Patients with mast cell activation syndrome tolerate COVID-19 vaccines
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PHOENIX — Patients with mast cell activation syndrome tolerated COVID-19 vaccination, according to an abstract presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.
“The likely situation for confirmed patients with [mast cell activation syndrome (MCAS)] is that they’re going to have the same side effects as patients who do not have MCAS, as described by the CDC,” Onyinye Iweala, MD, PhD, assistant professor of medicine in the division of rheumatology, allergy and immunology at University of North Carolina in Chapel Hill, told Healio.
Because patients with MCAS often experience anaphylaxis to multiple drugs, and vaccines can exacerbate mast cell mediator release symptoms, Iweala and colleagues sought to determine whether patients with confirmed or suspected MCAS tolerated the approved mRNA COVID-19 vaccines and the Johnson & Johnson replication-incompetent adenovirus vaccine.
“When the mRNA vaccines were initially rolled out, there were some reports of immediate allergic-like reactions happening among health care workers,” Iweala said. “That led to some blanket recommendations that individuals with food allergies or severe allergies should not get vaccinated until there was more understanding about the vaccines. This occurred alongside a lot of public mistrust around the development of the vaccine, leading to a lot of concern and hesitancy.
“My gestalt feeling was that most people would tolerate getting this vaccine, but I wanted to try and get more data,” she added.
Iweala and colleagues conducted a retrospective study using data from an allergy clinic to identify 379 patients with suspected or confirmed MCAS. Associated comorbidities among the 41 patients (female, 90.2%; white, 82.9%) with confirmed MCAS included chronic idiopathic urticaria/hives/angioedema (63.4%), postural orthostatic tachycardia syndrome/other dysautonomia (61%), allergic rhinitis (51.2%), asthma/reactive airway (46.3%), migraines (43.9%) and Ehlers-Danlos syndromes (41.5%).
Of all the patients with confirmed or suspected MCAS, 63.6% received at least one dose of one of the three COVID-19 vaccines between December 2020 and December 2021.
Overall, patients with MCAS reported common side effects from vaccination that matched those described by the CDC, including pain, redness and swelling at the injection site; fever; chills; fatigue; headache; muscle pain and nausea.
“I was really surprised that within 4 hours, we really didn't have any patients reporting swelling or angioedema, shortness of breath, wheezing, throat tightness or difficulty swallowing,” Iweala said. “Basically, we didn't have anyone declaring those immediate types of sensations that I would associate with an allergic-type reaction.”
Few of the 41 patients with confirmed MCAS reported immediate onset of symptoms associated with MCAS. According to Iweala, within the first 4 hours of receiving the initial dose, 5.9% of patients with confirmed MCAS reported a sense of impending doom, 5.9% reported diarrhea or abdominal pain, 5.9% reported nausea or vomiting,11.8% reported flushing, 11.8% reported hives or generalized itching, and 18% reported having a racing heart.
Within the first 5 hours to 7 days following vaccination, a little less than 6% of patients reported neurogenic-type symptoms, such as numbness, tingling, burning sensations or orthostatic intolerance.
Only three patients reported using emergency treatment for allergic reactions after receiving the vaccine; one used epinephrine and two patients used an oral antihistamine.
These side effects resolved for most patients within 21 days or less, researchers noted.
The researchers also acknowledged that the 63.6% rate of receiving at least one dose of a COVID-19 vaccine in this population was lower than the 71% rate for North Carolina and the 73.8% rate for the U.S., suggesting some degree of vaccine hesitancy among these patients, despite the proven tolerability observed in this study.
“One of the biggest things that we’re learning is how much mistrust varies things within medicine and vaccines in general but particularly with this vaccine,” Iweala said. “There’s been so much misinformation and disinformation, and then there’s been poor communication by our own validated agencies, like the CDC. We, in medicine, need to do better with how we communicate our science and medicine to the general population.”
When discussing vaccination with patients who express hesitancy, it may be helpful to simply ask them what is driving their hesitancy, Iweala said.
“Once you have an understanding as to why, that can help you figure out the next strategy,
ome people feel comfort in being able to get it in an environment with a doctor who they know, rather than at the pharmacy. Other people just want to have some questions answered from their personal physician or specialist who they’re familiar with. And, once they hear from that person, they're perfectly happy to go get vaccinated.”