Pseudo-Anaphylactic Reactions to Pfizer BNT162b2 Vaccine: Report of 3 Cases of Anaphylaxis Post Pfizer BNT162b2 Vaccination
Abstract
:1. Introduction
2. Methods
Antibodies to Pfizer BNT162b2 Vaccine, Anti-PEG IgG and IgM, Total Serum Tryptase, C3a and Cytokine ELISAs
3. Case Presentation and Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Patient | Reaction Onset | Atopy History | Signs and Symptoms | Brighton Level /Vaccine Dose | Treatment | Time of Blood Collection after Onset of Anaphylaxis | Tryptase ng/mL | C3a ug/mL |
---|---|---|---|---|---|---|---|---|
1 | 30 min | Asthma, urticaria to etoricoxib | Flushing, periorbital edema, globus sensation, wheezing | 1 (Second dose) | IM Adrenaline X 2 doses, IV hydrocortisone, IV diphenhydramine, nebulised salbutamol | 3 h | 3.2 | 83.2 |
5 weeks | N.A. | 58.6 | ||||||
2 | 30 min | Asthma, allergic rhinitis | Flushing, erythema, breathlessness, globus sensation, wheezing | 1 (First dose) | IM adrenaline, IV hydrocortisone, IV diphenhydramine, IV cimetidine, nebulised salbutamol and ipratropium | 6 h | 2.2 | 82.1 |
41 h | 3 | 81.2 | ||||||
4 weeks | N.A. | 9.0 | ||||||
3 | 20 min | Chronic rhinosinusitis | Generalised urticaria, periorbital edema, globus sensation, breathlessness | 2 (Second dose) | IM adrenaline, IV hydrocortisone and diphenhydramine | 6 h | 2.3 | 71.7 |
22 h | 1.9 | 28.0 | ||||||
5 weeks | N.A. | 2.5 | ||||||
Vaccine-naive controls (n = 6), Mean ± SD | Not Applicable | N.A. | <10 | |||||
Vaccine-tolerant controls (n = 6), Mean ± SD | Not Applicable | N.A. | <10 |
Patient | Time of Blood Collection after Onset of Anaphylaxis | PEG IgG U/mL | PEG IgM U/mL | Pfizer C-19 Vaccine IgG AU/mL | Pfizer C-19 Vaccine IgM AU/mL | Pfizer C-19 Vaccine IgE AU/mL | IL-4 pg/mL | IL-6 pg/mL | IL-33 pg/mL | sTNFRI pg/mL | TNF pg/mL | IL-10 pg/mL | MCP1 pg/mL |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 3 h | 93 | 859 | 15.9 | 29.6 | N.D. | 0.32 | 0.46 | 4.39 | 2635.2 | 0.34 | 8.97 | 198.3 |
5 weeks | 209 | 1004 | 14.6 | 27.6 | N.D. | 0.14 | 0.56 | 3.24 | 2670.4 | 0.19 | 9.08 | 268.8 | |
2 | 6 h | 1035 | 1682 | 101.6 | 42.5 | N.D. | 0.14 | 0.28 | 4.39 | 2658.6 | 0.39 | 8.45 | 195.7 |
41 h | 1021 | 1560 | 102.7 | 40.0 | N.D. | 0.14 | 0.97 | 0.94 | 2623.5 | 0.39 | 9.19 | 211.4 | |
4 weeks | 1474 | 2681 | 107.7 | 41.7 | N.D. | 0.14 | 0.88 | 0.94 | 2670.4 | 0.19 | 12.30 | 308.9 | |
3 | 6 h | 13,054 | 5091 | 176.1 | 138.5 | N.D. | 45.69 | 2.10 | 86.36 | 5450.4 | 0.84 | 22.98 | 439.8 |
22 h | 19,709 | 5310 | 266.4 | 86.6 | N.D. | 5.07 | 0.85 | 11.49 | 3745.9 | 0.19 | 11.74 | 305.5 | |
5 weeks | 10,493 | 3934 | 124.2 | 98.6 | N.D. | 7.72 | 1.13 | 18.19 | 4463.8 | 0.29 | 11.48 | 409.3 | |
Vaccine-naive controls | N.A. | 265 ± 37 | 1011 ± 224 | 37.0 ± 17.4 | 31.6 ± 13.0 | N.D. | 2.30 ± 1.11 | 1.70 ± 2.30 | 5.51 ± 2.73 | 4679.9 ± 1620.7 | 1.31 ± 2.84 | 12.49 ± 7.81 | 312.3 ± 107.5 |
Vaccine-tolerant controls | 4–5 weeks after 2nd dose of Pfizer C-19 vaccine | 785 ± 483 | 1007 ± 459 | 51.2 ± 29.3 | 23.6 ± 18.3 | N.D. | 1.26 ± 0.95 | 1.00 ± 1.05 | 4.47 ± 2.90 | 3492.1 ± 1181.1 | 1.56 ± 3.41 | 10.94 ± 2.75 | 254.08 ± 32.83 |
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Lim, X.R.; Leung, B.P.; Ng, C.Y.L.; Tan, J.W.L.; Chan, G.Y.L.; Loh, C.M.; Tan, G.L.X.; Goh, V.H.H.; Wong, L.T.; Chua, C.R.; et al. Pseudo-Anaphylactic Reactions to Pfizer BNT162b2 Vaccine: Report of 3 Cases of Anaphylaxis Post Pfizer BNT162b2 Vaccination. Vaccines 2021, 9, 974. https://doi.org/10.3390/vaccines9090974
Lim XR, Leung BP, Ng CYL, Tan JWL, Chan GYL, Loh CM, Tan GLX, Goh VHH, Wong LT, Chua CR, et al. Pseudo-Anaphylactic Reactions to Pfizer BNT162b2 Vaccine: Report of 3 Cases of Anaphylaxis Post Pfizer BNT162b2 Vaccination. Vaccines. 2021; 9(9):974. https://doi.org/10.3390/vaccines9090974
Chicago/Turabian StyleLim, Xin Rong, Bernard Pui Leung, Carol Yee Leng Ng, Justina Wei Lynn Tan, Grace Yin Lai Chan, Chien Mei Loh, Gwendolyn Li Xuan Tan, Valerie Hui Hian Goh, Lok To Wong, Chong Rui Chua, and et al. 2021. "Pseudo-Anaphylactic Reactions to Pfizer BNT162b2 Vaccine: Report of 3 Cases of Anaphylaxis Post Pfizer BNT162b2 Vaccination" Vaccines 9, no. 9: 974. https://doi.org/10.3390/vaccines9090974