Age: 35.0
Sex: F
Vaccine: COVID19
Symptoms: Cough, Dyspnoea, Pharyngeal swelling, Pruritus, Urticaria
Clinical narrative: Reported information from patient: I had a severe reaction to the COVID-19 vaccine.  Met with Dr. and did a series of skin testing for PEG allergy.  All were negative and progressed to a microdose of the vaccine.  Continued to have no reaction so remaining dose was administered.  I waited 2 hours in clinic and experienced some mild pruritic symptoms.  Took 2 zytrtec and went home.  the next day experienced some throat swelling with shortness of breath.  Took additional allergy medication and contacted Dr.  He prescribed prednisone and up to 4 allergy tabs a day.  I developed increased shortness of breath, hives on my tongue which developed into ulcerations.  The waves of throat swelling would come every 4 hours or so.  Was able to manage with oral agents, did not administer the prescribed epi-pen.  These symptoms started on that Tuesday and were severe enough to keep me home from work until Feb 15th (I work Monday/Wednesday).  Throat swelling and coughing persists but it markedly improved.   Now understand I have a non-IGE mediated allergy to PEG.   Patient wanted to receive the COVID vaccine so was seen by an allergist given previous history of possible polyethylene glycol allergy.  Following review and discussion of risks patient was scheduled to receive a test dose.  Provider notes as follows:  She has had several occasions where she has developed shortness of breath and "generally not feeling well," within 1 to 2 hours of taking MiraLAX.  She has not had any reactions to any prior injectable medications or vaccinations.  Due to this MiraLAX potential allergy there is a contraindication to receiving the Pfizer or my during a Covid vaccine.  What I have recommended since she would like to be vaccinated is to have her to return to clinic at which time we will do skin testing with skin prick and intradermal to polyethylene glycol as well as polysorbate 20 and polysorbate 80.  If the allergy testing to polyethylene clean glycol is negative we will then give her graded dosing of the COVID-19 vaccine and monitor her in clinic.  If the polyethylene glycol is positive but the polysorbate testing are negative she may be a candidate for receiving one of the newer vaccines which are yet to be on the market.     The patient was seen today for a new problem which is polyethylene glycol allergy and the need for COVID-19 vaccination.  She will return for testing to the vaccine components and then intramuscular graded challenge if necessary.     Prior to the graded challenge skin prick testing to MiraLAX was completed which was negative.  Skin prick testing and intradermal testing was also completed for Solu-Medrol, Depo-Medrol and triamcinolone.  The Depo-Medrol contains polyethylene glycol, the triamcinolone contains polysorbate 80 and the Solu-Medrol functions as a control without any polyethylene glycol or polysorbate.  All skin prick and intradermal testing was negative.  An ~10% dose of the COVID-19 vaccine was given and the patient was monitored for 30 minutes. The remaining ~90% of the COVID-19 vaccine was then given  and the patient was monitored for an additional 90 minutes. The patient received pre-medications with: Zyrtec and Tylenol