Potential mechanisms of anaphylaxis to COVID-19 mRNA vaccines

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:147

Article

Risma, Kimberly A.¹  Edwards, Kathryn M.²  Hummell, Donna S.³  Little, Frederic F.⁴  Norton, Allison E.³  Stallings, Amy⁵  Wood, Robert A.⁶  Milner, Joshua D.⁷ 

[1] Univ Cincinnati, Coll Med, Dept Pediat, Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH USA

[2] Vanderbilt Univ, Med Ctr, Dept Pediat, Div Infect Dis, 221 Kirkland Hall, Nashville, TN 37232 USA

[3] Vanderbilt Univ, Sch Med, Monroe Carell Jr Childrens Hosp Vanderbilt, Div Pediat Allergy Immunol & Pulm Med,Dept Pediat, Nashville, TN 37212 USA

[4] Boston Univ, Sch Med, Dept Pediat, Div Pulm Allergy Sleep & Crit Care Med, Boston, MA 02118 USA

[5] Duke Univ, Med Ctr, Div Pediat Allergy & Immunol, Durham, NC 27706 USA

[6] Johns Hopkins Univ, Sch Med, Div Pediat Allergy & Immunol, Baltimore, MD USA

[7] Columbia Univ, Dept Pediat, Irving Med Ctr, New York, NY 10027 USA

关键词: Peanut allergy;    adults;    prevalence;    food allergy COVID-19 vaccine;    mRNA vaccine;    anaphylaxis;    allergy;    polyethylene glycol;    PEGylated liposome;    lipid nanoparticle;    mast cells;   

DOI  :  10.1016/j.jaci.2021.04.002

来源: Elsevier

【 摘 要 】

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 antipolyethylene 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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