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Management and outcome of suspected and confirmed COVID-19 (SARS-CoV-2) vaccine hypersensitivity.
  • +18
  • Margitta Worm,
  • A. Alexiou,
  • Andrea Bauer,
  • Regina Treudler,
  • Gerda Wurpts,
  • Heinrich Dickel,
  • Timo Buhl,
  • Sabine Müller,
  • Andreas Jung,
  • R. Brehler,
  • Joachim Fluhr,
  • Ludger Klimek,
  • N. Mülleneisen,
  • W. Pfützner,
  • Ulrike Raap,
  • Stefani Röseler,
  • S. Schuh,
  • H. Timmermann,
  • Guido Heine,
  • Bettina Wedi,
  • Knut Brockow
Margitta Worm
Charite Universitatsmedizin Klinik fur Dermatologie Venerologie und Allergologie

Corresponding Author:[email protected]

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A. Alexiou
Charite Universitatsmedizin Klinik fur Dermatologie Venerologie und Allergologie
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Andrea Bauer
Klinik und Poliklinik für Dermatologie Comprehensive Allergy Center (CAC) Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden
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Regina Treudler
Universitatsklinikum Leipzig Klinik und Poliklinik fur Dermatologie Venerologie und Allergologie
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Gerda Wurpts
Klinik für Dermatologie und Allergologie Aachener Comprehensive Allergy Center (ACAC) Universitätsklinik der RWTH Aachen
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Heinrich Dickel
Abteilung für Allergologie Berufs- und Umweltdermatologie Klinik für Dermatologie Venerologie und Allergologie St Josef-Hospital Ruhr-Universität Bochum
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Timo Buhl
Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Göttingen Georg-August-Universität
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Sabine Müller
Klinik für Dermatologie und Allergologie Universitätsklinikum Freiburg
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Andreas Jung
Klinik für Dermatologie Venerologie und Allergologie Universitätsklinikum Gießen
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R. Brehler
Ambulanz für Allergologie Berufsdermatologie und Umweltmedizin Universitätsklinikum Münster
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Joachim Fluhr
Comprehensive Allergy Centre Charité CACC Campus Benjamin Franklin Charité - Universitätsmedizin Berlin
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Ludger Klimek
Allergiezentrum Wiesbaden/Rhein-Main Zentrum für Rhinologie und Allergologie
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N. Mülleneisen
Asthma- und Allergiezentrum Leverkusen
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W. Pfützner
Allergiezentrum Hessen Klinik für Dermatologie und Allergologie Universitätsklinikum Marburg
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Ulrike Raap
Allergiezentrum Oldenburg Universitätsklinik für Dermatologie und Allergologie Klinikum Oldenburg AöR
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Stefani Röseler
Klinik für Pneumologie Allergologie Schlaf- und Beatmungsmedizin Krankenhaus der Augustinerinnen Köln Kooperationspartner Aachener Comprehensive Allergy Center (ACAC)
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S. Schuh
Klinik für Dermatologie und Allergologie Universitätsklinikum Augsburg - am Standort Medizincampus Süd Augsburg
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H. Timmermann
Schwerpunktpraxis Colonaden Hamburg
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Guido Heine
Klinik für Dermatologie Venerologie und Allergologie Universitätsklinikum Schleswig-Holstein Campus Kiel Kiel
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Bettina Wedi
Klinik für Dermatologie Allergologie und Venerologie Comprehensive Allergy Center (CAC) Medizinische Hochschule Hannover
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Knut Brockow
Klinik und Poliklinik für Dermatologie und Allergologie am Biederstein Technische Universität München
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Abstract

Systemic allergic reactions to vaccines are very rare. In this study we assessed the management and outcome suspected SARS-CoV-2 vaccine hypersensitivity. We present data of 219 individuals, who experienced symptoms suspicious for an allergic reaction after the first (n=214) or the second vaccination (n=5). 195 reactions occurred after the first application of mRNA-based vaccines (157 Comirnaty®, and 38 Spikevax®) and eighteen reactions were reported after first application of a vector vaccine (Vaxzevria®). Of these 162 experienced immediate symptoms. Skin symptoms occurred in 91 cases. The most frequent cutaneous symptom was angioedema (n=45), followed by generalized urticaria (n=36) and generalized erythema/flush (n=20). 70 patients had cardiovascular symptoms, 45 showed respiratory symptoms and gastrointestinal symptoms were recorded in 14 patients. The allergological assessment of 334 individuals (219 with reactions after COVID vaccination and 115 with a history of vaccine related reactions) showed in 17% a suspicion of sensitization against the SARS-CoV-2 vaccine and/or their ingredients defined as one positive skin test and/or BAT. The majority of the SPT/IDT with the vaccines were negative. Of the 214 patients with suspected allergic symptoms after the first vaccination, 67/67 patients tolerated the re-vaccination. In this study, 334 individuals of a cohort resembling >2000 persons presenting for an allergy workup regarding SARS-CoV-2 vaccination only 45 were diagnosed in concordance with the anaphylaxis definition of the Brighton collaboration with anaphylactic immediate hypersensitivity reaction after SARS-CoV-2 vaccination. Identifiable characteristics of these patients with suspected, but also diagnosed SARS-CoV-2 vaccine hypersensitivity were female gender and the symptom angioedema. Overall, IgE-mediated hypersensitivity towards SARS-CoV-2 vaccines is extremely low and not increased in comparison to the reported hypersensitivity for other vaccines.