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![]() Dmg Personnel Skin Prick TestsAmong these same participants, 10 of 11 (91%) had positive basophil activation test results to PEG and 11 of 11 (100%) had positive basophil activation test results to their administered mRNA vaccine. Of patients who underwent skin prick tests, 0 of 11 tested positive to PEG, 0 of 11 tested positive to P80, and 1 of 10 (10%) tested positive to the same brand of mRNA vaccine used to vaccinate that individual. All reactions fully resolved. Concentrations of immunoglobulin (Ig) G and IgE antibodies to PEG were obtained to determine possible mechanisms.Results Of 22 patients (20 women mean age, 40.9 years 15 with clinical allergy history), 17 (77%) met Brighton anaphylaxis criteria. Basophil activation testing after stimulation for 30 minutes at 37 ☌ was also conducted. The reemergence of novel, more easily and quickly transmissible variants (eg, B.1.1.7 1.351 P.1) raise concerns about further spikes in cases and a greater ensuing public health burden.In December 2020, the US Food and Drug Administration (FDA) granted emergency use authorization to both Pfizer-BioNTech’s BNT162B2 mRNA and Moderna’s mRNA-1273 COVID-19 vaccines. Uncontrolled transmission of the SARS CoV-2 virus continues throughout the United States and in much of the world. Immunological testing suggests non–IgE-mediated immune responses to PEG may be responsible in most individuals.As of May 21, 2021, more than 32 million cases of COVID-19 have been confirmed in the United States, resulting in more than 615 000 deaths, which have disproportionately occurred in persons aged 65 years and older. Such treatment is more likely in health care workers who were overrepresented among the first wave of vaccinations, many of whom were vaccinated via occupational health programs in hospital settings. Additionally, the anaphylaxis case definition used by VAERS requires reactions to meet strict criteria, which can exclude mild reactions and some severe allergic reactions whose systemic involvement was limited by prompt treatment. Notably, VAERS is a passive reporting system requiring health care professionals to submit event reports that include vaccine lot numbers, which can be cumbersome to obtain and submit by treating clinicians. The US Centers for Disease Control and Prevention (CDC) reviewed 3486 reports of death among individuals who had received the COVID-19 vaccinate and found “no evidence that vaccination contributed to patient deaths.” 2VAERS provides valuable insights into vaccine-induced anaphylaxis however, it has limitations. 1 Of 66 confirmed anaphylaxis cases reported from 17 524 676 vaccine administrations, 95% occurred in women, and 79% and 32% of individuals with allergic reactions had a previous history of allergies and/or allergic reactions and anaphylaxis, respectively. Changing a column to text in excel for mac3As the global public health community expands vaccine access to include younger, more diverse populations who have historically exhibited higher rates of vaccine hesitancy, 4 it is especially critical that we better understand the mechanisms underlying vaccine-induced anaphylaxis for risk stratification and improved anaphylaxis management as well as to inform further vaccine refinement. Therefore, we hypothesized that life-threatening reactions to the vaccine are extremely rare and that most allergic reactions to vaccines are due to non–immunoglobulin (Ig) E–mediated pathways. Given the high and growing prevalence of allergic disease in the general US population, public concern about possible vaccine-induced anaphylaxis risk among individuals with allergies, and the key role of vaccination in achieving herd immunity to COVID 19, it is essential that additional, comprehensive, and up-to-date clinical data be evaluated to further understand this important topic. Patient data were obtained from the Stanford Research Repository, which houses all clinical data at Stanford Medicine, including the Veterans Administration Palo Alto Hospital.
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