ReviewThe Journal of allergy and clinical immunology2021
Potential mechanisms of anaphylaxis to COVID-19 mRNA vaccines.
Review in The Journal of allergy and clinical immunology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 93 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
93 citing papers in PubMed, 2 syntheses or guidelines pooled it, 151 citations in OpenAlex.
- Can Labs Help With Vaccination? In Vitro Tests in Diagnosis of Allergy to COVID-19 Vaccines-A Systematic Review.Immunity, inflammation and disease · 2025Pooled it
- The Risk of Allergic Reaction to SARS-CoV-2 Vaccines and Recommended Evaluation and Management: A Systematic Review, Meta-Analysis, GRADE Assessment, and International Consensus Approach.The journal of allergy and clinical immunology. In practice · 2021Pooled it
- Rationally Designed Zwitterionic Peptides Improve siRNA Delivery of Cationic Diblock Copolymer-Based Nanoparticle Drug-Delivery Systems.ACS applied nano materials · 2026Article
- Review
- Advances in Polyethyleneimine-Derived Nanoformulations.Small science · 2026Review
- Anti-PEG Immunogenicity of mRNA-LNP Vaccines in Humans: Evidence for Population-Level Changes in the Anti-PEG Antibody Repertoire.Pharmaceutics · 2026Article
- Polypeptide-engineered lipid nanoparticles for mRNA delivery with limited immunogenicity.Nature communications · 2026Article
- Overlapping Clinical Presentation of Long COVID and Postacute COVID-19 Vaccination Syndrome: Phenotypes, Severity, and Biomarkers.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- Clinical immunization safety assessment (CISA) project: COVID-19 vaccine consultations and case reviews.Vaccine · 2025Article
- Harnessing mRNA-lipid nanoparticles as innovative therapies for autoimmune diseases.Molecular therapy. Methods & clinical development · 2025Review
- Delivering the Message: Translating mRNA Therapy for Liver Inherited Metabolic Diseases.Journal of inherited metabolic disease · 2025Review
- Decrypting the Immune Symphony for RNA Vaccines.Vaccines · 2025Review
- Evaluating vaccination dosing strategies for SARS-CoV-2 in patients at high-risk for allergic reactions: Insights from vaccination campaign.The World Allergy Organization journal · 2025Article
- COVID-19 mRNA-1273 vaccination induced mast cell activation with strongly elevated ThInflammation research : official journal of the European Histamine Research Society ... [et al.] · 2025Article
- Delivery and adjuvant: liposomes for SARS-CoV-2 vaccines.Biotechnologia · 2025Review
- Network analysis of adverse event patterns following immunization with mRNA COVID-19 vaccines: real-world data from the European pharmacovigilance database EudraVigilance.Frontiers in medicine · 2025Article
- Article
- The role of leukocyte activation in suspected Non-IgE excipient-related COVID-19 vaccine reactions: An exploratory hypothesis-driven study of pathogenesis.Allergy and asthma proceedings · 2024Article
- The Ambivalence of Post COVID-19 Vaccination Responses in Humans.Biomolecules · 2024Review
- Article
33 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 8 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Anaphylaxis to vaccines is historically a rare event. The coronavirus disease 2019 pandemic drove the need for rapid vaccine production applying a novel antigen delivery system: messenger RNA vaccines packaged in lipid nanoparticles. Unexpectedly, public vaccine administration led to a small number of severe allergic reactions, with resultant substantial public concern, especially within atopic individuals. We reviewed the constituents of the messenger RNA lipid nanoparticle vaccine and considered several contributors to these reactions: (1) contact system activation by nucleic acid, (2) complement recognition of the vaccine-activating allergic effector cells, (3) preexisting antibody recognition of polyethylene glycol, a lipid nanoparticle surface hydrophilic polymer, and (4) direct mast cell activation, coupled with potential genetic or environmental predispositions to hypersensitivity. Unfortunately, measurement of anti-polyethylene glycol antibodies in vitro is not clinically available, and the predictive value of skin testing to polyethylene glycol components as a coronavirus disease 2019 messenger RNA vaccine-specific anaphylaxis marker is unknown. Even less is known regarding the applicability of vaccine use for testing (in vitro/vivo) to ascertain pathogenesis or predict reactivity risk. Expedient and thorough research-based evaluation of patients who have suffered anaphylactic vaccine reactions and prospective clinical trials in putative at-risk individuals are needed to address these concerns during a public health crisis.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.