciones Adversas a Fármacos y Alergia) (ARADyAL), Madrid, Spain
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22
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Perkins GB, Hurtado PR, Hissaria P. Basophil reactivity to BNT162b2 in COVID-19 convalescence. Allergy 2022; 77:3704-3705. [PMID: 36441594 PMCID: PMC9877828 DOI: 10.1111/all.15472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Griffith B. Perkins
- School of Biological SciencesUniversity of AdelaideAdelaideSouth AustraliaAustralia,SA PathologyAdelaideSouth AustraliaAustralia
| | - Plinio R. Hurtado
- Renal DepartmentRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia,Adelaide Medical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia
| | - Pravin Hissaria
- SA PathologyAdelaideSouth AustraliaAustralia,Adelaide Medical SchoolUniversity of AdelaideAdelaideSouth AustraliaAustralia,Immunology DepartmentRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
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23
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Worm M, Vieths S, Mahler V. An update on anaphylaxis and urticaria. J Allergy Clin Immunol 2022; 150:1265-1278. [PMID: 36481047 DOI: 10.1016/j.jaci.2022.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 10/17/2022] [Accepted: 10/17/2022] [Indexed: 12/07/2022]
Abstract
Notable scientific developments have taken place in the field of anaphylaxis and urticaria in recent years; they are highlighted in this review. Case-control studies, genome-wide association studies, and large omics analyses have promoted further insights into not only the underlying genetics but also the biomarkers of both anaphylaxis and urticaria. New evidence regarding IgE-dependent and non-IgE-dependent mechanisms of anaphylaxis and urticaria, including the Mas-related G protein-coupled receptor (MRGPR [formerly MRG]) signaling pathway, has been gained. Putative elicitors of anaphylactic reactions in the context of coronavirus disease 2019 (COVID-19) vaccination and impact of the COVID-19 pandemic on the management and course of chronic urticaria have been reported. Clinical progress has also been made regarding the severity grading and risk factors of anaphylaxis, as well as the distinction of phenotypes and elicitors of both diseases. Furthermore, novel treatment approaches for anaphylaxis and subtypes of urticaria have been assessed, with different outcome and potential for a better disease control or prevention.
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Affiliation(s)
- Margitta Worm
- Division of Allergy and Immunology, Department of Dermatology and Allergology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Vieths
- Federal Institute for Vaccines and Biomedicines, Paul-Ehrlich-Institut, Langen, Germany
| | - Vera Mahler
- Federal Institute for Vaccines and Biomedicines, Paul-Ehrlich-Institut, Langen, Germany.
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24
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SARS-CoV-2 Specific Humoral Immune Responses after BNT162b2 Vaccination in Hospital Healthcare Workers. Vaccines (Basel) 2022; 10:vaccines10122038. [PMID: 36560450 PMCID: PMC9782529 DOI: 10.3390/vaccines10122038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND COVID-19 pandemic has led to a loss of human life in millions and devastating socio-economic consequences worldwide. So far, vaccination is the most effective long-term strategy to control and prevent severe COVID-19 disease. The aim of the current study was to evaluate the humoral immune responses raised against the BNT162b2 vaccine in hospital healthcare workers. METHODS Total number of 173 healthcare workers enrolled in the study. Their blood samples were collected in three different time intervals after the second SARS-CoV-2 vaccination and evaluated by the ELISA method to detect anti-spike protein IgM and IgG antibodies. The baseline characteristics of all participants were collected using questionnaires and were evaluated for finding any significant data. RESULTS Our results demonstrated that the levels of antibodies were higher in the young group (21-30 years old) and also among male participants. Moreover, the highest levels of antibodies were detected from the group that received the third shot vaccination. CONCLUSIONS Our results indicate that age, gender and third-dose vaccination can affect the levels of humoral immune responses against the BNT162b2 vaccine in healthcare workers.
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25
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Bent RK, Faihs V, Tizek L, Biedermann T, Zink A, Brockow K. PEG allergy - A COVID-19 pandemic-made problem? A German perspective. World Allergy Organ J 2022; 15:100714. [PMID: 36337297 PMCID: PMC9618425 DOI: 10.1016/j.waojou.2022.100714] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/22/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background Polyethylene glycol (PEG) has been used for decades, but only caused allergic reactions exceptionally. Introduction of PEG-containing COVID-19 vaccines might have fostered public interest beyond medical reasoning. Objectives To investigate the impact of the SARS-CoV-2 pandemic on the public interest in PEG allergy in Germany and the published PEG allergy cases worldwide. Methods A retrospective longitudinal study was conducted to measure public interest in PEG allergy analyzing Google search volume in Germany from February 2018 to January 2022. Medically confirmed “PEG allergy” cases were analyzed by looking at the numbers of PubMed case reports and case series from 1977 until January 2022. Results Web results in Germany before COVID-19 show search volumes related to “PEG allergy/testing” was negligible, with 10 search queries per month. The pandemic led to a >200-fold increase from 250 queries 2 years before to 55 720 queries 2 years thereafter, reflecting tremendous public interest. Additionally, the maximum monthly search volume from before to during the pandemic increased immensely for “vaccination” (57-fold), “vaccination and adverse effects” (85-fold), “vaccination and allergy” (71-fold). In contrast, the increase of publication numbers for the search term “PEG allergy” was small from 2019 to 2021 (2.5-fold). Only a very low number of 211 cases with “PEG allergy” worldwide since 1977 could be identified. Conclusion PEG allergy became a topic of major public interest because of COVID-19 vaccination. Scientific publications have increased to a lesser extent, probably promoted by public awareness. Conversely, the overall number of cases published with PEG allergy remain very low. The current high demand for COVID-19 vaccination allergy testing is triggered by public interest instead of medical reasoning.
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Affiliation(s)
| | | | | | | | | | - Knut Brockow
- Corresponding author. Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein Technische Universität München, Biedersteiner Str. 29, 80802 München, Germany
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26
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Mouri M, Imamura M, Suzuki S, Kawasaki T, Ishizaki Y, Sakurai K, Nagafuchi H, Matsumura N, Uchida M, Ando T, Yoshioka K, Ooka S, Sugihara T, Miyoshi H, Mori M, Okada T, Yamaguchi M, Kunishima H, Kato M, Kawahata K. Serum polyethylene glycol-specific IgE and IgG in patients with hypersensitivity to COVID-19 mRNA vaccines. Allergol Int 2022; 71:512-519. [PMID: 35718709 PMCID: PMC9167845 DOI: 10.1016/j.alit.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/02/2022] [Accepted: 05/10/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The mechanism of allergic reactions to COVID-19 mRNA vaccines has not been clarified. Polyethylene glycol (PEG) is a potential antigen in the components of vaccines. However, there is little evidence that allergy after COVID-19 mRNA vaccination is related to PEG. Furthermore, the role of polysorbate (PS) as an antigen has also not been clarified. The objective of this study was to investigate whether PEG and PS allergies are reasonable causes of allergic symptoms after vaccination by detecting PEG-specific and PS-specific antibodies. METHODS Fourteen patients who developed immediate allergic reactions to BNT162b2 (Pfizer-BioNTech) or mRNA-1273 (Moderna) vaccines and nineteen healthy controls who did not present allergic symptoms were recruited. Serum PEG-specific immunoglobulin E (IgE) and immunoglobulin G (IgG) and PS-specific IgE and IgG were measured by enzyme-linked immunosorbent assay. Skin tests using PEG-2000 and PS-80 were applied to five patients and three controls. RESULTS Serum levels of PEG-specific IgE and IgG in patients with immediate allergic reactions to the COVID-19 mRNA vaccine were higher than those in the control group. Serum levels of PS-specific IgE in patients with allergy to the vaccine were higher than those in patients of the control group. Intradermal tests using PEG verified the results for PEG-specific IgE and IgG. CONCLUSIONS The results suggest that PEG is one of the antigens in the allergy to COVID-19 mRNA vaccines. Cross-reactivity between PEG and PS might be crucial for allergy to the vaccines. PEG-specific IgE and IgG may be useful in diagnosing allergy to COVID-19 mRNA vaccines.
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Affiliation(s)
- Mariko Mouri
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan; Department of Pediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Mitsuru Imamura
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan.
| | - Shotaro Suzuki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Tatsuya Kawasaki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yoshiki Ishizaki
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Keiichi Sakurai
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Hiroko Nagafuchi
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Norihiro Matsumura
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Marina Uchida
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Takayasu Ando
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Kohei Yoshioka
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Seido Ooka
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Takahiko Sugihara
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Hiroshi Miyoshi
- Department of Microbiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Masaaki Mori
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan; Department of Lifetime Clinical Immunology, Tokyo Medical and Dental University, Tokyo, Japan; Livelong Care Center for Rheumatic Diseases, Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Tomoyuki Okada
- Department of Otolaryngology and Health Service Center, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masao Yamaguchi
- Division of Respiratory Medicine, Third Department of Medicine, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Hiroyuki Kunishima
- Department of Infectious Disease, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Motohiro Kato
- Department of Pediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kimito Kawahata
- Division of Rheumatology and Allergology, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
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Nicaise-Roland P, Granger V, Soria A, Barbaud A, Pallardy M, Chollet-Martin S, de Chaisemartin L. Immediate hypersensitivity to COVID-19 vaccines: Focus on biological diagnosis. FRONTIERS IN ALLERGY 2022; 3:1007602. [PMID: 36249342 PMCID: PMC9561365 DOI: 10.3389/falgy.2022.1007602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/15/2022] [Indexed: 11/18/2022] Open
Abstract
Soon after the release of the new anti-COVID mRNA vaccines, reports came in from the US and the UK of anaphylactic reactions. Fueled by the necessary caution toward these new vaccine platforms, these reports had a great impact and were largely commented upon in the scientific literature and global media. The current estimated frequency is of 5 cases per million doses. Very little biological data are presented in the literature to support the anaphylaxis diagnosis in these patients in addition to skin tests. Allergic reactions to vaccines are rare and mostly due to vaccine excipient. Therefore, the poly-ethylene-glycol (PEG) present in both mRNA formulation, and already known to be immunogenic, was soon suspected to be the potential culprit. Several hypersensitivity mechanisms to PEG or to other vaccine components can be suspected, even if the classical IgE-dependent anaphylaxis seems to be one of the most plausible candidates. In the early 2022, the international guidelines recommended to perform skin prick tests and basophil activation tests (BAT) in people experiencing allergic reaction to the first dose of COVID-19 vaccine or with a history of PEG allergy. The aim of this review is to discuss the main potential mechanisms of immediate allergy to COVID19 vaccines based on published data, together with the various techniques used to confirm or not sensitization to one component.
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Affiliation(s)
- Pascale Nicaise-Roland
- Service d’Immunologie Biologique, Hôpital Bichat, DMU BIOGÉM, APHP, Paris, France
- Université Paris Cité, Inserm PHERE, Paris, France
| | - Vanessa Granger
- Service d’Immunologie Biologique, Hôpital Bichat, DMU BIOGÉM, APHP, Paris, France
- Université Paris-Saclay, Inserm, Inflammation Microbiome Immunosurveillance, Orsay, France
| | - Angèle Soria
- Département de Dermatologie et Allergologie, Sorbonne Université, Hôpital Tenon, Paris, France
- Centre D'immunologie et des Maladies Infectieuses - Paris (Cimi-Paris), INSERM, Paris, France
| | - Annick Barbaud
- Département de Dermatologie et Allergologie, Sorbonne Université, INSERM, Institut Pierre Louis D'Epidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Tenon, Paris, France
| | - Marc Pallardy
- Université Paris-Saclay, Inserm, Inflammation Microbiome Immunosurveillance, Orsay, France
| | - Sylvie Chollet-Martin
- Service d’Immunologie Biologique, Hôpital Bichat, DMU BIOGÉM, APHP, Paris, France
- Université Paris-Saclay, Inserm, Inflammation Microbiome Immunosurveillance, Orsay, France
- Correspondence: Sylvie Chollet-Martin
| | - Luc de Chaisemartin
- Service d’Immunologie Biologique, Hôpital Bichat, DMU BIOGÉM, APHP, Paris, France
- Université Paris-Saclay, Inserm, Inflammation Microbiome Immunosurveillance, Orsay, France
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28
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Tian Y, Gao Z, Wang N, Hu M, Ju Y, Li Q, Caruso F, Hao J, Cui J. Engineering Poly(ethylene glycol) Nanoparticles for Accelerated Blood Clearance Inhibition and Targeted Drug Delivery. J Am Chem Soc 2022; 144:18419-18428. [PMID: 36166420 DOI: 10.1021/jacs.2c06877] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Surface modification with poly(ethylene glycol) (PEGylation) is an effective strategy to improve the colloidal stability of nanoparticles (NPs) and is often used to minimize cellular uptake and clearance of NPs by the immune system. However, PEGylation can also trigger the accelerated blood clearance (ABC) phenomenon, which is known to reduce the circulation time of PEGylated NPs. Herein, we report the engineering of stealth PEG NPs that can avoid the ABC phenomenon and, when modified with hyaluronic acid (HA), show specific cancer cell targeting and drug delivery. PEG NPs cross-linked with disulfide bonds are prepared by using zeolitic imidazolate framework-8 NPs as templates. The reported templating strategy enables the simultaneous removal of the template and formation of PEG NPs under mild conditions (pH 5.5 buffer). Compared to PEGylated liposomes, PEG NPs avoid the secretion of anti-PEG antibodies and the presence of anti-PEG IgM and IgG did not significantly accelerate the blood clearance of PEG NPs, indicating the inhibition of the ABC effect for the PEG NPs. Functionalization of the PEG NPs with HA affords PEG NPs that retain their stealth properties against macrophages, target CD44-expressed cancer cells and, when loaded with the anticancer drug doxorubicin, effectively inhibit tumor growth. The innovation of this study lies in the engineering of PEG NPs that can circumvent the ABC phenomenon and that can be functionalized for the improved and targeted delivery of drugs.
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Affiliation(s)
- Yuan Tian
- Key Laboratory of Colloid and Interface Chemistry of the Ministry of Education, School of Chemistry and Chemical Engineering, Shandong University, Jinan, Shandong 250100, China
| | - Zhiliang Gao
- Key Laboratory of Colloid and Interface Chemistry of the Ministry of Education, School of Chemistry and Chemical Engineering, Shandong University, Jinan, Shandong 250100, China
| | - Ning Wang
- Key Laboratory of Colloid and Interface Chemistry of the Ministry of Education, School of Chemistry and Chemical Engineering, Shandong University, Jinan, Shandong 250100, China
| | - Ming Hu
- School of Physics and Electronic Science, East China Normal University, Shanghai 200241, China
| | - Yi Ju
- School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria 3083, Australia.,Department of Chemical Engineering, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Qiang Li
- Key Laboratory of Colloid and Interface Chemistry of the Ministry of Education, School of Chemistry and Chemical Engineering, Shandong University, Jinan, Shandong 250100, China
| | - Frank Caruso
- Department of Chemical Engineering, The University of Melbourne, Parkville, Victoria 3010, Australia
| | - Jingcheng Hao
- Key Laboratory of Colloid and Interface Chemistry of the Ministry of Education, School of Chemistry and Chemical Engineering, Shandong University, Jinan, Shandong 250100, China
| | - Jiwei Cui
- Key Laboratory of Colloid and Interface Chemistry of the Ministry of Education, School of Chemistry and Chemical Engineering, Shandong University, Jinan, Shandong 250100, China.,State Key Laboratory of Microbial Technology, Shandong University, Qingdao, Shandong 266237, China
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29
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Barbaud A, Garvey LH, Arcolaci A, Brockow K, Mori F, Mayorga C, Bonadonna P, Atanaskovic-Markovic M, Moral L, Zanoni G, Pagani M, Soria A, Jošt M, Caubet JC, Carmo A, Mona AA, Alvarez-Perea A, Bavbek S, Benedetta B, Bilo MB, Blanca-López N, Bogas HG, Buonomo A, Calogiuri G, Carli G, Cernadas J, Cortellini G, Celik G, Demir S, Doña I, Dursun AB, Eberlein B, Faria E, Fernandes B, Garcez T, Garcia-Nunez I, Gawlik R, Gelincik A, Gomes E, Gooi JHC, Grosber M, Gülen T, Hacard F, Hoarau C, Janson C, Johnston SL, Joerg L, Kepil Özdemir S, Klimek L, Košnik M, Kowalski ML, Kuyucu S, Kvedariene V, Laguna JJ, Lombardo C, Marinho S, Merk H, Meucci E, Morisset M, Munoz-Cano R, Murzilli F, Nakonechna A, Popescu FD, Porebski G, Radice A, Regateiro FS, Röckmann H, Romano A, Sargur R, Sastre J, Scherer Hofmeier K, Sedláčková L, Sobotkova M, Terreehorst I, Treudler R, Walusiak-Skorupa J, Wedi B, Wöhrl S, Zidarn M, Zuberbier T, Agache I, Torres MJ. Allergies and COVID-19 vaccines: An ENDA/EAACI Position paper. Allergy 2022; 77:2292-2312. [PMID: 35112371 DOI: 10.1111/all.15241] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/17/2021] [Accepted: 01/03/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Anaphylaxis, which is rare, has been reported after COVID-19 vaccination, but its management is not standardized. METHOD Members of the European Network for Drug Allergy and the European Academy of Allergy and Clinical Immunology interested in drug allergy participated in an online questionnaire on pre-vaccination screening and management of allergic reactions to COVID-19 vaccines, and literature was analysed. RESULTS No death due to anaphylaxis to COVID-19 vaccines has been confirmed in scientific literature. Potential allergens, polyethylene glycol (PEG), polysorbate and tromethamine are excipients. The authors propose allergy evaluation of persons with the following histories: 1-anaphylaxis to injectable drug or vaccine containing PEG or derivatives; 2-anaphylaxis to oral/topical PEG containing products; 3-recurrent anaphylaxis of unknown cause; 4-suspected or confirmed allergy to any mRNA vaccine; and 5-confirmed allergy to PEG or derivatives. We recommend a prick-to-prick skin test with the left-over solution in the suspected vaccine vial to avoid waste. Prick test panel should include PEG 4000 or 3500, PEG 2000 and polysorbate 80. The value of in vitro test is arguable. CONCLUSIONS These recommendations will lead to a better knowledge of the management and mechanisms involved in anaphylaxis to COVID-19 vaccines and enable more people with history of allergy to be vaccinated.
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Affiliation(s)
- Annick Barbaud
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP.Sorbonne Université, Hôpital Tenon, Département de dermatologie et allergologie, Paris, France
| | - Lene Heise Garvey
- Allergy Clinic, Copenhagen University Hospital at Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Alessandra Arcolaci
- Immunology Unit, University Hospital of Verona, Policlinico G.B. Rossi, Verona, Italy
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Faculty of Medicine, Technical University of Munich, Munich, Germany
| | - Francesca Mori
- Allergy Unit, Department of Pediatrics, Meyer Children's University Hospital
| | - Cristobalina Mayorga
- Allergy Clinical Unit, Hospital Regional Universitario de Málaga-Instituto de Investigación Biomédica de Málaga-IBIMA, ARADyAL, Málaga, Spain
| | | | | | - Luis Moral
- Moral Luis. Pediatric Allergy and Respiratory Unit, Alicante University General Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - Giovanna Zanoni
- Giovanna Zanoni, Immunology Unit, Policlinico G.B. Rossi, Azienda Ospedaliera Universitaria Integrata Verona, Italy
| | - Mauro Pagani
- Medicine Department, Medicine Ward Mantova Hospital, ASST di Mantova, Italy
| | - Angèle Soria
- Sorbonne Université, INSERM 1135 Cimi-Paris, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Departement de dermatologie et d'allergologie, Paris, France
| | - Maja Jošt
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
| | - Jean-Christoph Caubet
- Department of Women-Children-Teenagers, University Hospital of Geneva, Geneva, Switzerland
| | - Abreu Carmo
- Allergy and Clinical Immunology Unit, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real and Allergy and Clinical Immunology Unit, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal
| | - Al-Ahmad Mona
- Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait
| | | | - Sevim Bavbek
- School of Medicine, Department of Pulmonary Diseases, Division of Allergy, FAAAI, Ankara University, Ankara, Turkey
| | - Biagioni Benedetta
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Disease, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
| | - M Beatrice Bilo
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
- Allergy Unit - Department of Internal Medicine, University Hospital Ospedali Riuniti di Ancona, Italy
| | | | - Herrera Gádor Bogas
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, and Allergy Unit, Hospital Regional Universitario de Málaga-HRUM, Málaga, Spain
| | - Alessandro Buonomo
- Allergy Unit - Fondazione Policlinico Gemelli IRCCS - Largo Gemelli, Rome, Italy
| | | | - Giulia Carli
- SOS Allergologia e Immunologia, Azienda USL Toscana Centro, Ospedale S. Stefano, Prato, Italy
| | - Josefina Cernadas
- Allergy and Clinical Immunology Department, Centro Hospitalar Universitário de S. João, Porto and Allergy Unit, Hospital Lusíadas, Porto, Portugal
| | - Gabriele Cortellini
- Allergy Unit, Departments of Internal Medicine, Azienda Sanitaria della Romagna, Rimini, Hospital, Rimini, Italy
| | - Gülfem Celik
- Department of Chest Diseases, Division of Immunology and allergy, Ankara University School of Medicine cebeci Hospital, Ankara, Turkey
| | - Semra Demir
- Istanbul University, Istanbul Faculty of Medicine, Internal Medicine, Immunology and Allergic Diseases, Istanbul, Turkey
| | - Inmaculada Doña
- Allergy Research Group, Allergy Unit, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga-IBIMA, Plaza del Hospital Civil s/n, Málaga, Spain
| | | | - Bernadette Eberlein
- Faculty of Medicine, Department of Dermatology and Allergy Biederstein, Technical University of Munich, Munich, Germany
| | - Emilia Faria
- Allergy and Clinical Immunology Unit, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
| | - Bryan Fernandes
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Tomaz Garcez
- Immunology Department, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Radoslaw Gawlik
- Department of Internal Diseases, Allergology and Clinical Immunology, Medical University of Silesia, Katowice, Poland
| | - Asli Gelincik
- Istanbul University, Istanbul Faculty of Medicine, Internal Medicine, Immunology and Allergic Diseases, Istanbul, Turkey
| | - Eva Gomes
- Allergy Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Jimmy H C Gooi
- Department of Clinical Immunology, King's College Hospital, London, UK
| | - Martine Grosber
- Department of Dermatology, Universitair Ziekenhuis, Vrije Universiteit Brussel, Brussel, Belgium
| | - Theo Gülen
- Department of Respiratory Medicine and Allergy, Department of Medicine, Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Florence Hacard
- Allergology and Clinical Immunology Department, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France
| | - Cyrille Hoarau
- Service transversal d'allergologie et immunologie clinique, CHR de Tours, Tours, France
| | | | | | - Lukas Joerg
- Division of Allergology and Clinical Immunology, Department of Pneumology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Seçil Kepil Özdemir
- Department of Chest Diseases, Division of Allergy and Immunology, Chest Diseases and Surgery Training and Research Hospital, Izmir, Turkey
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | | | - Marek L Kowalski
- Department of Immunology and Allergy, Medical University of Lodz, Poland
| | - Semanur Kuyucu
- Faculty of Medicine, Dpt of Pediatric Allergy and Immunology, Mersin University, Mersin, Turkey
| | - Violeta Kvedariene
- Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University, Institute of Clinical Medicine, Clinic of Chest diseases, Immunology and Allergology, Faculty of Medicine, Vilnius, Lithuania
| | - Jose Julio Laguna
- Allergy Unit, Allergo-Anaesthesia Unit, Faculty of Medicine, Hospital Central de la Cruz Roja, Alfonso X El Sabio University, Madrid, Spain
| | | | - Susana Marinho
- Allergy Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust and University of Manchester, Manchester, UK
| | | | - Elisa Meucci
- SOS Allergologia ed Immunologia clinica, Azienda USL Toscana Centro, Ospedale San Giovanni di Dio, Firenze, Italy
| | | | | | | | - Alla Nakonechna
- Allergy and Clinical Immunology Department, University of Liverpool, Royal Preston Hospital, Lancashire Teaching Hospitals, NHS Foundation Trust, UK
| | - Florin-Dan Popescu
- Department of Allergology, Carol Davila University of Medicine and Pharmacy, Nicolae Malaxa Clinical Hospital, Bucharest, Romania
| | - Grzegorz Porebski
- Department of Clinical and Environmental Allergology, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Radice
- SOS Allergologia ed Immunologia clinica, Azienda USL Toscana Centro, Ospedale San Giovanni di Dio, Firenze, Italy
| | - Frederico S Regateiro
- Allergy and Clinical Immunology Unit, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
- Institute of Immunology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- ICBR - Coimbra Institute for Clinical and Biomedical Research, CIBB, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Heike Röckmann
- Department of Dermatology, University Medical Centre Utrecht-Heidelberglaan 100, Utrecht, The Netherlands
| | | | - Ravishankar Sargur
- Clinical Immunology and Allergy Unit, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Joaquin Sastre
- Allergy Department, Fundación Jiménez Diaz, Universidad Autonoma de Madrid, CIBERES, Instituto de Salud Carlos III, Spain
| | | | | | - Marta Sobotkova
- Department of Immunology, Motol University Hospital and 2nd Faculty of Medicine Charles University, Prague, Czech Republic
| | | | - Regina Treudler
- Department of Dermatology, Venerology and Allergology, Universitätsmedizin Leipzig, Leipzig, Germany
| | - Jolanta Walusiak-Skorupa
- Department of Occupational Diseases and Environmental Health, Walusiak-Skorupa Jolanta, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Bettina Wedi
- Department of Dermatology & Allergy, OE6600, Comprehensive Allergy Center, Hannover Medical School, Hannover, Germany
| | - Stefan Wöhrl
- Floridsdorf Allergy Center (FAZ), Vienna, Austria
| | - Mihael Zidarn
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, and Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Torsten Zuberbier
- Charité - Universitätsmedizin Berlin, Klinik für Dermatologie, Berlin, Germany
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Maria J Torres
- Allergy Unit, Regional University Hospital of Malaga, IBIMA-UMA-ARADyAL, Malaga, Spain
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30
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Tunbridge M, Perkins G, Lee M, Salehi T, Yuson C, Le A, Ryoo D, Kette F, Smith W, Gold M, Hissaria P. COVID vaccination can be completed in subjects with a history of allergic reactions to the vaccines or their components - experience from a specialist clinic in South Australia. Intern Med J 2022; 52:1884-1890. [PMID: 35848521 PMCID: PMC9350084 DOI: 10.1111/imj.15888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/10/2022] [Indexed: 11/28/2022]
Abstract
The development of vaccines against SARS-CoV2 has been a key public health response to the COVID-19 pandemic. However, since their introduction there have been reports of anaphylactic reactions in vaccinees with history of allergy. We developed an allergy testing protocol allowing vaccination with available COVID-19 vaccines in Australia. Patients referred to a state-wide COVID-19 vaccine allergy clinic between March and August 2021 with a history of allergy underwent skin prick testing and intradermal testing to both available vaccine formulations (BNT162b2, ChAdOx1-S), excipients (polyethylene glycol, polysorbate 80), excipient-containing medications, and controls. Where available, basophil activation testing was conducted. 53 patients underwent testing for possible excipient allergy (n = 19), previous non-COVID vaccine reaction (n = 13), or previous reaction to dose 1 of COVID-19 vaccine (n = 21). Patients were predominantly female (n = 43, 81%), aged 18-83 (median 54) years. 44 patients tested negative and 42 of these received at least their first dose of a COVID-19 vaccine. 9 patients tested positive to excipients or excipient-containing medication only (n = 3), or vaccines (n = 6). 5 patients were positive to just BNT162b2, 3/5 have been vaccinated with ChAdOx1-S. 1 who was skin test positive to both vaccines, but negative BAT to ChAdOx1-S was successfully vaccinated with ChAdOx1-S. Even in a high-risk population, most patients can be vaccinated with available COVID-19 vaccines. This paper reports local experiences using a combined allergy testing protocol with skin testing and BAT during the pandemic. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Matthew Tunbridge
- Immunology Department, Royal Adelaide Hospital, Adelaide, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Griffith Perkins
- University of Adelaide, Adelaide, Australia.,SA Pathology, Adelaide, Australia
| | - Maverick Lee
- Immunology Department, Royal Adelaide Hospital, Adelaide, Australia
| | - Tania Salehi
- Immunology Department, Royal Adelaide Hospital, Adelaide, Australia.,University of Adelaide, Adelaide, Australia
| | - Chino Yuson
- Immunology Department, Royal Adelaide Hospital, Adelaide, Australia
| | - Adriana Le
- Immunology Department, Royal Adelaide Hospital, Adelaide, Australia
| | - Dongjae Ryoo
- Immunology Department, Royal Adelaide Hospital, Adelaide, Australia
| | - Frank Kette
- Immunology Department, Royal Adelaide Hospital, Adelaide, Australia
| | - William Smith
- Immunology Department, Royal Adelaide Hospital, Adelaide, Australia
| | - Michael Gold
- Women's and Children's Hospital, Royal Adelaide Hospital, Adelaide, Australia
| | - Pravin Hissaria
- Immunology Department, Royal Adelaide Hospital, Adelaide, Australia.,SA Pathology, Adelaide, Australia
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31
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Hsieh MH, Yamaguchi Y. Immune Response in Regard to Hypersensitivity Reactions after COVID-19 Vaccination. Biomedicines 2022; 10:biomedicines10071641. [PMID: 35884946 PMCID: PMC9312871 DOI: 10.3390/biomedicines10071641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), is a member of the genus Betacoronavirus. This virus was first detected in December 2019, and the situation quickly escalated to cause a global pandemic within a few months. COVID-19 had caused more than 5.5 million deaths as of January 2022. Hence, the urgency of effective vaccination contributed to the fastest rate of vaccine development seen to date (i.e., within 1.5 years). Despite reports of good vaccine efficacy without severe systemic reactions at the clinical trial stage, hypersensitivity reactions have been reported following worldwide vaccination campaigns. We provide a brief review regarding the structure of SARS-CoV-2. We also review the most acceptable types of vaccines in terms of safety profiles, namely the BNT162b2, mRNA-1273, and AZD1222 vaccines. This review aims to facilitate an understanding of the possible immune mechanisms regarding COVID-19-vaccination-related hypersensitivity reactions, such as thrombosis and thrombocytopenia, cutaneous adverse reactions, myocarditis, and perimyocarditis.
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Paul P, Janjua E, AlSubaie M, Ramadorai V, Mushannen B, Vattoth AL, Khan W, Bshesh K, Nauman A, Mohammed I, Bouhali I, Khalid M, Zakaria D. Anaphylaxis and Related Events Post-COVID-19 Vaccination: A Systematic Review. J Clin Pharmacol 2022; 62:1335-1349. [PMID: 35794852 PMCID: PMC9349886 DOI: 10.1002/jcph.2120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/29/2022] [Indexed: 11/10/2022]
Abstract
The Coronavirus Disease 2019 (COVID-19), induced by the SARS CoV-2 virus, is responsible for a global pandemic following widespread transmission and death. Several vaccines have been developed to counter this public health crisis using both novel and conventional methods. Following approval based on promising efficacy and safety data, the AstraZeneca, Janssen, Moderna, Pfizer/BioNTech, and SinoVac vaccines have been administered globally among different populations with various reported side effects. Reports of life-threatening anaphylaxis following administration were of particular concern for both healthcare providers and the public. A systematic literature search using PubMed, Embase, Scopus, Web of Science, Science Direct, MedRxiv, and Lens.org databases identified relevant studies reporting anaphylaxis following vaccine administration. This systematic review includes 41 studies reporting anaphylaxis out of 19908 studies that were retrieved for screening. A total of 7942 cases, including 43 deaths, were reported across 14 countries. Most cases occurred following the administration of the first dose. Importantly, the benefits of vaccination far outweigh the risks of anaphylaxis. Subsequently, as populations continue to get vaccinated, it is important for healthcare providers to be able to recognize individuals at risk of developing anaphylaxis. Furthermore, they must be familiar with both the clinical hallmarks and treatment of anaphylactic reactions to minimize long term sequalae and prevent death in vaccinated individuals. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Pradipta Paul
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Emmad Janjua
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Mai AlSubaie
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Vinutha Ramadorai
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Beshr Mushannen
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | | | - Wafa Khan
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Khalifa Bshesh
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Areej Nauman
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Ibrahim Mohammed
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar.,Internal Medicine, Albany Medical Center Hospital, Albany, New York, USA
| | - Imane Bouhali
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Mohammed Khalid
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Dalia Zakaria
- Weill Cornell Medicine Qatar, Qatar Foundation, Education City, Doha, Qatar
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Kelso JM. The adverse reactions to vaccines practice parameter 10 years on-what have we learned? Ann Allergy Asthma Immunol 2022; 129:35-39. [PMID: 35101646 PMCID: PMC8801260 DOI: 10.1016/j.anai.2022.01.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/21/2021] [Accepted: 01/10/2022] [Indexed: 02/02/2023]
Abstract
Objective To provide updated information on the evaluation and management of adverse reactions to vaccines. Data Sources PubMed (MEDLINE) search since publication of a practice parameter in 2012. Study Selections Original articles and guidelines on adverse reactions to vaccines, including vaccines against severe acute respiratory syndrome coronavirus 2 or coronavirus disease 2019 (COVID-19). Results Current guidelines conclude that patients with egg allergy are not at increased risk for reaction to egg-based influenza vaccines. Except for gelatin, most patients with allergy to vaccine constituents tolerate vaccines containing them. Most patients who have immediate reactions after receiving COVID-19 vaccines go on to receive a subsequent dose uneventfully. Conclusion The risk of reactions to vaccination should be weighed against the risk of having a vaccine-preventable disease if the vaccine is withheld. There is no need to ask about egg allergy before the administration of influenza vaccines, including on screening forms. In most cases, an allergy to a vaccine constituent is not a contraindication to the vaccine containing it. Patients who have had possible anaphylactic reactions to vaccines should be evaluated by an allergist rather than simply being labeled allergic, because most can go on to receive subsequent doses. Most immediate reactions to COVID-19 vaccines are not allergic, and care should be taken to not label such reactions as anaphylactic. The role, if any, of polyethylene glycol in these reactions has yet to be revealed.
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Affiliation(s)
- John M Kelso
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, California.
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Labella M, Céspedes JA, Doña I, Shamji MH, Agache I, Mayorga C, Torres MJ. Reply to correspondence: Basophil reactivity to BNT162b2 in COVID-19 convalescence. Allergy 2022; 77:2266-2267. [PMID: 35770813 PMCID: PMC9350273 DOI: 10.1111/all.15208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Marina Labella
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Jose Antonio Céspedes
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Inmaculada Doña
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Mohamed H Shamji
- National Heart and Lung Institute, Imperial College London, London, UK.,NIHR Imperial Biomedical Research Centre, London, UK
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Cristobalina Mayorga
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain
| | - Maria José Torres
- Allergy Research Group, Instituto de Investigación Biomédica de Málaga-IBIMA, Málaga, Spain.,Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain.,Departamento de Medicina, Universidad de Málaga, Malaga, Spain
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Labella M, Céspedes JA, Doña I, Shamji MH, Agache I, Mayorga C, Torres MJ. The value of the basophil activation test in the evaluation of patients reporting allergic reactions to the BNT162b2 mRNA COVID-19 vaccine. Allergy 2022; 77:2067-2079. [PMID: 34689351 PMCID: PMC8653141 DOI: 10.1111/all.15148] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND mRNA-based COVID-19 vaccines have been reported to induce hypersensitivity reactions (HSR) in a small number of individuals. We aimed to evaluate the real-world incidence of the BNT162b2 mRNA COVID-19 vaccine HSR and to determine the value of the basophil activation test (BAT) in the allergological workup of patients reporting these reactions. METHODS We prospectively enrolled patients with a clinical history indicative of HSR to the BNT162b2 mRNA COVID-19 vaccine. The allergological workup included skin testing (STs) and BAT with polyethylene glycol (PEG) and the vaccine. In those with negative allergy assessments, the administration of the second dose of the BNT162b2 mRNA COVID-19 vaccine was offered. RESULTS Seventeen adults were included. Eleven cases (64.7%) tested negative in the allergological workup and tolerated the re-administration of the second dose of the vaccine and considered non-allergic. Six cases (35.3%) were considered allergic and classified into three groups: 2 subjects displayed positive STs and/or BAT to PEG (Group A), two individuals displayed positive BAT to the vaccine (Group B), and in 2 patients with moderate or severe reactions, the culprit was not identified, tested negative to STs and BAT to both PEG and vaccine (Group C). We further evaluated the value of BAT when the results were positive to the vaccine and negative to PEG by performing BAT in controls groups, finding positive BAT results in 50% of controls, all of them recovered from COVID-19 infection. In contrast, BAT was negative in patients who had not suffered from COVID-19 disease. CONCLUSIONS BAT can be used as a potential diagnostic tool for confirming allergy to PEG excipient but not to the vaccine as a positive result in BAT may indicate a past COVID-19 infection instead of an allergy.
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Affiliation(s)
- Marina Labella
- Allergy Research GroupInstituto de Investigación Biomédica de Málaga‐IBIMAMálagaSpain,Allergy UnitHospital Regional Universitario de MálagaMálagaSpain
| | - Jose Antonio Céspedes
- Allergy Research GroupInstituto de Investigación Biomédica de Málaga‐IBIMAMálagaSpain
| | - Inmaculada Doña
- Allergy Research GroupInstituto de Investigación Biomédica de Málaga‐IBIMAMálagaSpain,Allergy UnitHospital Regional Universitario de MálagaMálagaSpain
| | - Mohamed H. Shamji
- National Heart and Lung InstituteImperial College LondonLondonUK,NIHR Imperial Biomedical Research CentreLondonUK
| | - Ioana Agache
- Faculty of MedicineTransylvania UniversityBrasovRomania
| | - Cristobalina Mayorga
- Allergy Research GroupInstituto de Investigación Biomédica de Málaga‐IBIMAMálagaSpain
| | - Maria José Torres
- Allergy Research GroupInstituto de Investigación Biomédica de Málaga‐IBIMAMálagaSpain,Allergy UnitHospital Regional Universitario de MálagaMálagaSpain,Departamento de MedicinaUniversidad de MálagaMalagaSpain
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Evaluation of Patients with Vaccine Allergies Prior to mRNA-Based COVID-19 Vaccination. Vaccines (Basel) 2022; 10:vaccines10071025. [PMID: 35891189 PMCID: PMC9319755 DOI: 10.3390/vaccines10071025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 11/19/2022] Open
Abstract
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 mRNA-based 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.
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Allergic Reactions to COVID-19 Vaccines: Risk Factors, Frequency, Mechanisms and Management. BioDrugs 2022; 36:443-458. [PMID: 35696066 PMCID: PMC9190452 DOI: 10.1007/s40259-022-00536-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 12/01/2022]
Abstract
Conventional vaccines have been widely studied, along with their risk of causing allergic reactions. These generally consist of mild local reactions and only rarely severe anaphylaxis. Although all the current COVID-19 vaccines marketed in Europe have been shown to be safe overall in the general population, early post-marketing evidence has shown that mRNA-based vaccines using novel platforms (i.e., lipid nanoparticles) were associated with an increased risk of severe allergic reactions as compared to conventional vaccines. In this paper we performed an updated literature review on frequency, risk factors, and underlying mechanisms of COVID-19 vaccine-related allergies by searching MEDLINE and Google Scholar databases. We also conducted a qualitative search on VigiBase and EudraVigilance databases to identify reports of “Hypersensitivity” and “Anaphylactic reaction” potentially related to COVID-19 vaccines (Comirnaty, Spikevax, Vaxzevria and COVID-19 Janssen Vaccine), and in EudraVigilance to estimate the reporting rates of “Anaphylactic reaction” and “Anaphylactic shock” after COVID-19 vaccination in the European population. We also summarized the scientific societies’ and regulatory agencies’ recommendations for prevention and management of COVID-19 vaccine-related allergic reactions, especially in those with a history of allergy.
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Cabanillas B, Novak N, Akdis CA. The form of PEG matters: PEG conjugated with lipids and not PEG alone could be the specific form involved in allergic reactions to COVID-19 vaccines. Allergy 2022; 77:1658-1660. [PMID: 34816455 DOI: 10.1111/all.15187] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/04/2021] [Accepted: 11/21/2021] [Indexed: 12/19/2022]
Abstract
The excipient polyethylene glycol (PEG) contained in the mRNA vaccines for COVID-19 has been pointed out as one of the possible triggers of the hypersensitivity reactions that have been described since the beginning of the vaccine campaigns for COVID-19 protection.1 However, PEG is not present in the mRNA vaccines in an isolated form but in conjugation with lipid-nanoparticles (LNPs), which are spherical vesicles constituted by ionizable lipids, thanks to a process called PEGylation, which could potentially alter the immunogenic properties of PEG. PEG coats the surface of the LNPs reducing opsonization, aggregation, and improving mRNA delivery to the target cells.
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Affiliation(s)
- Beatriz Cabanillas
- Department of Allergy Research Institute Hospital 12 de Octubre Madrid Spain
| | - Natalija Novak
- Department of Dermatology and Allergy University Hospital Bonn Bonn Germany
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF) University of Zurich Davos Switzerland
- Christine Kühne‐Center for Allergy Research and Education Davos Switzerland
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Stehlin F, Mahdi-Aljedani R, Canton L, Monzambani-Banderet V, Miauton A, Girard C, Kammermann K, Meylan S, Ribi C, Harr T, Yerly D, Muller YD. Intradermal Testing With COVID-19 mRNA Vaccines Predicts Tolerance. FRONTIERS IN ALLERGY 2022; 3:818049. [PMID: 36238929 PMCID: PMC9552867 DOI: 10.3389/falgy.2022.818049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/14/2022] [Indexed: 11/26/2022] Open
Abstract
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 a suspected allergic reaction after the first dose remains to be defined. Methods In this real-life study, we defined two cohorts of individuals: one pre-vaccination including 187 individuals with high-risk profiles for developing anaphylaxis and a second post-vaccination including 87 individuals with suspected allergic reactions after the COVID-19 mRNA vaccine. Upon negative skin test with an mRNA vaccine, a two-step (10–90%) vaccination protocol was performed. Positive skin tests were confirmed with the basophil activation test (BAT). Results Among 604,267 doses of vaccine, 87 suspected allergic reactions (5 after the booster) 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% of 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 isolated asthmatic reactions 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. Conclusion Sensitization to SARS-CoV-2 mRNA vaccines can be detected with intradermal testing. Significantly more individuals were sensitized to mRNA vaccines in the post-vaccination cohort. A two-step 10–90%-vaccination protocol can be safely administered upon negative skin testing.
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Affiliation(s)
- Florian Stehlin
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
| | - Rima Mahdi-Aljedani
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
| | - Loris Canton
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Alix Miauton
- Tropical, Travel and Vaccination Clinic, Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Cedric Girard
- Division of Pharmacy, University Hospital of Lausanne, Lausanne, Switzerland
| | - Kevin Kammermann
- Adverse Drug Reactions - Analysis & Consulting (ADR-AC) GmbH, Bern, Switzerland
| | - Sylvain Meylan
- Infectious Diseases Service, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Camillo Ribi
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
| | - Thomas Harr
- Division of Immunology and Allergy, University Hospital of Geneva, Geneva, Switzerland
| | - Daniel Yerly
- Adverse Drug Reactions - Analysis & Consulting (ADR-AC) GmbH, Bern, Switzerland
| | - Yannick D. Muller
- Division of Immunology and Allergy, University Hospital of Lausanne, Lausanne, Switzerland
- *Correspondence: Yannick D. Muller
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Miyake K, Ito J, Karasuyama H. Role of Basophils in a Broad Spectrum of Disorders. Front Immunol 2022; 13:902494. [PMID: 35693800 PMCID: PMC9186123 DOI: 10.3389/fimmu.2022.902494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
Basophils are the rarest granulocytes and have long been overlooked in immunological research due to their rarity and similarities with tissue-resident mast cells. In the last two decades, non-redundant functions of basophils have been clarified or implicated in a broad spectrum of immune responses, particularly by virtue of the development of novel analytical tools for basophils. Basophils infiltrate inflamed tissues of patients with various disorders, even though they circulate in the bloodstream under homeostatic conditions. Depletion of basophils results in the amelioration or exaggeration of inflammation, depending on models of disease, indicating basophils can play either beneficial or deleterious roles in a context-dependent manner. In this review, we summarize the recent findings of basophil pathophysiology under various conditions in mice and humans, including allergy, autoimmunity, tumors, tissue repair, fibrosis, and COVID-19. Further mechanistic studies on basophil biology could lead to the identification of novel biomarkers or therapeutic targets in a broad range of diseases.
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Rama TA, Miranda J, Silva D, Amaral L, Castro E, Coimbra A, Moreira A, Plácido JL. COVID-19 Vaccination Is Safe among Mast Cell Disorder Patients, under Adequate Premedication. Vaccines (Basel) 2022; 10:vaccines10050718. [PMID: 35632474 PMCID: PMC9146268 DOI: 10.3390/vaccines10050718] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
Reported cases of anaphylaxis following COVID-19 vaccination raised concerns about the safety of these vaccines, namely in patients suffering from clonal mast cell (MC) disorders—a heterogenous group of disorders in which patients may be prone to anaphylaxis caused by vaccination. This study aimed to assess the safety of COVID-19 vaccines in patients with clonal MC disorders. We performed an ambidirectional cohort study with 30 clonal MC disorder patients (n = 26 in the prospective arm and n = 4 in the retrospective arm), that were submitted to COVID-19 vaccination. Among these, 11 (37%) were males, and median age at vaccination date was 41 years (range: 5y to 76y). One patient had prior history of anaphylaxis following vaccination. Those in the prospective arm received a premedication protocol including H1- and H2-antihistamines and montelukast, while those in the retrospective arm did not premedicate. Overall, patients received a total of 81 doses, 73 under premedication and 8 without premedication. No MC activation symptoms were reported. COVID-19 vaccination seems to be safe in patients with clonal mast cell disorders, including those with prior anaphylaxis following vaccination. Robust premedication protocols may allow for vaccination in ambulatory settings.
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Affiliation(s)
- Tiago Azenha Rama
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
- EPIUnit—Institute of Public Health, University of Porto, 4050-600 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
- Correspondence:
| | - Joana Miranda
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
| | - Diana Silva
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
- EPIUnit—Institute of Public Health, University of Porto, 4050-600 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
| | - Luís Amaral
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
| | - Eunice Castro
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
| | - Alice Coimbra
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
| | - André Moreira
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
- Serviço de Imunologia Básica e Clínica, Departamento de Patologia, Faculdade de Medicina, Universidade do Porto, 4200-319 Porto, Portugal
- EPIUnit—Institute of Public Health, University of Porto, 4050-600 Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600 Porto, Portugal
| | - José Luís Plácido
- Serviço de Imunoalergologia, Centro Hospitalar Universitário São João, 4200-319 Porto, Portugal; (J.M.); (D.S.); (L.A.); (E.C.); (A.C.); (A.M.); (J.L.P.)
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Li M, Wang H, Tian L, Pang Z, Yang Q, Huang T, Fan J, Song L, Tong Y, Fan H. COVID-19 vaccine development: milestones, lessons and prospects. Signal Transduct Target Ther 2022; 7:146. [PMID: 35504917 PMCID: PMC9062866 DOI: 10.1038/s41392-022-00996-y] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 12/15/2022] Open
Abstract
With the constantly mutating of SARS-CoV-2 and the emergence of Variants of Concern (VOC), the implementation of vaccination is critically important. Existing SARS-CoV-2 vaccines mainly include inactivated, live attenuated, viral vector, protein subunit, RNA, DNA, and virus-like particle (VLP) vaccines. Viral vector vaccines, protein subunit vaccines, and mRNA vaccines may induce additional cellular or humoral immune regulations, including Th cell responses and germinal center responses, and form relevant memory cells, greatly improving their efficiency. However, some viral vector or mRNA vaccines may be associated with complications like thrombocytopenia and myocarditis, raising concerns about the safety of these COVID-19 vaccines. Here, we systemically assess the safety and efficacy of COVID-19 vaccines, including the possible complications and different effects on pregnant women, the elderly, people with immune diseases and acquired immunodeficiency syndrome (AIDS), transplant recipients, and cancer patients. Based on the current analysis, governments and relevant agencies are recommended to continue to advance the vaccine immunization process. Simultaneously, special attention should be paid to the health status of the vaccines, timely treatment of complications, vaccine development, and ensuring the lives and health of patients. In addition, available measures such as mix-and-match vaccination, developing new vaccines like nanoparticle vaccines, and optimizing immune adjuvant to improve vaccine safety and efficacy could be considered.
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Affiliation(s)
- Maochen Li
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Han Wang
- Laboratory for Clinical Immunology, Harbin Children's Hospital, Harbin, China
| | - Lili Tian
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Zehan Pang
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Qingkun Yang
- College of Materials Science and Engineering, Beijing University of Chemical Technology, Beijing, China
| | - Tianqi Huang
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China
| | - Junfen Fan
- Institute of Cerebrovascular Disease Research and Department of Neurology, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Lihua Song
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China.
| | - Yigang Tong
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China. .,Beijing Advanced Innovation Center for Soft Matter Science and Engineering, Beijing University of Chemical Technology, Beijing, China.
| | - Huahao Fan
- College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, China.
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43
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Fernandez-Davila N, Taylor MG, Anvari S. Hypersensitivity Reactions to COVID-19 Vaccines-Identify High-risk Children and Vaccinate the Rest. JAMA Pediatr 2022; 176:443-444. [PMID: 35254412 DOI: 10.1001/jamapediatrics.2022.0088] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Natalia Fernandez-Davila
- Division of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Margaret G Taylor
- Division of Infectious Diseases, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Sara Anvari
- Division of Immunology, Allergy and Retrovirology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston.,William T. Shearer Center for Human Immunobiology, Texas Children's Hospital, Houston
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44
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Eberlein B, Mathes S, Fischer J, Darsow U, Biedermann T, Brockow K. Do basophil activation tests help elucidate allergic reactions to the ingredients in COVID-19 vaccines? Allergy 2022; 77:2924-2936. [PMID: 35266570 PMCID: PMC9111482 DOI: 10.1111/all.15278] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 01/27/2023]
Abstract
The worldwide use of COVID-19 vaccines has shown that immediate allergic reactions to the ingredients are rare but should be clarified by means of an allergological work-up. This review aims to highlight the current state of knowledge and possible pathogenesis based on the literature published to date. In addition to recording a detailed history and performing skin tests, cellular tests (basophil activation or basophil histamine release test) by using the vaccines or modified compounds containing polyethylene glycol (PEG), rather than unmodified PEGs, have proven to be particularly helpful. Negative results with vaccines seem to indicate tolerance. Details of the performance of these cellular tests with different vaccines, PEGs of different molecular weights, other ingredients of the vaccines, as well as other PEGylated drugs, and the results in the context of COVID-19 vaccination of various working groups worldwide are summarized.
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Affiliation(s)
- Bernadette Eberlein
- Department of Dermatology and Allergy BiedersteinSchool of MedicineTechnical University of MunichMunichGermany
| | - Sonja Mathes
- Department of Dermatology and Allergy BiedersteinSchool of MedicineTechnical University of MunichMunichGermany
| | - Jörg Fischer
- Department of DermatologyEberhard Karls UniversityTübingenGermany,Division of Experimental Allergy and ImmunodermatologyUniversity of OldenburgOldenburgGermany
| | - Ulf Darsow
- Department of Dermatology and Allergy BiedersteinSchool of MedicineTechnical University of MunichMunichGermany
| | - Tilo Biedermann
- Department of Dermatology and Allergy BiedersteinSchool of MedicineTechnical University of MunichMunichGermany
| | - Knut Brockow
- Department of Dermatology and Allergy BiedersteinSchool of MedicineTechnical University of MunichMunichGermany
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45
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Yang W, Wang L, Fang M, Sheth V, Zhang Y, Alyssa M. Holden, Donahue ND, Green DE, Frickenstein AN, Mettenbrink EM, Schwemley TA, Francek ER, Haddad M, Hossen MN, Mukherjee S, Wu S, DeAngelis PL, Wilhelm S. Nanoparticle Surface Engineering with Heparosan Polysaccharide Reduces Serum Protein Adsorption and Enhances Cellular Uptake. NANO LETTERS 2022; 22:2103-2111. [PMID: 35166110 PMCID: PMC9540343 DOI: 10.1021/acs.nanolett.2c00349] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Nanoparticle modification with poly(ethylene glycol) (PEG) is a widely used surface engineering strategy in nanomedicine. However, since the artificial PEG polymer may adversely impact nanomedicine safety and efficacy, alternative surface modifications are needed. Here, we explored the "self" polysaccharide heparosan (HEP) to prepare colloidally stable HEP-coated nanoparticles, including gold and silver nanoparticles and liposomes. We found that the HEP-coating reduced the nanoparticle protein corona formation as efficiently as PEG coatings upon serum incubation. Liquid chromatography-mass spectrometry revealed the protein corona profiles. Heparosan-coated nanoparticles exhibited up to 230-fold higher uptake in certain innate immune cells, but not in other tested cell types, than PEGylated nanoparticles. No noticeable cytotoxicity was observed. Serum proteins did not mediate the high cell uptake of HEP-coated nanoparticles. Our work suggests that HEP polymers may be an effective surface modification technology for nanomedicines to safely and efficiently target certain innate immune cells.
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Affiliation(s)
- Wen Yang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Lin Wang
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Mulin Fang
- Department of Chemistry and Biochemistry, University of Oklahoma, Norman, OK, 73019, USA
| | - Vinit Sheth
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Yushan Zhang
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104, USA
| | - Alyssa M. Holden
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Nathan D. Donahue
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Dixy E. Green
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, 73104, USA
| | - Alex N. Frickenstein
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Evan M. Mettenbrink
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Tyler A. Schwemley
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Emmy R. Francek
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Majood Haddad
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Md Nazir Hossen
- Department of Pharmaceutical and Biomedical Sciences, College of Pharmacy, California Northstate University, Elk Grove, CA, 95757, USA
| | - Shirsha Mukherjee
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
| | - Si Wu
- Department of Chemistry and Biochemistry, University of Oklahoma, Norman, OK, 73019, USA
| | - Paul L. DeAngelis
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, 73104, USA
| | - Stefan Wilhelm
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, Oklahoma, 73019, USA
- Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, 73104, USA
- Institute for Biomedical Engineering, Science, and Technology (IBEST), University of Oklahoma, Norman, Oklahoma, 73019, USA
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Nicaise-Roland P, Mehlal S, Bouz C, Chollet-Martin S. Biomarqueurs et tests fonctionnels dans l’hypersensibilité immédiate aux vaccins ARNm dirigés contre le SARS-CoV-2. REVUE FRANÇAISE D'ALLERGOLOGIE 2022; 62:624-627. [PMID: 35291288 PMCID: PMC8913372 DOI: 10.1016/j.reval.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/03/2022] [Indexed: 11/29/2022]
Abstract
Les phénomènes d’hypersensibilité aux vaccins à ARNm dirigés contre le SARS-CoV-2 sont très rares. Ils peuvent être liés à un mécanisme IgE-dépendant impliquant les PEG contenus dans les vaccins sous forme de liposomes. Une activation directe de la voie classique du complément (CARPA) a été également fortement suspectée. En complément des tests cutanés, des biomarqueurs ont été proposés, en particulier la recherche d’anticorps anti-PEG, le dosage des anaphylatoxines C5a et C3a ou du complexe soluble C5b-9. Les anticorps anti-PEG sont dosables par quelques méthodes non standardisées mais leur présence dans ces réactions n’a pas été confirmée. Il en est de même pour les protéines du complément. L’histamine et la tryptase ont rarement pu être dosées au moment de la réaction et leur augmentation est inconstante selon les études. Une tryptase basale un peu élevée chez certains patients suggère qu’une hyper-alpha-tryptasémie pourrait être impliquée. Le test d’activation des basophiles s’est imposé comme un examen pouvant être utile mais les résultats sont encore difficiles à interpréter en raison de la variabilité des allergènes utilisés : PEG, PEG sous forme de liposomes ou vaccin lui-même. L’absence de positivité des tests cutanés alors que les basophiles sont capables de s’activer en présence du même allergène ex vivo chez certains patients est en faveur, dans ce cas, d’un phénomène non IgE-dépendant. En conclusion, dans l’exploration des réactions immédiates aux vaccins à ARNm contre le SARS-CoV-2, l’importance de la place de marqueurs biologiques nécessite des études complémentaires afin de mieux identifier les acteurs et les mécanismes impliqués.
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Affiliation(s)
- P Nicaise-Roland
- Service d'immunologie biologique « Autoimmunité, Hypersensibiltés et Biothérapies », hôpital Bichat, DMU BIOGéM, APHP, 75018 Paris, France
| | - S Mehlal
- Laboratoire Cerba, Cerba Healthcare, 7/11 rue de l'Equerre, 95310 Saint-Ouen l'Aumône, France
| | - C Bouz
- Laboratoire Eurofins Biomnis, 17/19, avenue Tony-Garnier, BP 7322, 69357 Lyon cedex 07, France
| | - S Chollet-Martin
- Service d'immunologie biologique « Autoimmunité, Hypersensibiltés et Biothérapies », hôpital Bichat, DMU BIOGéM, APHP, 75018 Paris, France
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47
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Banerji A, Wolfson AR, Robinson LB, McMahon AE, Cogan AS, Saff RR, Blumenthal KG. COVID-19 vaccines tolerated in patients with paclitaxel and docetaxel allergy. Allergy 2022; 77:1048-1051. [PMID: 34779000 PMCID: PMC8652939 DOI: 10.1111/all.15178] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/21/2021] [Accepted: 11/11/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Aleena Banerji
- Division of Rheumatology, Allergy, and Immunology Department of Medicine Massachusetts General Hospital Boston Massachusetts USA
| | - Anna R. Wolfson
- Division of Rheumatology, Allergy, and Immunology Department of Medicine Massachusetts General Hospital Boston Massachusetts USA
| | - Lacey B. Robinson
- Division of Rheumatology, Allergy, and Immunology Department of Medicine Massachusetts General Hospital Boston Massachusetts USA
| | - Aubree E. McMahon
- Division of Rheumatology, Allergy, and Immunology Department of Medicine Massachusetts General Hospital Boston Massachusetts USA
| | - Amelia S. Cogan
- Division of Rheumatology, Allergy, and Immunology Department of Medicine Massachusetts General Hospital Boston Massachusetts USA
| | - Rebecca R. Saff
- Division of Rheumatology, Allergy, and Immunology Department of Medicine Massachusetts General Hospital Boston Massachusetts USA
| | - Kimberly G. Blumenthal
- Division of Rheumatology, Allergy, and Immunology Department of Medicine Massachusetts General Hospital Boston Massachusetts USA
- Edward P. Lawrence Center for Quality and Safety Massachusetts General Hospital Boston Massachusetts USA
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48
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Safety of COVID-19 vaccination in patients with polyethylene glycol allergy: A case series. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:620-625.e1. [PMID: 34949564 PMCID: PMC8685412 DOI: 10.1016/j.jaip.2021.11.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/21/2022]
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49
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Cahill JA, Kan M. Successful administration of second dose of BNT162b2 COVID-19 vaccine in two patients with potential anaphylaxis to first dose. Allergy 2022; 77:337-338. [PMID: 34965310 DOI: 10.1111/all.14996] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/06/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022]
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50
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Li K, Zhang Z, Mei Y, Li M, Yang Q, WU Q, Yang H, HE LIANGCAN, Liu S. Targeting innate immune system by nanoparticles for cancer immunotherapy. J Mater Chem B 2022; 10:1709-1733. [DOI: 10.1039/d1tb02818a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Various cancer therapies have advanced remarkably over the past decade. Unlike the direct therapeutic targeting of tumor cells, cancer immunotherapy is a new strategy that boosts the host's immune system...
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