Evidence map›Paper›PMID 36321821›Full record

SynthesisAllergy2023

Diagnostic accuracy of vaccine and vaccine excipient testing in the setting of allergic reactions to COVID-19 vaccines: A systematic review and meta-analysis.

Matthew Greenhawt, Marcus Shaker, David B K Golden, Elissa M Abrams, Kimberly G Blumenthal, Anna R Wolfson, Cosby A Stone, Matthew S Krantz, Derek K Chu, Ben A Dwamena

Open access · bronzeAbstract readMeta-AnalysisSystematic Review
In one paragraph

Synthesis in Allergy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 1 pooled it
4.7field-weighted citation impact, top 5% of its field
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 1 synthesis or guideline pooled it, 27 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Review
  4. Review
  5. Article
  6. Article
  7. Article
  8. Article
  9. Article
  10. In vitro selection of aptamers and their applications.Nature reviews. Methods primers · 2023
    Article
  11. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 8 institutions in 2 countries.

Matthew GreenhawtSection of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA.ORCID 0000-0002-2365-9372
Marcus ShakerDartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon, New Hampshire, USA.
David B K GoldenDivision of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.ORCID 0000-0001-7596-3707
Elissa M AbramsDepartment of Pediatrics and Child Health, Section of Allergy and Immunology, The University of Manitoba, Winnipeg, Manitoba, Canada.ORCID 0000-0003-3433-1986
Kimberly G BlumenthalDivision of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Anna R WolfsonDivision of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Cosby A StoneDivision of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.ORCID 0000-0002-1888-4188
Matthew S KrantzDivision of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.ORCID 0000-0001-7589-9127
Derek K ChuDepartment of Medicine, McMaster University, Hamilton, Ontario, Canada.ORCID 0000-0001-8269-4496
Ben A DwamenaDivision of Nuclear Medicine, Department of Radiology, Michigan Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Harvard University · USVanderbilt University · USChildren's Hospital Colorado · USDartmouth College · USJohns Hopkins University · USManitoba Health · CAOntario Clinical Oncology Group · CAUniversity of Michigan · US

Funding

Clinical and Translational Training Program in Pulmonary MedicineT32HL087738 · NHLBI · VANDERBILT UNIVERSITY MEDICAL CENTER · PI Lorraine B Ware · 2007 to 2026
$7.0M
NHLBI NIH HHS T32 HL087738
6 · The paper itself

Abstract

For persons with immediate allergic reactions to mRNA COVID-19 vaccines, skin testing (ST) to the vaccine/excipients (polyethylene glycol[PEG] and polysorbate 80 [PS]) has been recommended, but has unknown accuracy. To assess vaccine/excipient ST accuracy in predicting all-severity immediate allergic reactions upon re-vaccination, systematic review was performed searching Medline, EMBASE, Web of Science, and the WHO global coronavirus database (inception-Oct 4, 2021) for studies addressing immediate (≤4 h post-vaccination) all-severity allergic reactions to 2nd mRNA COVID-19 vaccination in persons with 1st dose immediate allergic reactions. Cases evaluating delayed reactions, change of vaccine platform, or revaccination without vaccine/excipient ST were excluded. Meta-analysis of diagnostic testing accuracy was performed using Bayesian methods. The GRADE approach evaluated certainty of the evidence, and QUADAS-2 assessed risk of bias. Among 20 studies of mRNA COVID-19 first dose vaccine reactions, 317 individuals underwent 578 ST to any one or combination of vaccine, PEG, or PS, and were re-vaccinated with the same vaccine. Test sensitivity for either mRNA vaccine was 0.2 (95%CrI 0.01-0.52) and specificity 0.97 (95%CrI 0.9-1). PEG test sensitivity was 0.02 (95%CrI 0.00-0.07) and specificity 0.99 (95%CrI 0.96-1). PS test sensitivity was 0.03 (95%CrI 0.00-0.0.11) and specificity 0.97 (95%CrI 0.91-1). Combined for use of any of the 3 testing agents, sensitivity was 0.03 (95%CrI 0.00-0.08) and specificity was 0.98 (95%CrI 0.95-1.00). Certainty of evidence was moderate. ST has low sensitivity but high specificity in predicting all-severity repeat immediate allergic reactions to the same agent, among persons with 1st dose immediate allergic reactions to mRNA COVID-19 vaccines. mRNA COVID-19 vaccine or excipient ST has limited risk assessment utility.

Indexed as

COVID-19HypersensitivityHypersensitivity, ImmediateVaccinesBayes TheoremCOVID-19 VaccinesExcipientsHumansPolysorbatesVaccine ExcipientsCOVID-19 VaccinesExcipientsPolysorbatesVaccine ExcipientsVaccinesallergic reactionsCOVID-19mRNA COVID-19 vaccinetest sensitivitytest specificity

Identifiers

PMID36321821
PMCPMC9878056
OpenAlexW4307965907

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.