TABLE 4.
Characteristics and vaccination management of new patients with confirmed PEG allergy
Age | Sex | Elicitor | Reaction | Skin test results | Interpretation | Management |
---|---|---|---|---|---|---|
73 | M | Colon cleansing solution (=PEG 3350) | 30 min after third or fourth cup of PEG‐preparation palmar erythema, generalized itch, dizziness |
SPT: Pos. to PEG 3350, 4000 Neg. to: PEG 2000, PEG 6000, PS 80 IDT: Pos. to PEG 3350, 4000, 6000. After IDT generalized itch and palmar erythema Neg. to PEG 2000 and PS 80 BAT: Pos. to PEG 4000, 6000, Comirnaty®, Moderna Neg. to PEG 2000, 3350, PS80, Vaxzevria® |
No OCT was performed because of systemic reaction after skin test High risk for reaction to mRNA‐containing COVID‐19 vaccines. Low risk for reaction to Vaxzevria® because of negative skin tests and BAT and thus unlikely cross‐reactivity to polysorbate 80 |
mRNA vaccination avoidance DNA vaccination against COVID‐19 indicated. Tolerated first shot of fractionated Vaxzevria® (0.1 mL; 0.4 mL) under inpatient emergency preparedness, without premedication |
59 | F |
(1) Colon cleansing solution Movicol Orange® (=PEG 3350) (2) Corticosteroid +local anesthetic injection (lidocaine/triamcinolone, + PEG) |
(1) 1 h after intake of Moviprep Orange® swelling of hands, generalized urticaria, nausea, vomiting, diarrhea (2) Few min after injection of Lidocaine/Triamcinolon‐ preparation generalized urticaria, dyspnea, dizziness |
SPT: Pos. to PEG 4000, 6000 Neg. to PEG 2000, PS80, Moviprep Orange After SPT nausea and dizziness BAT: Pos. to Moderna‐vaccine, Neg. to PEG 2000, 3350, 4000, 6000, PS80, Comirnaty®, Vaxzevria® |
No OCT was performed because of systemic reaction after skin test High risk for reaction to mRNA‐containing COVID‐19 vaccines. Low risk for reaction to Vaxzevria® because of negative skin tests and BAT and thus unlikely cross‐reactivity to polysorbate 80 |
Subcutaneous challenge to triamcinolone, articaine negative. mRNA vaccination avoidance. DNA vaccination against COVID‐19 recommended as in other patients but not yet done |
28 | F |
(1) Cold medication sirup (PEG 6000) (2) Local anesthetic injection (mepivacaine, contains PEG) (3) Colon cleansing solution (Movicol®, is PEG 3350) (4) Iodide solution (cont. PEG) |
(1) Few min after intake throat swelling, dyspnea, generalized pruritus (2) Few min after injection urticaria, dyspnea, drop in blood pressure, runny nose (3) 5 min after intake urticaria, dyspnea, drop in blood pressure. (4) One hour after application (foot) urticaria |
2013: SPT: Pos. to: PEG 4000 After SPT generalized urticaria 2021: SPT Neg. to: PEG 2000, 4000, 6000, PS 80, Comirnaty® IDT Pos. to: Comirnaty®. Generalized urticaria 1 h after IDT Neg. to: PEG 2000, 4000, 6000, PS 80, Vaxzevria® BAT: Neg. to PEG 2000, 4000, 6000, PS 80, Vaxzevria® Pos. to: Comirnaty®, Moderna‐vaccine |
No OCT was performed because of systemic reaction after skin test High risk for reaction to mRNA‐containing COVID‐19 vaccines. Low risk for reaction to Vaxzevria® because of negative skin tests and BAT and thus unlikely cross‐reactivity to polysorbate 80 |
mRNA vaccination avoidance DNA vaccination against COVID‐19 indicated. Tolerated first shot of fractionated Vaxzevria® (0.1 mL; 0.4 mL) under inpatient emergency preparedness, without premedication |
Abbreviations: BAT, basophil activation test; IDT, intradermal test; mi, minutes; Neg, negative; OCT, oral challenge test; PEG, polyethylene glycol; Pos, positive; PS80, polysorbate 80; SPT, skin prick test.