ArticleThe journal of allergy and clinical immunology. In practice2021
First-Dose mRNA COVID-19 Vaccine Allergic Reactions: Limited Role for Excipient Skin Testing.
Article in The journal of allergy and clinical immunology. In practice, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 78 papers, 3 of them syntheses that pooled it.
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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.
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Who cites it
78 citing papers in PubMed, 3 syntheses or guidelines pooled it, 142 citations in OpenAlex.
- Pooled it
- The adverse reactions to vaccines practice parameter 10 years on-what have we learned?Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology · 2022Guideline
- Risk of Second Allergic Reaction to SARS-CoV-2 Vaccines: A Systematic Review and Meta-analysis.JAMA internal medicine · 2022Pooled it
- High Frequency of Chronic Urticaria Following an Investigational HIV-1 BG505 MD39.3 Trimer mRNA Vaccine in a Phase 1, Randomized, Open-Label Clinical Trial (HVTN 302).Annals of internal medicine · 2025Trial
- A randomized double-blinded trial to assess recurrence of systemic allergic reactions following COVID-19 mRNA vaccination.The Journal of allergy and clinical immunology · 2024Trial
- Review
- Polyethylene Glycol (PEG)-Induced Anaphylaxis: A Cautionary Case for the Gastroenterologist in the COVID Era.Cureus · 2025Article
- Safety of COVID-19 revaccination in patients with prior hypersensitivity reactions: a retrospective study.Tropical diseases, travel medicine and vaccines · 2025Article
- 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
- Cutaneous reactions to vaccination.Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG · 2025Review
- Article
- Gastrointestinal reflux contributes to laryngopharyngeal symptoms that mimic anaphylaxis: COVID-19 vaccination experience.The journal of allergy and clinical immunology. Global · 2024Article
- Challenges in diagnosing polyethylene glycol and polysorbate 80 allergies: implications for allergic reactions in COVID-19 mRNA vaccination program: experience from Qatar.Frontiers in allergy · 2024Article
- Article
- [Reasons for allergology consultations prior to COVID-19 vaccination and their outcomes : Two-year experience of an allergy center in North Rhine-Westphalia].Dermatologie (Heidelberg, Germany) · 2023Article
- [Vaccination approach in patients with an allergic reaction to COVID-19 vaccines or at risk of developing allergic reactions].Tuberkuloz ve toraks · 2023Article
- Anaphylatoxin Complement 5a in Pfizer BNT162b2-Induced Immediate-Type Vaccine Hypersensitivity Reactions.Vaccines · 2023Article
- Immune-Mediated Organ-Specific Reactions to COVID-19 Vaccines: A Retrospective Descriptive Study.Pharmaceuticals (Basel, Switzerland) · 2023Article
- Utility of eConsults for COVID-19 vaccine-related concerns in Ontario: a cross-sectional analysis.Allergy, asthma, and clinical immunology : official journal of the Canadian Society of Allergy and Clinical Immunology · 2023Article
- Article
18 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
11 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundThe Centers for Disease Control and Prevention state that a severe or immediate allergic reaction to the first dose of an mRNA COVID-19 vaccine is a contraindication for the second dose.
objectiveTo assess outcomes associated with excipient skin testing after a reported allergic reaction to the first dose of mRNA COVID-19 vaccine.
methodsWe identified a consecutive sample of patients with reported allergic reactions after the first dose of mRNA COVID-19 vaccine who underwent allergy assessment with skin testing to polyethylene glycol (PEG) and, when appropriate, polysorbate 80. Skin testing results in conjunction with clinical phenotyping of the first-dose mRNA COVID-19 vaccine reaction guided second-dose vaccination recommendation. Second-dose mRNA COVID-19 vaccine reactions were assessed.
resultsEighty patients with reported first-dose mRNA COVID-19 vaccine allergic reactions (n = 65; 81% immediate onset) underwent excipient skin testing. Of those, 14 (18%) had positive skin tests to PEG (n = 5) and/or polysorbate 80 (n = 12). Skin testing result did not affect tolerance of the second dose in patients with immediate or delayed reactions. Of the 70 patients who received the second mRNA COVID-19 vaccine dose (88%), 62 had either no reaction or a mild reaction managed with antihistamines (89%), but 2 patients required epinephrine treatment. Three patients with positive PEG-3350 intradermal (methylprednisolone) testing tolerated second-dose mRNA COVID-19 vaccination. Refresh Tears caused nonspecific skin irritation.
conclusionsMost individuals with a reported allergic reaction to the first dose of mRNA COVID-19 vaccines, regardless of skin test result, received the second dose safely. More data are needed on the value of skin prick testing to PEG (MiraLAX) in evaluating patients with mRNA COVID-19 vaccine anaphylaxis. Refresh Tears should not be used for skin testing.
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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.