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Potential mechanisms of anaphylaxis to COVID-19 mRNA vaccines.

Publication ,  Journal Article
Risma, KA; Edwards, KM; Hummell, DS; Little, FF; Norton, AE; Stallings, A; Wood, RA; Milner, JD
Published in: J Allergy Clin Immunol
June 2021

Anaphylaxis to vaccines is historically a rare event. The coronavirus disease 2019 pandemic drove the need for rapid vaccine production applying a novel antigen delivery system: messenger RNA vaccines packaged in lipid nanoparticles. Unexpectedly, public vaccine administration led to a small number of severe allergic reactions, with resultant substantial public concern, especially within atopic individuals. We reviewed the constituents of the messenger RNA lipid nanoparticle vaccine and considered several contributors to these reactions: (1) contact system activation by nucleic acid, (2) complement recognition of the vaccine-activating allergic effector cells, (3) preexisting antibody recognition of polyethylene glycol, a lipid nanoparticle surface hydrophilic polymer, and (4) direct mast cell activation, coupled with potential genetic or environmental predispositions to hypersensitivity. Unfortunately, measurement of anti-polyethylene glycol antibodies in vitro is not clinically available, and the predictive value of skin testing to polyethylene glycol components as a coronavirus disease 2019 messenger RNA vaccine-specific anaphylaxis marker is unknown. Even less is known regarding the applicability of vaccine use for testing (in vitro/vivo) to ascertain pathogenesis or predict reactivity risk. Expedient and thorough research-based evaluation of patients who have suffered anaphylactic vaccine reactions and prospective clinical trials in putative at-risk individuals are needed to address these concerns during a public health crisis.

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Published In

J Allergy Clin Immunol

DOI

EISSN

1097-6825

Publication Date

June 2021

Volume

147

Issue

6

Start / End Page

2075 / 2082.e2

Location

United States

Related Subject Headings

  • SARS-CoV-2
  • Risk Factors
  • RNA, Messenger
  • Nanoparticles
  • Mast Cells
  • Lipids
  • Humans
  • Drug Hypersensitivity
  • COVID-19 Vaccines
  • COVID-19
 

Citation

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Risma, K. A., Edwards, K. M., Hummell, D. S., Little, F. F., Norton, A. E., Stallings, A., … Milner, J. D. (2021). Potential mechanisms of anaphylaxis to COVID-19 mRNA vaccines. J Allergy Clin Immunol, 147(6), 2075-2082.e2. https://doi.org/10.1016/j.jaci.2021.04.002
Risma, Kimberly A., Kathryn M. Edwards, Donna S. Hummell, Frederic F. Little, Allison E. Norton, Amy Stallings, Robert A. Wood, and Joshua D. Milner. “Potential mechanisms of anaphylaxis to COVID-19 mRNA vaccines.J Allergy Clin Immunol 147, no. 6 (June 2021): 2075-2082.e2. https://doi.org/10.1016/j.jaci.2021.04.002.
Risma KA, Edwards KM, Hummell DS, Little FF, Norton AE, Stallings A, et al. Potential mechanisms of anaphylaxis to COVID-19 mRNA vaccines. J Allergy Clin Immunol. 2021 Jun;147(6):2075-2082.e2.
Risma, Kimberly A., et al. “Potential mechanisms of anaphylaxis to COVID-19 mRNA vaccines.J Allergy Clin Immunol, vol. 147, no. 6, June 2021, pp. 2075-2082.e2. Pubmed, doi:10.1016/j.jaci.2021.04.002.
Risma KA, Edwards KM, Hummell DS, Little FF, Norton AE, Stallings A, Wood RA, Milner JD. Potential mechanisms of anaphylaxis to COVID-19 mRNA vaccines. J Allergy Clin Immunol. 2021 Jun;147(6):2075-2082.e2.
Journal cover image

Published In

J Allergy Clin Immunol

DOI

EISSN

1097-6825

Publication Date

June 2021

Volume

147

Issue

6

Start / End Page

2075 / 2082.e2

Location

United States

Related Subject Headings

  • SARS-CoV-2
  • Risk Factors
  • RNA, Messenger
  • Nanoparticles
  • Mast Cells
  • Lipids
  • Humans
  • Drug Hypersensitivity
  • COVID-19 Vaccines
  • COVID-19