A 75 year-old woman with history of severe T2 asthma, now well-controlled on Nucala 100mg q four weeks presents for COVID-19 vaccine risk assessment. The only severe allergic reaction she has ever experienced was an anaphylactic event to the application of a facial cosmetic product 50 years ago. It is possible that this cosmetic may have contained polysorbate 80; however an allergic evaluation was never done. She continues unrestricted use of cosmetics. The Nucala which she receives and tolerates monthly contains polysorbate 80. (0.67 mg/single dose vial). My plan is to provide routine vaccination with 30 minutes observation. Is it advisable that she need to be skin tested to polysorbate 80 prior to COVID-19 vaccination?
The mRNA vaccines do not contain polysorbate 80. Therefore, in this patient it would be appropriate to administer either of the two mRNA vaccines and observe for 30 min. There is no need to skin test in this patient.
I hope this is helpful.
Mitchell Grayson, MD