COVID-19 Vaccine-Related eConsults: Case 4

eConsult Clinical Question

A 62-year-old female patient had a severe anaphylactic reaction to the Pfizer COVID vaccine. Can she get a booster shot of the Johnson & Johnson variety (No polyethylene glycol [PEG] in it) or should she wait for the Covavax?

eConsult Response

1. Restatement of the question: thank you for asking about this 62-year-old woman who had a severe anaphylactic reaction to the Pfizer COVID vaccine, you have asked whether it would be safe or advisable for her to be boosted with a different vaccine that does not contain polyethylene glycol.
2. Recommendation(s): I suggest referring this patient to our allergy team for further assessment and discussion.
3. Rationale and/or evidence for recommendation: In most cases, I think the proposed plan that you have suggested would be exactly the way to go. Specifically, transitioning from an mRNA vaccine to the Johnson & Johnson/Janssen vaccine. This is for the reason that you have highlighted: Polyethylene glycol is an ingredient in the mRNA vaccines, which is not present in the adenovirus DNA based vaccine made by Janssen. Although I do not usually think about cross-reactivity between polyethylene glycol and polysorbate, in this case I notice a very long list of allergies, 18 in total. I have reviewed each of them, many seem not to be true allergies rather intolerances. But, on a number of occasions, there are reports of hives and shortness of breath. Therefore, in the context of this particular patient, I do think a conversation with a board-certified allergist makes sense.
4. Contingency plan: I am happy to discuss this recommendation, please call me directly with any questions.

These real-life examples have some limitations. Given the evolving recommendations and guidance on COVID-19 care, these cases should not be considered complete or definitive and may not reflect the most up-to-date guidance.