Study of Excipients in Delayed Skin Reactions to mRNA Vaccines: Positive Delayed Intradermal Reactions to Polyethylene Glycol Provide New Insights for COVID-19 Arm
Abstract
:1. Background
2. Methods
2.1. Patients
2.2. Clinical Protocol
2.3. Skin Testing Protocol
3. Results
3.1. Demographic Baseline
3.2. Clinical Characterization of Skin Reactions Due to mRNA COVID-19 Vaccines
3.3. Patch Testing Results
3.4. Intradermal Testing Results in Patients with Delayed Reactions
3.5. Skin Testing Health Care Workers without Skin Reactions
3.6. Skin Biopsy of PEG Reactions
4. Discussion
4.1. Skin Reactions Features
4.2. Skin Testing Results for PEG
4.3. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Skin Reactions | DLLR | ILR | Morbilliform and Pityriasis Rosea-Like Rash | Urticariform Rash | Psoriasiform Rash | BMS |
---|---|---|---|---|---|---|
Clinical picture | n = 18 | n = 5 | n = 4 | n = 2 | n = 1 | No image n = 1 |
Median age (IQR) | 38.9 (47–30) | 47.6 (61.5–34) | 43.8 (59.5–28) | 35.5 | 72 | 44 |
Sex, n (%) | ||||||
Women | 16 (88.9) | 5 | 3 | 2 | None | 1 |
Men | 2 | None | 1 | None | 1 | None |
Allergies, n (%) | 11 (61.1) | 1 | 2 | 1 | 1 | 1 |
Past anaphylaxis, n | 2 | None | None | None | None | None |
Chronic skin disorder, n | ||||||
AD | 3 | 2 | None | 1 | None | None |
CSU | 3 | 1 | 1 | 1 | None | None |
Median onset (days) (IQR) | 8.1 (9–7) | 2.4 (3.5–1.5) | 6.8 (8.5–5) | 6 | 10 | 1 |
Median duration (days) (IQR) | 4.8 (7–3) | 3 (4.5–1.5) | 4.3 (6–2.5) | 6.5 | 15 | 10 |
Vaccine, n (%) | ||||||
Moderna | 16 (88.9) | 5 | 1 | None | 1 | None |
Pfizer | 2 | None | 3 | 2 | None | 1 |
Dose, n (%) | ||||||
1st | 13 (72.2) | 5 | 3 | None | None | 1 |
2nd | 5 | None | 1 | 2 | 1 | None |
Relapse with 2nd dose, n | 3 | 1 | None | None | None | None |
Local symptoms, n (%) | 16 (88.9) | 3 | 4 | 2 | None | 1 |
Response to treatment | All patients presented a good response to conventional treatments | |||||
Vaccine discontinuation | No vaccine discontinuation was needed for any patient with the 2nd dose |
Skin Reaction | Intradermal Testing (Readings at 20 min/2 h/D2; if All Negative: Neg) | ||||||||||||||||
PEG-400 | PEG-2000 | TR | 3-PC | ||||||||||||||
1.0% | 0.1% | 0.01% | 0.001% | 1.0% | 0.1% | 0.01% | 0.001% | 1.0% | 0.1% | 0.01% | 0.001% | 1.0% | 0.1% | 0.01% | 0.001% | ||
Widespread skin reactions | 1 | (+/+/−) | (+/+/−) | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg |
2 | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | |
3 | Neg | Neg | Neg | Neg | (+/+/−) | (+/+/−) | (+/−/−) | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | |
4 | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | |
5 | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | |
“COVID ARMS” or DLLR | 6 | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg |
7 | (+/+/+) | (+/+/−) | Neg | Neg | (+/+/+) | (+/+/−) | (+/+/−) | Neg | Neg | Neg | Neg | Neg | (+/−/−) | Neg | Neg | Neg | |
8 | Neg | Neg | Neg | Neg | (+/+/−) | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | |
9 | (+/+/−) | (+/+/−) | (+/+/−) | Neg | (+/+/+) | (+/+/+) | (+/+/−) | (+/+/−) | (+/−/−) | (+/−/−) | (+/−/−) | (+/−/−) | Neg | Neg | Neg | Neg | |
10 | (+/+/−) | Neg | Neg | Neg | (+/+/−) | (+/+/−) | (+/+/−) | (+/+/−) | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | |
11 | Neg | Neg | Neg | Neg | (+/+/−) | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | |
12 | Neg | Neg | Neg | Neg | (+/+/−) | (+/−/−) | (+/−/−) | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | |
13 | (+/+/−) | Neg | Neg | Neg | (+/+/−) | (+/+/−) | (+/+/−) | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | |
14 | Neg | Neg | Neg | Neg | (+/+/−) | (+/+/−) | (+/+/−) | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | |
15 | Neg | Neg | Neg | Neg | (+/+/−) | (+/+/−) | (+/+/−) | (+/+/−) | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | |
16 | Neg | Neg | Neg | Neg | (+/+/+) | (+/+/−) | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg | Neg |
Skin Reaction | Type | Grading | Duration (days) | Vertical D (cm) | Horizontal D (cm) | |
---|---|---|---|---|---|---|
Widespread skin reactions | 1 | Psoriasiform eruption | 3 | 15 | NA | NA |
2 | Pityriasis rosea rash | 3 | 6 | NA | NA | |
3 | Morbilliform rash | 3 | 4 | NA | NA | |
4 | Urticariform rash | 3 | 7 | NA | NA | |
5 | Urticariform rash | 3 | 6 | NA | NA | |
“COVID ARMS” or DLLR | 6 | NA | 1 | 6 | 6.5 | 8.0 |
7 | NA | 2 | 3 | 11.0 | 6.1 | |
8 | NA | 2 | 7 | 8.4 | 5.3 | |
9 | NA | 2 | 15 | 14.5 | 7.4 | |
10 | NA | 2 | 7 | 8.5 | 6.8 | |
11 | NA | 1 | 6 | 5.8 | 4.5 | |
12 | NA | 2 | 4 | 8.5 | 7.2 | |
13 | NA | 2 | 7 | 9.5 | 7.0 | |
14 | NA | 2 | 6 | 8.8 | 7.5 | |
15 | NA | 2 | 7 | 8.0 | 6.5 | |
16 | NA | 1 | 3 | 9.5 | 5.0 |
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Pesqué, D.; Pujol, R.M.; Marcantonio, O.; Vidal-Navarro, A.; Ramada, J.M.; Arderiu-Formentí, A.; Albalat-Torres, A.; Serra, C.; Giménez-Arnau, A.M. Study of Excipients in Delayed Skin Reactions to mRNA Vaccines: Positive Delayed Intradermal Reactions to Polyethylene Glycol Provide New Insights for COVID-19 Arm. Vaccines 2022, 10, 2048. https://doi.org/10.3390/vaccines10122048
Pesqué D, Pujol RM, Marcantonio O, Vidal-Navarro A, Ramada JM, Arderiu-Formentí A, Albalat-Torres A, Serra C, Giménez-Arnau AM. Study of Excipients in Delayed Skin Reactions to mRNA Vaccines: Positive Delayed Intradermal Reactions to Polyethylene Glycol Provide New Insights for COVID-19 Arm. Vaccines. 2022; 10(12):2048. https://doi.org/10.3390/vaccines10122048
Chicago/Turabian StylePesqué, David, Ramon Maria Pujol, Orianna Marcantonio, Ainhoa Vidal-Navarro, José María Ramada, Alba Arderiu-Formentí, Agustí Albalat-Torres, Consol Serra, and Ana María Giménez-Arnau. 2022. "Study of Excipients in Delayed Skin Reactions to mRNA Vaccines: Positive Delayed Intradermal Reactions to Polyethylene Glycol Provide New Insights for COVID-19 Arm" Vaccines 10, no. 12: 2048. https://doi.org/10.3390/vaccines10122048
APA StylePesqué, D., Pujol, R. M., Marcantonio, O., Vidal-Navarro, A., Ramada, J. M., Arderiu-Formentí, A., Albalat-Torres, A., Serra, C., & Giménez-Arnau, A. M. (2022). Study of Excipients in Delayed Skin Reactions to mRNA Vaccines: Positive Delayed Intradermal Reactions to Polyethylene Glycol Provide New Insights for COVID-19 Arm. Vaccines, 10(12), 2048. https://doi.org/10.3390/vaccines10122048