Covid Vaccines and Allergies
Updated 13 Jan 2022
I am not clinically qualified and this note has not been peer reviewed. It is subject to change. Please bear this in mind and cross-check anything I say before believing (or denouncing) it.
"Get your Covid vaccine shots" is all the cry, but what if you have allergies? Will it be safe? Quite possibly not; recorded reactions against the jabs range from mild Covid arm to a few rare cases of death. This note tries to paint the overall picture, in the hope that someone out there might find it useful.
Allergies and lesser reactions can arise to all sorts of substances. Often, what begins as a mild reaction increases on each dose until it soon becomes life-threatening. Two allergens of particular concern here are polyethylene glycol (PEG) and its close relative polysorbate. Every Covid vaccine available in the West contains a form of at least one of these substances. They are typically used as "adjuvants", to enhance the action of the active ingredients, although at least one vaccine includes one of them as an excipient (an inactive ingredient, including adjuvants) for another reason. Although relatively new to us, they have also become widely used in cosmetics, hygiene products and even packaged foods. Indications are growing that some people can have significant immune reactions, even allergies, to them. So what might have been tolerable for your first one or two Covid shots might become severe when you get your next booster.
PEG and polysorbate each come in various forms. A given individual's reaction to each form can be different, while two individuals will react differently to any given form. Moreover, most sufferers will have relatively mild symptoms and not report them; only the rare, severe cases come to clinical attention, and the way that previous exposures may have felt OK can complicate the diagnosis. So systematising any meaningful results from test or symptomatic data is difficult and challenging.
PEG (macrogol) and Polysorbate 80 (E 433) are especially significant in Covid vaccines and post-infection treatments (see for example COVID-19 Vaccines aned Allergy from the Melbourne Vaccination Education Centre).
The extent to which these additives in Covid vaccines and treatments may cause allergic and other immune reactions is still under scrutiny. The mad rush to vaccinate humanity against Covid is an especially chaotic environment to try to work in. Our official state of knowledge seems to have begun with Stone et. al.; "Immediate Hypersensitivity to Polyethylene Glycols and Polysorbates: More Common Than We Have Recognized", J Allergy Clin Immunol Pract, May-Jun 2019;7(5), pp1533-40. For more recent studies, see for example Bigini et. al.; "The role and impact of polyethylene glycol on anaphylactic reactions to COVID-19 nano-vaccines", Nature, November 2021. Of course, the sufferers are rather more clear about it, but may not accurately diagnose the causes of their own symptoms. Nevertheless, the body of evidence is growing, and is supported by conversations with my local allergy specialist who is seeing a steady rise in reported issues with these allergens.
All Covid vaccines and treatments have side effects, and other reactions to them are also noticed in clinical trials. A big problem is, if allergens are present in the formula, then how many of those reactions are to the allergen and how many to the active ingredients? To answer that it is imperative to baseline the potential allergens. For example if we know that four in every thousand react to the allergen, and six in every thousand to the vaccine, then two in every thousand are reacting to the active ingredient alone, and up to four might be reacting to both. While PEG2000 (known as macrogol in the USA) is already under the spotlight, I can find no such studies on polysorbate 80. We have no real idea of its prevalence as an allergen, and hence no idea of the safety (or otherwise) of the active ingredients it gets packaged with. Anecdotal evidence, such as provided by the case study below, is just not enough.
If you or someone you know is experiencing adverse reactions to a Covid vaccine, or is concerned at the possibility, you might want to check out the Anaphylaxis Campaign's web page on Covid-19 Vaccines and Allergies. They also have a useful FAG, instructions on What to Do in an Emergency in case of an acute attack (anaphylaxis) and other resources. Allergy UK also have a COVID-19 Vaccinations and Allergies FAQ. I have not found any similar resource for post-infection treatments.
The vaccines and treatments approved for use in any given country may vary, for example not all are available in the UK.
The UK Health Security Agency maintains an up-to-date list of vaccines and UK equivalents, the COVID-19 vaccination programme: Information for healthcare practitioners (Current version 3.11, dated 21 Dedember 2021, or later).
Fuller lists of vaccines around the world, including a list of the many still in the lab and not yet approved anywhere, is provided by the Regulatory Affairs Professionals Socitey (RAPS) COVID-19 vaccine tracker (Current version dated 20 December 2021, or later).
The table below is slightly different. It lists the various Covid vaccines and specific drug treatments available in a significant number of countries, together with their most significant properties as far as allergens and treatment within the UK are concerned. I have been astonished to find that nobody else seems to have pulled all this information together in one place yet. Certainly, the very obvious lessons that scream out from it are acknowledged only by a very few sufferers and specialist practitioners. I hope you find it instructive and, perhaps, even useful.
|AstraZeneca (Oxford, Vaxzevria, Covishield)||Vaccine||Viral vector||Polysorbate 80||Approved and available|
|Convidecia (CanSino, Pakvac)||Vaccine||Viral vector||Polysorbate 80||Not approved in the UK, even for visitors|
|Covaxin (BBV152)||Vaccine||Deactivated Covid virus||None that I know of||Approved for visitors but not for residents||Ingredients: inactivated SARS-CoV-2 antigen NIV-2020-770, aluminium hydroxide gel, imidazoquinolinone (TLR 7/8 agonist), 2-phenoxyethanol, phosphate buffer saline.|
|Janssen (Johnson & Johnson)||Vaccine||Viral vector||Polysorbate 80||Approved but not currently available|
|Moderna||Vaccine||mRNA||PEG2000||Approved and available|
|Molnupiravir (Lagevrio)||Early‑onset treatment||Antiviral drug (Pill)||None that I know of||Approved and available||Ingredients (including capsule and ink): molnupiravir, croscarmellose sodium (E468), hydroxypropyl cellulose (E463), magnesium stearate (E470b), microcrystalline cellulose (E460), hypromellose (E464), titanium dioxide (E171), red iron oxide (E172), butyl alcohol, dehydrated alcohol, isopropyl alcohol, potassium hydroxide, propylene glycol (E1520), purified water, shellac, strong ammonia solution, titanium dioxide (E171).|
|Novavax (Nuvaxovid, Covovax)||Vaccine||Spike protein||Polysorbate 80||WHO interim approved. Not approved in the UK.||Note that polysorbate 80 is not listed as an adjuvant as such, but is included as an excipient (presumably for some other reason).||Paxlovid PF-07321332 (Nirmatrelvir) and ritonavir||Early‑onset treatment||Antiviral drugs (Two separate pills)||PEG, polysorbate 80, lactose||Approved||Also reacts badly with many other medications. Lactose is not discussed here, but is a well-known allergen.|
|Pfizer (BioNTech, Comirnaty)||Vaccine||mRNA||PEG2000||Approved and available||Not to be given to anybody with a history of allergies.|
|Sinopharm (Beijing)||Vaccine||Deactivated Covid virus||None that I know of||Approved for visitors but not for residents||Ingredients: inactivated antigen of SARS-CoV-2 WIV04, aluminium hydroxide, sodium chloride, disodium hydrogen phosphate, sodium dihydrogen phosphate, water.|
|Sinovac (Coronavac)||Vaccine||Deactivated Covid virus||None that I know of||Approved for visitors but not for residents||Ingredients: inactivated SARS-CoV-2 CZ02, aluminium hydroxide, disodium hydrogen phosphate, sodium dihydrogen phosphate, sodium chloride, water.|
|Sotrovimab||Early‑onset treatment||Antiviral drug (Intravenous)||Polysorbate 80||Approved and available|
|Sputnik V and Sputnik Light (Gam-COVID-Vac)||Vaccine||Viral vector||Polysorbate 80||Not approved in the UK, even for visitors||Sputnik Light is simply the first dose of Sputnik V, administered as a single-dose vaccine.|
|Veklury (remdesivir)||Early-onset treatment||Antifiral drug (Intravenous)||None that I know of||Approved (and available?)||Remdesivir (RNA polymerase inhibitor), betadex sulfobutyl ether sodium, USP, water. May also include hydrochloric acid and/or sodium hydroxide (for PH balance).|
A few years ago A. had begun suffering from what seemed like a sensitivity to sunlight. In summer, when they went out in the sun their face would increasingly turn red, swell and become painful. A. suspected their sunscreen and tried every brand in the shops but nothing helped. Some cosmetics also brought on itchy reactions and A. had to try different brands until they found one which was comfortable. One autumn, their annual flu jab caused their arm to swell up and become sore for a few days – it never had before.
At this point, A. received their first Covid jab, which at that time was AstraZeneca. They felt lousy and their arm was worse than before, and it lasted a week. After the second jab it was even worse and lasted a month. Then, a new tube of their favourite toothpaste caused their tongue to get sore, swell and even to split painfully.
It all seemed too much to be a coincidence. A. started looking for explanations on the Internet. Two common factors soon emerged: PEG and polysorbate. They were new wonder ingredients, being introduced into one product after another. They were even appearing in processed foods. Every one of those products she had tried turned out to contain one or other of these new wonder ingredients. Even her flu jab had been a new formula, only just introduced that year.
A. eventually persuaded their GP to refer them to an allergy specialist. Sensitivity to PEG was already under study, and the specialist also recognised the polysorbate sensitivity as something they had encountered often enough before to know the answer, at least for the sunscreen. They recommended an imported Australian brand called Blue Lizard (SPF 30+), which did not contain either chemical. It was expensive but it worked, and A. can at last go out in strong sunlight again. For the present topic, this highlights that polysorbate must be taken seriously as an allergen. Magnifying glass in hand to read the small print, they also changed their brand of toothpaste and, abandoning the big name retailers for cheap bargain shops, found safe cosmetics (presumably they were made so cheaply that the manufacturers didn't want to pay for additives).
A. is over 65 and therefore at high risk from Covid, so vaccinations and boosters are especially important for them. And presently it became time for their booster jab. Their reaction to PEG means that Pfizer and Modena are unsafe. The only other vaccine available in the UK is AstraZeneca, the one that had given them Covid arm. The best that A. could do was to take antihistamines against the swelling and suffer the consequences a dose of Polysorbate 80 in the AstraZeneca shot. Such reactions tend to increase as the patient becomes sensitised on each occasion, but what choice has a high-risk patient got? And indeed, A. turned out to be no exception. From mild arm swelling with the 'flu jab, through moderate to severe with the two Covid shots, now the booster caused their whole face, throat and tongue to swell and become painful. It was a struggle even to swallow the next antihistamine pill. A. was taken to hospital, where they were diagnosed with acute angioedema. A rare symptom of this is swelling around the heart as well, which can be lethal. Luckily, this had not happened, but A. was given a course of strong steroids to keep the swelling down. The problem with steroids is that they interfere with the action of the vaccine, making it less effective.
The next day A. came down with a sore throat and sniffle, every sign of a common cold. Was that all, coincidentally caught off someone in passing, or was it another reaction to the vaccine? Or, there was a third possibiity. AstraZeneca uses a viral vector, a live virus genetically modified to carry Covid markers. The vector virus is specially chosen to be almost harmless but, with their immune system suppressed by the steroids, might it be able to attack them worse than usual?
A. now faces a bleak future. With their booster reduced in effectiveness they are not only especially vulnerable, but are also relatively defenceless. Any future booster would cause more harm and danger that it could prevent, so there is no medical intervention that can help them any more. Their only hope lies in the new post-diagnostic treatments which, if taken soon enough after contracting Covid, can reduce the severity of the disease and the risks of permanent damage or death. But whoa there, cowboy! Even the latest intravenous drip is stuffed with Polysorbate 80. For A. that makes it intravenous death! They can only hope that if they do go down with Covid, they will be awake enough to catch the hospital doctors before they administer the lethal dose, and steer them onto the safer Molnupiravir pill.
The UK government's advice on such cases has been to contact your GP, who may refer you to an allergy specialist, or arrange a particular vaccine for you. But allergy specialists are in desperately short supply and (as A. and others have found to their cost) a GP's attitude to your case or their facilities for handling vaccines can vary widely. There is no other guidance or immediate action to make available safe vaccines for the vulnerable.
Nor is any significant clinical data available. Some specialists have been recording their own data based on their case notes, but this is fragmentary and uncoordinated. The vaccine manufacturers are of cource organising studies into the side effects of their own vaccines, but the extent to which allergies and similar reactions might be involved – and especially might be aggravated by repeat exposure – is not on their agendas; indeed, in the rush to market they tend to actively avoud testing their vaccines on known allergy sufferers.
In the desperate rush to roll out effective measures for the vast majority, in the face of ever-evolving new variants, it is inevitable that governments, researchers and manufacturers have no time or resources left for the marginal cases. That is understandable enough. Studies into allergic reactions are at least now under way, but will not be offering conclusions for some time, and action on those conclusions is even farther away.
However it means that, if you are already an allergy sufferer or are steadily becoming sensitised, then for now at least you are pretty much on your own. You have little more than this page of notes to help you through.
While A. is a rare case, casual conversations with those involved, such as the allergy specialist and various other frontline staff, have revealed an increasing awareness of such sensitivities in the wider population. Covid arm is, of course, already widespread and a growing issue. Coupled with the way in which these sensitivities will in some individuals worsen with repeated exposure to the allergen, there is clearly much cause for concern in the future. We must take A. not as an unusual rarity but as an indicator of what is to come for many of us.
I am not given to startling headlines when analysing complex health issues, but one conclusion stands out starkly:
THE ONLY ALLERGY-SAFE COVID MEDICATION IN THE UK IS THE MOLNUPIRAVIR POST-INFECTION PILL. THERE IS NO ALLERGY-SAFE COVID VACCINE AVAILABLE IN THE UK!
Note that even Molnupiravir is not without its side effects. It may be allergy-safe (as far as we know) but it still needs to be administered under specialist care.
A. spent days and days researching the Internet, calling NHS support lines and emailing those responsible. Many hours have been spent by NHS staff following up or escalating the issues raised, and responding or treating them as best they can. Many hours of NHS time have been spent on A. that should not have been necessary, including two ambulance visits to A&E. Had the information been available and the UK Government taken a few simple measures, this could easily have been avoided. Yes, they can easily do something about this, even if the full monty will take them years to work through. What we need right now is to:
The first three actions are especially easy to do; they could begin saving lives and releasing NHS staff to focus on their mainstream tasks, right now.
One substitute adjuvant for vaccines and intravenous medications might prove to be peptide SN50, according to new research by the University of Chicago Pritzker School of Molecular Engineering. See "New vaccine design reduces inflammation, enhances protection".
Meanwhile the truly desperate or the continuing traveller might consider visiting a country where Covaxin, Sinopharm or Sinovac is approved and available. However there can be no guarantee that these vaccines meet the UK's stringent clinical safety standards.