British Journal of Anaesthesia

Anaphylaxis to the first COVID-19 vaccine: is polyethylene glycol (PEG) the culprit?

Published:December 17, 2020DOI:
      Editor—The day after the world watched the first person receiving the coronavirus disease 2019 (COVID-19) vaccine on December 8, 2020, reports of three cases of suspected allergic reactions in connection with the vaccine emerged from the UK. Two were reports of anaphylaxis in healthcare workers, with onset within minutes of vaccination, responding well to treatment with epinephrine. Both recovered fully and were reported to have severe allergies to foods and drugs, respectively. The third case was less severe and did not require epinephrine.


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        • Su J.R.
        • Moro P.L.
        • Ng C.S.
        • Lewis P.W.
        • Said M.A.
        • Cano M.V.
        Anaphylaxis after vaccination reported to the vaccine adverse event reporting system, 1990-2016.
        Allergy Clin Immunol. 2019; 143: 1465-1473
      1. Centers for Disease Control and Prevention. Vaccine excipient summary: excipients included in U.S. vaccines, by vaccine 2020. Available from accessed 21, dec 2020

        • Stone Jr., C.A.
        • Rukasin C.R.F.
        • Beachkofsky T.M.
        • Phillips E.J.
        Immune-mediated adverse reactions to vaccines.
        Br J Clin Pharmacol. 2019; 85: 2694-2706
        • Badiu I.
        • Geuna M.
        • Heffler E.
        • Rolla G.
        Hypersensitivity reaction to human papillomavirus vaccine due to polysorbate 80.
        BMJ Case Rep. 2012; 2012bcr0220125797
        • Greenhawt M.
        • Turner P.J.
        • Kelso J.M.
        Administration of influenza vaccines to egg allergic recipients: a practice parameter update 2017.
        Ann Allergy Asthma Immunol. 2018; 120: 49-52
      2. Nanomedicine and the COVID-19 vaccines.
        Nat Nanotechnol. 2020; 15: 963
        • Wenande E.
        • Garvey L.H.
        Immediate-type hypersensitivity to polyethylene glycols: a review.
        Clin Exp Allergy. 2016; 46: 907-922
        • Sellaturay P.
        • Nasser S.
        • Ewan P.
        Polyethylene glycol-induced systemic allergic reactions (anaphylaxis).
        J Allergy Clin Immunol Pract. 2020; (Advance Access published on October 1, 2020)
        • Mahase E.
        COVID-19: people with history of significant allergic reactions should not receive Pfizer vaccine, says regulator.
        BMJ. 2020; 371 (m4780)
        • Garvey L.H.
        • Dewachter P.
        • Hepner D.L.
        • et al.
        Management of suspected immediate perioperative allergic reactions: an international overview and consensus recommendations.
        Br J Anaesth. 2019; 123 (e50–64)
        • Rose M.A.
        • Garcez T.
        • Savic S.
        • Garvey L.H.
        Chlorhexidine allergy in the perioperative setting: a narrative review.
        Br J Anaesth. 2019; 123 (e95–103)
        • Zhou Z.H.
        • Stone Jr., C.A.
        • Jakubovic B.
        • et al.
        Anti-PEG IgE in anaphylaxis associated with polyethylene glycol.
        J Allergy Clin Immunol Pract. 2020; (Advance Access published on November 17, 2020)