key: cord-0688190-t8sfmesh
authors: Lellig, Elodie; Mouton-Faivre, Claudie; Abs, Diane; Bursztejn, Anne-Claire
title: Fixed drug eruption after Pfizer-BioNTech COVID-19 vaccine: a case report
date: 2022-04-22
journal: J Allergy Clin Immunol Pract
DOI: 10.1016/j.jaip.2022.03.033
sha: 0fb111df70a5b0ac7b6d0bc6a40d1af807ea41fa
doc_id: 688190
cord_uid: t8sfmesh

nan

hours. Patch test with petrolatum was negative. Patch test with vaccine diluted at 30% in petrolatum, 51 undiluted vaccine, PEG and petrolatum were performed on normal skin (on the back) and were 52 negative. Patch with 30% vaccine in petrolatum and PEG diluted at 30% in petrolatum were done on 5 53 other controls and were negative.

After discussion, we decided to contraindicate the use of PEG in injectable forms and in colic 55 preparations (for laxative use), considering the largest amount of PEG contained in these medications.

Indeed, there are alternative treatments to colic preparations. The patient has never taken PEG for 57 laxative use before. The benefit-risk balance is positive for the vaccine if a third dose is necessary, 58 although it contains PEG. Cross-reactivity between PEG and polysorbate has been suggested in 59 immediate allergies but polysorbate 80 (PS) contained in vaccine is tolerated by PEG allergic patients.

(1) Therefore we didn't test PS nor contraindicate any PS excipient drug. FDE located on a wrist and one FDE located on a hand (4) . Among these 3 cases, patch-tests were 68 performed for 2 of them (4) and were positive using vaccine diluted at 10% in petrolatum. The time of 69 onset was from 1 to 3 days. Egg protein was supposed to be imputable but was not contraindicated. One 70 case of localized bullous FDE after the second Human Papilloma Virus (HPV) vaccine injection (5) is 71 described, however delay of onset was only 2 hours and patch tests were negative. One case of bullous 72 FDE localized to the nose (6) was reported 4 days after yellow fever vaccination without allergological 73 investigations. For all cases, contraindication to excipients and vaccines were not discussed. 

The Polysorbate 86 containing AstraZeneca COVID-19 vaccine is tolerated by polyethylene glycol (PEG) allergic 87 patients

SARS-CoV-2 mRNA Vaccine-Associated Fixed Drug 89

Generalized 91 bullous fixed-drug eruption secondary to the influenza vaccine

Fixed drug eruption due to influenza vaccine

Bullous fixed drug 96 eruption following Human Papilloma Virus vaccination

Localized bullous fixed drug eruption following yellow fever 99 vaccine

Allergic Reactions Including Anaphylaxis After Receipt of the First 101

Dose of Pfizer-BioNTech COVID-19 Vaccine

Polyethylene Glycol-Induced Systemic Allergic Reactions 103 (Anaphylaxis)

Prevent COVID-19 Disease and Reported Allergic Reactions: Current Evidence and 106 Suggested Approach

Figure 1: Well-defined erythematous patch on the left wrist 24 hours after the first dose of 114 mRNA COVID-19 vaccine Comirnaty®-BioNTech/Pfizer

Skin test results on lesional skin with Comirnaty®-BioNTech/Pfizer diluted at 30% 117 in petrolatum showing positive reactivity (+) after 48 hours