The Polysorbate containing AstraZeneca COVID‐19 vaccine is tolerated by polyethylene glycol (PEG) allergic patients

• Published in: Clinical and experimental allergy Vol. 52; no. 1; pp. 12 - 17
• Main Authors: Sellaturay, Priya, Gurugama, Padmalal, Harper, Verah, Dymond, Tom, Ewan, Pamela, Nasser, Shuaib
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.01.2022
• Subjects: Adult; Aged; Allergies; Anaphylaxis; ChAdOx1 nCoV-19 - immunology; Cosmetics; COVID-19; COVID-19 - prevention & control; COVID-19 vaccines; drug allergy; Drug Hypersensitivity - etiology; Drug Hypersensitivity - immunology; Female; Household products; Humans; Immunization; Male; Middle Aged; mRNA; Patients; PEG allergy; Polyethylene glycol; Polyethylene Glycols; polysorbate 80; Polysorbates; SARS-CoV-2; Skin; Skin Tests; Vaccines; COVID-19; COVID-19 vaccines; polysorbate 80; drug allergy; PEG allergy
• ISSN: 0954-7894; 1365-2222; 1365-2222
• DOI: 10.1111/cea.14064

Background Polyethylene glycol (PEG) is the excipient found in the mRNA COVID‐19 vaccines. We previously demonstrated PEG allergy was a cause of severe anaphylaxis to the Pfizer/BioNTech COVID‐19 vaccine. PEG is widely used in many household products, cosmetics and medicines. However PEG allergy is rare, there have been few confirmed cases of PEG allergy. The excipient of potential concern in the AstraZeneca COVID‐19 vaccine is polysorbate 80 (PS80). Cross‐reactivity between PEG and polysorbate has been suggested, based on their composition and skin‐test data. The aim of this study was to determine whether PEG‐allergic patients could be vaccinated with the PS80 containing AstraZeneca COVID‐19 vaccine. Method Eight patients with PEG allergy were identified by the allergy clinic at Cambridge University Hospital. Patients underwent skin prick testing to PS80 (20%) and to the AstraZeneca COVID‐19 vaccine prior to vaccination. Results All eight patients allergic to PEG tolerated the AstraZeneca COVID‐19 vaccine, even in 2 patients where the PS80 skin prick test was positive and 1 with a positive skin prick test to the AstraZeneca COVID‐19 vaccine. Conclusion Patients allergic to PEG, previously denied COVID vaccination, may now be safely vaccinated with the PS80 containing AstraZeneca vaccine and need only avoid the PEG‐containing mRNA COVID‐19 vaccines. This opens up the possibility that these patients will also tolerate other vaccines containing PS80 such as the Janssen/Johnson and Johnson COVID‐19 vaccine. Clinical cross‐reactivity between PEG and PS80 did not occur in this vaccine setting. The Pfizer/BioNTech COVID‐19 vaccine contains polyethylene glycol (PEG), whereas the AstraZeneca vaccine contains polysorbate 80 (PS80). Cross‐reactivity between PEG and PS80 has been suggested, based on their structural similarity. We show that 8/8 PEG‐allergic patients tolerated the AstraZeneca vaccine, even in 2 patients where the PS80 skin prick test was positive. This suggests that PEG‐allergic patients previously denied COVID vaccination, may now be safely vaccinated with the AstraZeneca vaccine and need only avoid the PEG containing mRNA COVID vaccines.