Table 1.

Characteristics and Skin Test Results of Patients With Reaction to First COVID-19 Vaccine Dose and Previous PEG/Polysorbate Allergy^a

Patient	Age/sex	Previous allergic disease	Culprit agents	Symptoms	Anaphylaxisb	Time to onset	Treatment	ED	Time to resolution	Skin test performed	Time from reaction to the skin test	Skin test result	Time between vaccine doses	Vaccine outcomec
1	24F	None	Pfizer-BioNTech vaccine	Urticaria	No	3 h	Antihistamines	No	4 d	PEG	12 d	Negative	23 d	No reaction
2	54F	Drug allergy	Pfizer-BioNTech vaccine	Tachycardia, rhinorrhea	No	10 min	None	No	10 min	PEG, MP acetate	7 d	Negative	18 d	No reaction
3	36F	None	Pfizer-BioNTech vaccine	Facial flushing	No	5 min	Antihistamines	No	1 h	PEG, MP acetate, TC acetonide	20 d	Negative	21 d	No reaction
4	52M	Venom anaphylaxis	Pfizer-BioNTech vaccine	Oral pruritus, throat fullness	No	Immediate	None	No	5 min	PEG	10 d	Negative	21 d	No reaction
5	45F	Food allergy	Pfizer-BioNTech vaccine	Urticaria, throat tightness	No	8 h	None	No	Unknown	PEG	20 d	Negative	29 d	No reaction
6	33F	Asthma, venom anaphylaxis	Pfizer-BioNTech vaccine	Urticaria, tachycardia	No	15 min	Antihistamines	No	12-24 h	PEG	20 d	Negative	23 d	No reaction
7	20M	Vaccine allergy (flu)	Moderna vaccine	Angioedema	No	3 h	Steroids, antihistamines	Yes	24 h	Expandedd	20 d	Negative	N/A	Not given
8	22F	Allergic rhinitis	Moderna vaccine	Angioedema, wheezing, throat pruritus	Level 1	20 min	Antihistamines, steroids	Yes	6 h	Expandedd	21 d	Negative	51 d	Minor lip/tongue tingling
9	69M	Drug allergy	Moviprep (PEG)	Rash, flushing	No	During prep	Antihistamines	No	1 h	PEG	2 y	Negative	N/A	No reaction (Pfizer)
10	73F	Asthma, drug allergy	Moviprep (PEG)	Headache, nausea	No	Unknown	Unknown	No	Unknown	PEG	5 y	Negative	N/A	No reaction (Moderna)
11	46F	Vaccine allergy (flu)	Methylprednisolone acetate (PEG)	Urticaria, dizzy, flushing	No	15 min	Epinephrine, steroids, antihistamines	No	12 h	Expandedd	3 mo	Positive (PEG and MP acetate)e	N/A	Not given
12	74M	Drug allergy	Triamcinolone acetonide (polysorbate 80)	Urticaria, wheezing	Level 1	1 h	Steroids, antihistamines	Yes	Unknown	PEG, MP acetate, TC acetonide	3 y	Negative	N/A	No reaction (Pfizer)
13	55F	Anaphylaxis	Influenza vaccinesf (polysorbate 20/80)	Flushing, wheezing, cough, throat tightness	Level 1	20 min	Epinephrine, steroids, antihistamines	Yes	Unknown	PEG, Polysorbate 20	7 y	Negative	N/A	No reaction (Pfizer)
14	67F	Food allergy, anaphylaxis	MiraLAX (PEG)	Oral urticaria	No	2 h	Unknown	No	Unknown	Expandedd	Unknown	Negative	N/A	No reaction (Moderna)
15	60M	Vaccine allergy (Shingrix)	Shingrix (polysorbate 80)	Flushing, urticaria	No	2 h	Antihistamines, steroids	Yes	2 d	Expandedd	3 mo	Negative	N/A	No reaction (Moderna)

Abbreviations: COVID-19, coronavirus disease 2019; ED, emergency department; F, female; M, male; MP, methylprednisolone; PEG, polyethylene glycol; TC, triamcinolone.

^aPatients 1 to 8: reaction to first COVID vaccine dose; patients 9 to 15: no previous vaccine dose, reported previous PEG or polysorbate allergy.

^bDetermined by using the Brighton criteria.⁹

^cRefers to second vaccine dose in patients 1 to 8 or first vaccine dose in patients 9 to 15. All doses were given with a 30-minute observation period.

^dExpanded skin testing included PEG, methylprednisolone acetate, methylprednisolone sodium, triamcinolone acetonide, and polysorbate 20.

^ePEG 1:1 skin prick: 5 × 5 wheal, 10 × 10 flare; methylprednisolone acetate 0.1 mg/mL intradermal: 6 × 6 wheal, 8 × 8 flare (all measurements in mm).

^fH1N1 vaccines FluBlok and Fluxrix.