ABSTRACT
Case report The first approved COVID-19 vaccines include BNT162B2 Pfizer-BioNTech and mRNA-1273 Moderna mRNA vaccines. Some severe allergic reactions to these vaccines have been report, and even though there is a lack of robust evidence, IgE-mediated hypersensitivity to excipients may be the cause of several. The excipient polyethylene glycol (PEG) is present in both, whilst Moderna further contains trometamol (or tromethamine), a buffer additive present in drug formulations and contrast media. We report the case of a 40 year-old woman, with controlled allergic rhinitis and asthma, who was referred to our Immunoallergology Department due to an anaphylactic reaction to Moderna COVID-19 vaccine. She described an episode of cervical and facial pruritus 5 minutes after receiving the first dose of vaccine, which rapidly evolved to generalized urticaria. She was promptly given intravenous (IV) clemastine with improvement of symptoms. However, 1h later she developed respiratory symptoms (dry cough, shortness of breath and wheezing). IV hydrocortisone was also given, and the patient was kept under medical supervision for 6h, after which she was discharged home. The following day, she had urticaria that resolved with oral deflazacort (60 mg). She denies exercise practice, alcohol consumption or outset of new drugs prior to vaccination. During investigation, the patient described two similar reactions in the past, 5 minutes after the administration of trometamol-containing contrast media (10 years before with an iodinated contrast and 2 years ago with a gadolinium contrast, both with trometamol). A week after the reaction all laboratory evaluation were within normal limits, including tryptase level. Skin tests were performed, 2 months after, with contrast media that contain trometamol (iopromide, iomeprol, iodixanol, ioversol, gadobutrol) and that do not (ioxitalamate, amidotrizoate, gadoterate meglumine), in accordance with the EAACI/ENDA guidelines. Iopromide and iodixanol were positive on intradermal testing (1:10 dilution), suggesting trometamol as the culprit excipient. She was advised not to receive the 2nd dose of Moderna vaccine. She received Pfizer-BioNTech vaccine at the hospital, without any reactions. This case demonstrates that an IgE-mediated reaction to trometamol may be an underlying mechanism for immediate hypersensitivity to mRNA Moderna vaccine. The risk of an allergic reaction to it increases when a previous history of hypersensitivity to contrast media exists.
ABSTRACT
A atuacao do psicologo no pronto socorro nao se refere apenas a atencao direta ao paciente, refere-se tambem atencao que e dispensada a familia e a equipe de saude, dentro de sua atuacao profissional. O psicologo promove mudancas, atividades curativas e de prevencao, minimizando o sofrimento do impacto da hospitalizacao, principalmente em tempos que o paciente e a familia nao podem estar juntos em um momento tao delicado. O presente trabalho foi idealizado a partir da experiencia do recebimento das familias no PSA nos tempos de COVID-19 no Hospital Samaritano Higienopolis. Como resultado dessas praticas, esse trabalho pretendeu reunir uma analise de dados referentes aos meses de trabalho, com o objetivo central de propiciar uma reflexao acerca da importancia do apoio psicologico no hospital geral durante a pandemia COVID-19. De setembro de 2020 a janeiro de 2022, foram realizados 2147 atendimentos aos pacientes e familiares, somando 541 familiares atendidos no programa de cuidados especiais ao obito, 129 pacientes e familiares em saude mental com COVID, 323 pacientes e familiares no protocolo de cuidados paliativos, 110 pacientes e familiares da oncologia, 625 pacientes e familiares em protocolo idoso fragil. Por esses dados, podemos perceber que em nosso hospital, a equipe de psicologia esta inserida de forma que abrange grande parte dos pacientes hospitalizados. O acompanhamento psicologico a familia durante a pandemia foi essencial pois o momento de crise acometido pelo sentimento de impotencia frente ao adoecer de seu ente querido resultava em intenso sofrimento psiquico e fragil estado emocional geral, aos pacientes, familiares e tambem as equipes de saude. Nessa medida, incluimos um fluxo constituido pelo recebimento afetuoso do familiar ja no Pronto Socorro Adulto, favorecimento de rituais de despedida nesse momento de separacao, realizacao de prontuario afetivo, transicao de cuidados a equipe das Unidades de Terapia Intensiva, acompanhamento do paciente nos exames diagnosticos, preparo para internacao nas Unidades COVID, preparo para intubacao (tambem com rituais de despedida atraves de video chamada), acompanhamento psicologico do paciente e acompanhamento remoto aos familiares. Constatamos que a flexibilizacao do fazer psicologico a partir dessa nova realidade, foi fundamental, pois o acolhimento a familia e a possibilidade de trocas imediatas com a equipe moldou o cenario do Pronto Socorro favorecendo o melhor cuidado. Copyright © 2022
ABSTRACT
Background: COVID-19 vaccination is essential for the pandemic control. Adverse reactions after vaccination are com-mon, although anaphylaxis is rare. Objective(s): To characterize the immunoallergological reactions responsible for pre--vaccination referral by Primary Care (PC), to analyze the impact of drug allergy on this referral, and to evaluate the vaccination outcome after risk stratification. Method(s): Retrospective observational study including patients referred by PC to the Allergy & Clinical Immunology Department of a tertiary hospital to evaluate the risk of severe hypersensitivity reactions (HSR) after COVID-19 vaccination, from January to June 2021. Risk stratification was carried out in accordance with the Allergy & Clinical Immunology Department's protocol. Result(s): From a total of 733 patients referred by the CSP, 510 were admitted, 445 of which were evaluated, 369 (83%) females, mean age 66+/-13 years [20-99 years], 122 (27%) atopic. The majority (n=349, 78%) were referred due to previous drug reactions, of whom 69 (15.5%) due to vaccine reactions. Nonste-roidal anti-inflammatory drugs (n=97, 51%) and antibiotics (n=70, 36%) were the most reported drugs in suspected/confirmed HSRs. Drug reaction profile differed in low-risk (61% with HSR, 39% anaphylaxis) and intermediate/high risk (92% with HSR, 65% anaphylaxis) patients. After risk assessment, 323 patients were referred for vaccination at the vaccination center, of whom 280 received at least one dose of the vaccine. Two patients had chronic urticaria worsening and one patient had a vasovagal reaction after the vaccine. 122 patients were vaccinated at the hospital, of whom 69 received one dose of the vaccine. Only two patients had mild skin reactions. Conclusion(s): Drug allergy was the main cause for pre-vaccination risk assessment. Most patients were vaccinated at the vaccination center with no HSR. Risk assessment protocol was effective, with no significant reactions or cases of anaphylaxis. Copyright © 2022, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved.