TABLE 1.
Evaluation of patients with severe acute reactions after Dose 1 of COVID‐19 vaccine
| No. | Age in years | Sex | History of allergy | 1st dose of vaccine | Symptoms after vaccination | Time to onset | Treatment | SPT with PEG and PEG derivatives | Vaccination outcome (2nd dose): all were vaccinated with Comirnaty vaccine |
|---|---|---|---|---|---|---|---|---|---|
| 1 | 40–50 | F | Systemic reaction: wheezing, shaking, chills during pollen allergen immunotherapy | Comirnaty | Chills, shivering, anxiety, light‐headedness | 20 min | Epinephrine, antihistamine, oral steroid, oxygen | Negative | No reaction |
| 2 | 30–40 | F | Redness and skin irritation after exposure to different cosmetic products | Comirnaty | Inconsistent history. Dizziness, nausea, giddiness. Unclear vital parameters | Within a few minutes after vaccination | Epinephrine, antihistamine | Negative | Patient declined vaccination |
| 3 | 20–30 | F (trans‐gender) | None | Vaxzevria | Swelling sensation in the tongue, dizziness, giddiness, generalized pruritus. No objective symptoms | 15 min | Epinephrine, antihistamine, oral steroid | Negative | No reaction |
| 4 | 50–60 | F | Severe angioedema to penicillin | Comirnaty | Sensation of throat closure | 10 min | Epinephrine, antihistamine, oral steroid | Negative | No reaction |
| 5 | 40–50 | F | None | Moderna | Generalized erythema (assessed as urticaria), nausea, tachycardia, hypertension | Within a few minutes | Epinephrine, antihistamine, oral steroid | Negative | Hyperventilation, assessed as anxiety‐ related reaction |
| 6 | 20–30 | F | Anaphylaxis to peanut | Vaxzevria | Generalized pruritus, diplopia, dry throat, dyspnoea, anxiety | 10 min | Epinephrine, antihistamine, oral steroid | Negative | No reaction |
| 7 | 40–50 | F | None | Comirnaty | Shortness of breath. Generalized malaise. Sensation of throat closure | Within a few minutes | Epinephrine, antihistamine, oral steroid | Negative | No reaction |
| 8 | 50–60 | F | None | Comirnaty | Shortness of breath, generalized erythema, obstructive breathing sound over the lungs (Level 2 of diagnostic certainty according to Brighton Collaboration) | 20 min | Epinephrine, antihistamine, oral steroid, short‐acting beta‐agonist | Negative | No reaction |
| 9 | 50–60 | M | Anaphylaxis to H1N1 influenza vaccine and to another vaccine (unclear) | Comirnaty | Hypotension, vomiting, dizziness, decreasing saturation (from 95–96% to 91–93%) Tryptase 14 µg/l, not significantly elevated above baseline (13 µ/l)’. (Level 2 of diagnostic certainty according to Brighton Collaboration) | 15 min | Epinephrine, antihistamine, oral steroid, oxygen |
Negative SPT. IgE neg BAT positive |
No reaction |
| 10 | 30–40 | F | None | Comirnaty | Flush, generalized pruritus, sensation of throat closure, shortness of breath. (Level 2 of diagnostic certainty according to Brighton Collaboration) | 10 min | Antihistamine, oral steroid | Negative | No reaction |
| 11 | 10–20 | F | None | Comirnaty | Nausea, generalized erythema, sensation of throat closure, abdominal discomfort. (Level 2 of diagnostic certainty according to Brighton Collaboration) | 15 min | Antihistamine, oral steroid | Negative | No reaction |
| 12 | 90–100 | M | None. | Comirnaty | Generalized pruritus, verbal and motoric distress, slight hoarseness | Within a few minutes after vaccination | Antihistamine, oral steroid | Negative | No reaction |
| 13 | 50–60 | F | Generalized angioedema to wasp | Comirnaty | Paraesthesia in the scalp, soles, tongue and palms, sensation of swollen tongue) | Within a few minutes | Antihistamine, oral steroid | Negative | No reaction |
| 14 | 50–60 | F | None | Comirnaty | Sensation of swollen throat, dizziness, cold sweat | Within a few minutes | Antihistamine, oral steroid | Negative | No reaction |
| 15 | 20–30 | F | Anaphylaxis to soya, peanuts, latex, NSAID | Comirnaty | Urticaria, nausea, dizziness and headache, sensation of swollen throat (Level 2 of diagnostic certainty according to Brighton Collaboration) | Within a few minutes | None | Negative | No reaction |
| 16 | 6–70 | F | Diverse food allergy, no anaphylaxis | Vaxzevria | Itching, angioedema, dyspnoea, (Level 2 of diagnostic certainty according to Brighton Collaboration) | Within 60 min | Antihistamine, oral steroid | Negative | No reaction |
| 17 | 50–60 | F | Anaphylaxis to penicillin | Comirnaty | Hoarse voice, sensation of swollen throat | Within a few minutes | Antihistamine, oral steroid | Negative | No reaction |
| 18 | 40–50 | F | Anaphylaxis to wasp | Comirnaty |
Hoarseness, generalized erythema, tachycardia Tryptase 10 microgram/l, not significantly elevated above basal tryptase (Level 2 of diagnostic certainty according to Brighton Collaboration) |
5 min | Antihistamine, oral steroid | Negative | No reaction |
| 19 | 40–50 | F | Anaphylaxis to local anaesthetics | Comirnaty | Urticaria, itching throat, hoarseness, swollen sensation in the throat (Level 2 of diagnostic certainty according to Brighton Collaboration) | 15–20 min | Antihistamine, oral steroid | Negative | No reaction |
| 20 | 40–50 | F | Worsening of asthma after NSAID exposure. | Vaxzevria | Dyspnoea, described as asthma attack by the patient | 10 min | Short‐acting beta‐ agonist | Negative | No reaction |
| 21 | 40–50 | F | Nausea after exposure to radiocontrast agents. Anaphylaxis to peanut | Comirnaty | Dyspnoea, sensation of swollen throat, prickling sensation in the feet and legs | 25 min | Short‐acting beta‐ agonist | Negative. | No reaction |
| 22 | 50–60 | F | Angioedema after NSAID exposure | Vaxzevria | Acute systemic urticaria, paraesthesia in lips | Within a few minutes after vaccination | Antihistamine, oral steroid | Negative | No reaction |
| 23 | 50–60 | F | Generalized flush to histamine‐rich food and beverages | Vaxzevria | Generalized erythema or urticaria. Two referrals for the same patient, inconsistent documentation | 20 min | Antihistamine | Negative | No reaction |
| 24 | 50–60 | F | None | Vaxzevria | Itching throat, generalized erythema | 10 min | Antihistamine, oral steroid | Negative | No reaction |
| 25 | 30–40 | F | Anaphylaxis to peanut | Comirnaty | Severe generalized pruritus with erythema. Prickling sensation in the fingers | Within a few minutes | Epinephrine, antihistamine, oral steroid | Negative | No reaction |
| 26 | 70–80 | M | Anaphylaxis to wasp | Comirnaty | Itching of the scalp, generalized urticaria | 1 h | Antihistamine, oral steroid | Negative | No objective symptoms. Slight pruritus in the scalp during skin testing and after vaccination |
| 27 | 40–50 | M | None | Comirnaty | Generalized erythema and pruritus, prickling sensation in face and neck | 5 min | Antihistamine, oral steroid | Negative | Slight redness on the chest |
Abbreviations: F, female; M, male; SPT, skin prick test.