Table 3.
Characteristics of the Patients With Positive SPT Result
| Age and sex | History of HSR | Clinical manifestations of PEG allergy | Treatment for the HSR | Positive PEG skin testing | COVID-19 vaccine administered | Setting of COVID-19 vaccine administration | Clinical manifestations after vaccination |
|---|---|---|---|---|---|---|---|
| 57/M | PEG 3350 (Lax-a-day) | Throat tightness, chest tightness, and facial swelling. | Cetirizine 20 mg | SPT positive to PEG 3350: 10 mm, PEG 20,000 10%: 9 mm, PEG 20,000 1%: 9 mm, PEG 20,000 0.1%: 7 mm, PEG 20,000 0.01%: 9 mm. Flare was not recorded Tested 1 wk after the second vaccination. |
AstraZeneca | He received both doses in the vaccination center | No reaction |
| 69/F |
PEG 3350 (PEGylate) | Angioedema of the lips and tongue with generalized hives. | Spontaneous resolution | SPT positive to PEG 3350: W: 7 mm, F: 7 mm, PEG 20,000 10%: W: 10 mm, F: 30 mm, 1%: W: 8 mm, F: 20 mm, 0.1%: W: 8 mm, F: 10 mm, 0.01%: W: 6 mm, F: 8 mm DPT + PEG 3350 (Lax-a-Day): diffuse urticaria and lip angioedema 10 min after ingesting 7 g. Treated with cetirizine. Tested 1 wk before the first vaccination. |
AstraZeneca | Received both doses in the vaccination center | No reaction |
| 39/F | COVID-19 vaccine Pfizer-BioNTech | Palpitation, generalized hives, erythema, throat globus sensation, and vomiting. | Epi-pen, Benadryl, and Hydrocortisone injection. | SPT delayed positive to polysorbate 80, after 4 h. Tested 2 mo after the second vaccination. |
Pfizer-BioNTech | Received both doses in the vaccination center | First dose: uneventful. Second dose: as described. |
| 49/F | -COVID-19 vaccine (Moderna) first dose -Cefazolin -Amoxicillin |
Generalized erythema and urticaria. | Cetirizine 10 mg | SPT delayed positive to Cremophor EL (PEG 35) wheal 9 mm after 3 h. DPT with PEG 3350 (Lax-A-Day) was negative. Tested 3 mo before the second vaccination. |
Moderna | Graded dosing | Pruritus and subjective throat globus sensation, managed with cetirizine. |
| 66/F | -Moderna COVID-19 vaccine -Anileridine -Prevnar vaccine -Shingrix vaccine |
Generalized hives with angioedema and pruritus. | Benadryl and rupatadine. | SPT delayed positive to Cremophor EL (PEG 35): 5 mm, PEG 300: 6 mm, PEG 3000: 5 mm, PEG 3350: 6 mm, PEG 20,000 (10%, 1%, 0.1%, and 0.01%) 5 mm. Tested 1 mo before the second vaccination. |
Moderna | Graded dosing | Reported small itchy spot, after the completion of the protocol. No objective finding. |
Abbreviations: COVID-19, coronavirus disease 2019; DPT, drug provocation test; F, female; HSR, hypersensitivity reaction; M, male; PEG, polyethylene glycol; SPT, skin prick test.