en
Scientific article
Open access
English

Intradermal Testing With COVID-19 mRNA Vaccines Predicts Tolerance

Published inFrontiers in allergy, vol. 3, 818049
Publication date2022
First online date2022-05-31
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.

eng
Keywords
  • COVID-19
  • PEG
  • SARS-CoV-2
  • Allergy
  • Anaphylaxis
  • Basophil activation test
  • Polyethylene glycol
  • Vaccine
Citation (ISO format)
STEHLIN, Florian et al. Intradermal Testing With COVID-19 mRNA Vaccines Predicts Tolerance. In: Frontiers in allergy, 2022, vol. 3, p. 818049. doi: 10.3389/falgy.2022.818049
Main files (1)
Article (Published version)
Identifiers
ISSN of the journal2673-6101
17views
3downloads

Technical informations

Creation10/05/2023 1:13:23 PM
First validation02/21/2024 9:07:04 AM
Update time02/21/2024 9:07:04 AM
Status update02/21/2024 9:07:04 AM
Last indexation05/06/2024 5:58:33 PM
All rights reserved by Archive ouverte UNIGE and the University of GenevaunigeBlack