Study number 18 (UMCG) 67 (UMCU) 155 (EMC) 168 (UMCG) 193 (UMCG) 194 (UMCG)
Gender Female Female Female Female Female Female
Age 24 29 28 52 43 43
Reason of vaccination in a hospital setting Anaphylaxis to previous COVID-19 (Comirnaty) vaccine Anaphylaxis to several food products first COVID-19 (Comirnaty) vaccine Reaction to previous COVID-19 (Comirnaty) vaccine in person with severe poorly controlled asthma and drug-related anaphylaxis in medical history Reaction to previous COVID-19 (Comirnaty) vaccine Anaphylaxis to several drugs (including vaccines)
Reaction after vaccination dose (no.) 1 first Covid vaccine ever 1 1 1 First Covid vaccine ever
Symptoms (objective )before referral
Conjunctivitis; hypotension (systolic BP 80mmHg while normally around 120mmHg)
N/A
Itchy red skin rash, shortness of breath, nausea and diarrhea
Generalized urticaria Stridor/ decreased O2
Objective facial angioedema
N/A
Symptoms (subjective) before referral
Globus pharyngeus/sense of swollen throat; hoarseness; dyspnea; nausea; dizziness
N/A
Globus pharyngeus/sense of swollen throat Locoregional skin rash
Globus pharyngeus/sense swollen throat
Globus pharyngeus/ sense of swollen throatdyspnea/ dizziness
N/A
Medication for reaction, before referral
Antihistamines iv Corticosteroid iv Epinephrine im
N/A
Antihistamines iv epinephrine im Antihistamines iv Epinephrine im Antihistamines iv Epinephrine im
N/A
Skin test performed
COVID-19 polysorbaat 80 PEG3500 PEG6000 PEG3500 Polysorbaat 80: Trometamol Covid 19 Trometamol Polysorbaat 80 PEG3500 PEG4000
Not performed because of daily use of prednisone, clemastine, montelukast, imatinib and mepolizumab
None
None
Skin test result positive
COVID-19 Pfizer SPT undiluted positive
PEG(SPT) and PEG (ICT) COVID-19 1:100 and1:10 PEG (ICT0
N/A
N/A
N/A
Name vaccine in the hospital Moderna Comirnaty Comirnaty Comirnaty Comirnaty Comirnaty
Symptoms after in hospital vaccination
Conjunctivitis, rhinitis, hoarseness and (subjective) globus pharyngeus
Local erythema, itch, tingling tongue, nausea malaise, sputum, vomiting, inspiratory stridor (preexistent) dyspnoe, wheezing, globus feeling Shortness of breath Itch Local urticaria (additional premedication with clemastine 2mg iv, salbutamol inh) Local erythema, dizziness, novel wheezing for which salbutamol was readministered. After 3rd and last incremental step direct and quickly progressing erythema chest, arms, face, sense of doom with tachycardia for which 1st epinephrine was administered. 2nd dose was administered when symptoms returned after 20 minutes AND BP to 110/65, previously 140/70
(sense of) swollen throat, facial erythema, chest pain, dyspnea, tachycardia
(sense of) swollen throat, dyspnea, headache, nausea
Reason for epinephrine Insufficient response to clemastine i.v. and wish to complete vaccination (was incrementally administered) Increase of nausea and vomiting, despite levocetirizine, salbutamol, + metoclopramide+ prednisolone Urticaria direct and quickly progressing erythema chest, arms, face, sense of doom with tachycardia, later also decrease of BP combination of the above Combination of the above, quickly progressing despite clemastine
Response to epinephrine Relief of symptoms yes No response Relief of symptoms Partial relief of symptoms Relief of symptoms
Tryptase (reference <11.4 ug/L)
2.92 2.46 ug/L (after)
3.4 ug/L
6.2 ug/L
6.104.97 ug/L
2.84 ug/L
Not measured
Interpretation of symptoms (type 1 allergy/ adverse side effect/ other )
CARPA or CAS-related
No allergic reaction, respiratory complaints in a person known with asthma (bronchial hyperreactivity)
No allergic reaction, Urticaria in person with known urticaria
Suspicion of type 1 allergy to PEG (because of combination with other severe drug allergies) but this could not be tested; alternatively, IRSS in a person with severe uncontrolled asthma and also susceptible to contact urticaria
Most likely hyperventilation (arterial blood gas confirmed this) and stress, at the index reaction combined with facial angioedema in a person with known U/A
Other (stress-related)