Sufferers tolerate mRNA COVID-19 vaccines regardless of hypersensitivity to taxanes

June 17, 2022

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Sufferers with a historical past of delicate to reasonable hypersensitivity reactions to taxanes safely obtained the mRNA vaccines for COVID-19, based on a research printed in The Journal of Allergy and Medical Immunology: In Follow.

This analysis is the biggest security analysis of those vaccines in sufferers who’ve had prior reactions to chemotherapies that embody polyethylene glycol (PEG) derivatives, Leila A. Alenazy, MD, MMSc, an allergy and medical immunology fellow with the division of allergy and medical immunology within the division of medication at McGill College Well being Centre in Montreal, and colleagues wrote.

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In response to the researchers, the chemotherapeutic agent paclitaxel is a generally used taxane that features Cremophor EL, a PEG with small molecular weight. Cremophor EL is also within the BNT162b2 Pfizer-BioNTech and mRNA-1273 Moderna messenger RNA (mRNA)-based COVID-19 vaccines. Nonetheless, the researchers famous that the function of PEG in anaphylaxis caused by mRNA COVID-19 vaccines stays unknown.

Additionally, docetaxel, one other taxane, consists of polysorbate 80, which is an excipient that’s utilized in AstraZeneca and Janssen COVID-19 vaccines.

Between Jan. 1 and Oct. 31, 2021, the researchers assessed 26 sufferers (imply age, 61 years; 100% feminine; 84.6% white) who had a historical past of reactions to cremophor-bound paclitaxel (n = 23), docetaxel (n = 2) or each (n = 1).

Every affected person had a pores and skin prick take a look at for PEG with excessive and low molecular weight and for polysorbate 80. Additionally, sufferers had been challenged with PEG 3,350 or had a direct problem with the Pfizer-BioNTech, Moderna or AstraZeneca COVID-19 vaccines. The researchers then contacted the sufferers every week later to evaluate delayed reactions.

Preliminary signs had been cutaneous and included flushing in 65% of sufferers, urticaria in 7.6% and pruritis in 3.8%, adopted by dyspnea in 42.3%, again ache in 38.5% and chest heaviness in 15.4%.

Preliminary reactions included kind I non-IgE mediated reactions in 50% of sufferers, cytokine-release reactions in 23%, blended speedy reactions in 23% and delayed-type IV reactions in 3.8%. Severity of preliminary hypersensitivity reactions included delicate reactions in seven sufferers, reasonable reactions in 18 and a extreme response in a single.

All of those hypersensitivity reactions occurred inside 60 minutes of infusion apart from one affected person. Additionally, none of those sufferers had any prior anaphylactic reactions to taxanes, nor did anybody require epinephrine.

After the hypersensitivity reactions, many of the sufferers then tolerated paclitaxel and/or docetaxel with antihistamine H1 and H2 receptor antagonist and/or corticosteroid premedication (n = 25) and slower infusions (n = 22). One of many sufferers was desensitized to paclitaxel, two switched to another drug and one discontinued paclitaxel.

Additionally, 19 sufferers had unfavourable SPTs to PEG and PEG derivatives. Three sufferers had PEG 3,350 graded challenges and had unfavourable outcomes.

As soon as testing was full, all the sufferers obtained an mRNA COVID-19 vaccine efficiently with none proof of speedy or delayed hypersensitivity reactions and with none premedication.

All however one of many sufferers who tolerated the mRNA vaccines had a earlier delicate to reasonable taxane hypersensitivity response. The remaining affected person had a extreme hypersensitivity response, pneumonitis, after receiving paclitaxel. Additionally, this affected person tolerated the Moderna vaccine.

One other affected person who had reacted to PEG-doxorubicin and paclitaxel had a unfavourable SPT along with a unfavourable oral problem to PEG 3,350 and tolerated the Pfizer-BioNTech vaccine.

Noting that each one the sufferers had unfavourable SPT for PEG derivatives of upper and decrease molecular weights, the researchers discovered that they might be much less more likely to react to the PEG derivatives that had been used within the research.

The sufferers who didn’t have SPT tolerated the COVID-19 vaccines, the researchers continued, main the researchers to conclude that pores and skin testing just isn’t crucial for evaluating the security of COVID-19 vaccines after hypersensitivity reactions to taxanes.

In different phrases, the researchers wrote, sufferers who had earlier hypersensitivity reactions to paclitaxel with the excipient Cremophor EL or docetaxel with the excipient polysorbate 80 tolerated COVID-19 vaccines safely. Sufferers with comparable histories of taxane hypersensitivity reactions might then obtain these vaccines safely too, the researchers added, with out prior SPT or premedication.


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