Table I.
Demographic data, clinical characteristics, skin test, and vaccine results in 10 PEG-allergic patients who tolerated Janssen COVID-19 vaccine
| Country, patient no. | Age (y), sex | Drugs causing reactions before diagnosis | Severity WAO grade8 | Positive skin test results at diagnosis∗†‡ | Time interval from diagnosis to vaccination/Time interval from last anaphylaxis to vaccination | Skin prick test results before vaccination‡§ | Tolerance of Janssen vaccine |
|---|---|---|---|---|---|---|---|
| US, 1 | 62, M | Colonoscopy preparation (PEG 3350) × 1 Intraarticular steroid (PEG 3350) × 2 |
Anaphylaxis × 1 WAO grade 5 Anaphylaxis × 2 WAO grade 5 |
PEG 3350 PEG 8000 Methylprednisolone acetate (PEG 3350) Poloxamer 407 IDT positive to triamcinolone acetonide (PS 80) |
8 y/5 y | Pfizer negative Moderna negative Janssen negative |
Tolerated Flare at injection site at 45 min |
| US, 29 | 60, M | Liposomal perflutren echocardiogram contrast (PEG 5000) Colonoscopy preparation (PEG 3350) Intraarticular steroid (PEG 3350) |
Anaphylaxis × 1 WAO grade 5 Anaphylaxis × 1 WAO grade 5 Anaphylaxis × 1 WAO grade 5 |
PEG 3350 PEG 8000 Methylprednisolone acetate (PEG 3350) Poloxamer 407 IDT positive to triamcinolone acetonide (PS 80) |
2 y/2 y | Pfizer negative Moderna negative Janssen negative |
Tolerated No allergic symptoms |
| US, 3 | 33, M | Allegra (PEG 6000) Colonoscopy preparation (PEG 3350) Amlodipine (PEG 3350) Toothpaste (PEG unknown) |
WAO grade 2 WAO grade 2 WAO grade 2 WAO grade 2 |
PEG 3350 Methylprednisolone acetate (PEG 3350) IDT positive to triamcinolone acetonide (PS 80) |
2 y/2 y | ND | Tolerated No allergic symptoms |
| DK, 46 | 68, F |
Intraarticular steroid (PEG 3350) × 1 | Anaphylaxis × 1 WAO grade 5 |
PEG 3000 PEG 6000 |
9 y/9 y | Pfizer negative Moderna negative Janssen negative PEG 2000 negative PS 20 negative PS 80 negative |
Tolerated No allergic symptoms |
| DK, 56 | 59, M | Unidentified perioperative exposure during coronary stent insertion | Anaphylaxis × 1 WAO grade 4 |
PEG 3000 PEG 6000 PEG 20,000 Poloxamer 407 |
7 y/7 y | Pfizer negative Moderna negative Janssen negative PEG 2000 negative PS 20 negative PS 80 negative |
Tolerated No allergic symptoms |
| DK, 6 | 60, F |
Intraarticular steroid (PEG 3350) Balancid Novum reflux tablet (PEG 6000) Ibuprofen (PEG unknown) |
Anaphylaxis × 1 WAO grade 3 WAO grade 1 WAO grade 1 |
PEG 20,000 Poloxamer 407 |
3 y/4 y | Pfizer negative Moderna negative Janssen negative PEG 2000 negative PS 20 negative PS 80 negative |
Tolerated No allergic symptoms |
| DK, 7 | 57, F |
Intraarticular steroid (PEG 3350) × 1 Provocation intraarticular steroid (PEG 3350) Vepicombin (PEG 6000) tablet × 2 (phenoxymethylpenicillin) |
Anaphylaxis × 1WAO grade 3 WAO grade 1 WAO grade 1 |
PEG 20,000 Poloxamer 407 |
3 mo/7 mo | Pfizer positive Moderna positive Janssen negative PEG 2000 negative PS 20 negative PS 80 negative |
Tolerated No allergic symptoms |
| DK, 8 | 67, F |
Colonoscopy preparation (PEG 3350) | WAO grade 1 | PEG 20,0000 | 2 mo/3 mo | Pfizer negative Moderna negative Janssen negative PEG 2000 negative PS 20 negative PS 80 negative |
Tolerated No allergic symptoms |
| DK, 96 | 43, M | Vepicombin (PEG 6000) tablet × 2 (phenoxymethylpenicillin) Mucoangin throat lozenge (PEG 6000) Burana (ibuprofen) tablet (PEG 6000) Xerodent (sodium fluoride) tablet (PEG 6000) Balancid Novum reflux tablet (PEG 6000) |
Anaphylaxis × 2 WAO grade 5 Anaphylaxis × 1 WAO grade 3 WAO grade 1 WAO grade 1 WAO grade 1 |
PEG 6000 PEG 20,000 Poloxamer 407 PS 80 |
7 y/7 y | Pfizer negative Moderna negative Janssen negative PEG 2000 negative PS 20 negative PS 80 negative |
Tolerated No allergic symptoms |
| DK, 10 | 28, F |
Colonoscopy preparation (PEG 3350) | Anaphylaxis × 1 WAO grade 4 |
PEG 3000 PEG 6000 Poloxamer 407 PS 80 |
10 mo/10 mo | Pfizer negative (itch) Moderna negative (itch) Janssen negative (itch) PEG 2000 negative PS 20 negative PS 80 negative (itch) |
Tolerated No allergic symptoms |
DK, Denmark; F, female; IDT, intradermal testing; M, male; ND, not done; PEG, polyethylene glycol; PS, polysorbate; US, United States; WAO, World Allergy Organization.
Skin testing at time of PEG allergy diagnosis, Gentofte Hospital, Denmark: All patients were skin prick tested with PEG 300 (1 g/mL), PEG 2000 (500 mg/mL), PEG 3000 (500 mg/mL), PEG 6000 (500 mg/mL), PEG 20,000 (0.1 mg/mL, 1 mg/mL, 10 mg/mL, 100 mg/mL, 200 mg/mL), Poloxamer 407 (100 mg/mL), and polysorbate 80 (200 mg/mL). All products were purchased as pure solutions from SIGMA-Aldrich. Details of preparation of solutions have been previously published (see Bruusgaard-Mouritsen et al6).
Skin testing at time of PEG allergy diagnosis, Vanderbilt Allergy Clinic, United States: All patients were skin prick tested with PEG 300 (0.1 mg/mL) (Professional Compunding Centers of America [PCCA]), PEG 3350 (using 17 g Miralax in 100 cc sterile water) (1.7 mg/mL, 17 mg/mL, 170 mg/mL), PEG 8000 (0.1 mg/mL, 1 mg/mL, 10 mg/mL) (Professional Compunding Centers of America [PCCA]), Poloxamer 407 (0.1 mg/mL, 1 mg/mL, 10 mg/mL) (Professional Compunding Centers of America [PCCA]), triamcinolone acetonide containing polysorbate 80 (0.1 mg/mL and 1 mg/mL), and methylprednisolone acetate containing PEG 3350 (0.04 mg/L 0.4 mg/mL, and 4 mg/mL). Intradermal testing with methylprednisolone acetate was used only if SPT testing result was negative across all reagents (see Stone et al7).
SPT: A positive reaction was defined as a wheal diameter of >3 mm. IDT: A positive reaction was defined as a wheal ≥ saline wheal + 3 mm and flare.
SPT before vaccination was performed with the 3 COVID-19 vaccines from Pfizer, Moderna, and Janssen “as is.” DK cases were additionally skin prick tested with PEG 2000 (500 mg/mL), polysorbate 20 (200 mg/mL), and polysorbate 80 (200 mg/mL).