期刊
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
卷 147, 期 6, 页码 2098-2107出版社
MOSBY-ELSEVIER
DOI: 10.1016/j.jaci.2021.03.047
关键词
COVID-19 vaccine; mRNA vaccine; anaphylaxis; al-lergy; polyethylene glycol; PEGylated liposome; lipid nanoparticle; mast cells
资金
- Fondation de France
- Tous unis contre le virus framework Alliance (Fondation de France, AP-HP, Institut Pasteur)
- Agence Nationale de la Recherche (ANR Flash COVID19 program)
- SARS-CoV-2 Program of the Faculty of Medicine from Sorbonne University ICOViD programs
- Programme Hospitalier de Recherche Clinique [PHRC-20-0375]
- Christine Kuhne - Center for Allergy Research and Education
- Initiative and Networking Fund (Immunology AMP
- Inflammation) of the Helmholtz Association
Anaphylactic reactions to the novel mRNA lipid nanoparticle vaccines have raised significant public concern due to their unexpected occurrence, particularly among atopic individuals. Various potential contributors to these reactions have been considered, yet the clinical utility of available testing methods remains unclear. Further research and clinical trials are needed to address these concerns and ensure safety during public health emergencies.
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. (J Allergy Clin Immunol 2021;147:2075-82.)
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