Immediate-Type Hypersensitivity to Polyethylene Glycol (PEG) and a PEG-Containing COVID-19 Vaccine Revealed by Intradermal Testing
Julia Pickert, Iris Hennighausen, Stefan Mühlenbein, Christian Möbs, Wolfgang Pfützner
Abstract
Determination of serum parametersConcentrations of mast cell tryptase (2.3µg/mL), total IgE (109kU/L) and allergen-specific IgE topenicilloyl G and V, ampicilloyl, amoxicilloyl, ethylene oxide, the major birch pollen allergen Bet v 1 (4.61kUA/L) dermatophagoides pteronyssinus (4.34kUA/L) and farinae (1.34kUA/L), alphagalactosidase, Tri a 14, Tri a 19, Cor a 8, Cor a 9, Cor a 14, and natural rubber latex were quantified by the Phadia ImmunoCAP system (Thermo Fisher Scientific, Uppsala, Sweden) according to the manufacturer's instructions (positive ImmunoCap results are indicated in parentheses). Skin testsSkin tests comprised skin prick (SPT) and intradermal testing (IDT) with different drugs, excipients as well as vaccines.Briefly, SPT were carried out using a sterile prick lancet, for IDT the substances were injected intradermally using a tuberculine syringe with a 21 gauge.As negative control 0.9% NaCl was applied (SPT, IDT), as a positive control 0.1% histamine (SPT).The substances were tested in various dilution stages (Table 1 andTable E1).Polyethylene glycol (PEG) 2000 and 6000 (both Sigma-Aldrich, Merck KGaA, Darmstadt, Germany) were diluted in aqua dest.Polysorbate was diluted in aqua dest.(1:10) and heated in a water bath at 37°C until completely solved.All substances were filtered sterile.A mean wheal diameter (sum of largest and hereto vertical diameter divided by two), recorded 20 minutes after applying the test, of ≥ 3mm and ≥ 6mm was judged as a positive test result for SPT and IDT, respectively.To avoid interindividual variations, the same, herein trained and experienced person executed and evaluated the skin tests.