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.