The major part of the program today is allergic reactions to the COVID-19 vaccines
yes there are reactions yes there have been some serious reactions
get the facts before you make a decision not to take this vaccine I've got a couple of people
in my family for example one is the person who's got severe food allergies tree nut allergies the
other is a person who's had significant allergies to vaccines before the first one was really not
that much of a conversation he understood he took his Auvi-Q it's like Epipen he'll take that with him
when he goes to get his vaccination the other one again was a little bit dicier it's a family member
that's had problems with tetanus vaccines in the past we looked it up we focused on that for a
little bit I researched a few things about it and you'll see why that was more of a concern at the
end of the day she didn't didn't have an Apipen and Auvi-Q but we ordered her one and she's
going to go ahead and get the vaccine now here's the focus on those vaccine reactions in vaccine
trials Pfizer and Moderna excluded participants with a history of an allergic reaction to any
components of the COVID vaccine Pfizer also excluded participants with a history of severe
allergy associated with any vaccine so that's the second family member that I was just talking about
on December 11th the FDA issued an EUA emergency use authorization for Pfizer the Pfizer vaccine
on December 14th general vaccination of health care started on December 15 one day later a 32-
year-old female health care worker in Alaska who had known allergies presented with an anaphylactic
reaction within 10 minutes after the first dose severe cases of anaphylaxis have been reported
in the US after vaccinating 2 million health care workers the CDC has then recommended the exclusion
of any person who has a history of a severe or immediate allergic reaction associated with any of
the vaccine components and that if you go back to my original story about my family member that was
the difference it's not somebody with immediate or severe reactions to any vaccine it's the vaccine
components of this vaccine there's a specific chemical that we'll talk about in just a second
that appears to be the agent that's causing this the offending agent it's called here's
the technical name polyethylene glycol or PEG for short PEG so let's talk a little bit more about
that if you're wondering again where some of this information is coming from this was an article in
the review article in the New England Journal very recently just over the past week about this topic
now what is anaphylaxis anaphylaxis is a severe reaction it can kill you there are no permanent
problems with it if you are saved getting through that and this the way to save a patient that
has that problem is fairly simple epinephrine that's why we talked about having that Epipen
or Auvi-Q available for both of these individuals what's the problem what does it cost well it's
a serious multi-system reaction it's got rapid onset you start getting this flushing your skin
turns red you get laryngeal edema that means the larynx the major airway to your lungs can close up
as it swells that's what causes the immediate life-threatening component most everything else
hypotension low blood pressure that can cause a little bit of a serious problem
cardiovascular collapse those occasionally can cause the problem but the big problem with
anaphylaxis is closing the airway epinephrine opens it right back up again you get other things
wheezing nausea vomiting fast heartbeat again but the big issue is closing that airway the cause is
activation of mast cells part of the immune system through the antigen binding and cross linking with
one of the immunoglobulin families igE or antibody family family IgE this requires prompt attention
and treatment with epinephrine to halt the rapid progression of the life-threatening symptoms
anaphylaxis is a treatable condition with no permanent effects nevertheless news of allergic
reactions have raised fear about the risks of the new COVID vaccine acute allergic reactions caused
by an antigen the dead or weakened bacteria the foreign body that's what antigen means
or excipient now excipient I mentioned a few minutes ago that I was going to talk about what
the chemical was in there again that polyethylene glycol first of all what isn't an excipient
anyway so before we cover excipients let's talk about anaphylaxis with previous vaccines
historically anaphylaxis with previous vaccines has been more associated with the inactivated
components like egg the gelatin latex you know we used to make vaccines by putting in inoculating
eggs with the virus the virus would go through make a bunch of the antigen that we wanted so you
had gelatin in there you had latex in there you had most of all egg products so people with egg
allergies couldn't take those vaccines now this is more of an excipient what's that an excipient it's
another ingredient found in very small amounts in a vaccine excipients are often preservatives
james and I were talking about this the reactions a couple of months ago and I was thinking what is
that preservative that is often related to vaccine anaphylaxis thimerosal was the preservative I was
trying to think of and again thimerosal is not the problem with the COVID vaccine it's PEG adjuvants
now what's an adjuvant an adjuvant is a small amount of a chemical that inflates or magnifies
the immune response to the antigen to the foreign body aluminum salts are an example and if you've
taken the new herpes virus vaccine the one for older individuals that one has a lot of adjuvants
that's why people tend to get sicker with that vaccine stabilizers now stabilizers will keep the
vaccine potent during transportation and storage for example sugars or gelatins cell culture
materials used to grow the vaccine antigens like I talked about the egg protein and ingredients
used to kill viruses or inactivate toxins for example formaldehyde so those are the sort of
things that you'll see as excipients you just you're going to find some of those in there still
after the production method Pfizer and Moderna vaccines use a lipid or fat/oil-based
nanoparticle meaning a very tiny particle smaller than microscopic it's a particle carrier system
to prevent the rapid degradation of the messenger RNA and facilitate in vitro delivery this system's
further stabilized by a PEG 2000 lipid conjugate now wait a minute let's break that down what
does that mean PEG again is polyethylene glycol now never heard of that it's in it's all over
most of us are routinely exposed to a lot of household products that include polyethylene
glycols they're used as thickeners softeners moisture carrying agents penetration enhancers
surfactants we won't go into definitions on that widespread in household products from skincare to
cosmetics to baby wipes to cleaners PEGs were long thought to be biologically inert but there are
some pieces of evidence that suggests that maybe not so inert health concerns for PEG contamination
of ethylene oxide and 1,4-dioxane both are have some carcinogenic or cancer-causing components
both compounds are not intentionally added as ingredients to any of these household products
I'm actually if you look at this slide this slide is mostly talking about polyethylene glycol it's
not so much talking about the COVID-19 vaccines is talking about PEG in use in things like
Miralax PEGs are penetration enhancers when PEGs are in formulations containing toxic ingredients
those ingredients could penetrate the skin more readily in a 2016 study as much as 72 percent have
some antibodies to PEGs presumably as a result of exposure through cosmetics pharmaceuticals
etc and about seven percent have a high enough level to trigger potential anaphylaxis reactions
so those are the folks that we worry about in terms of these vaccines PEG is used as an
excipient in medications including the Pfizer and Moderna vaccines it's been implicated in a rare
hidden danger cause of IgE-mediated reactions in recurrent anaphylaxis the risk of sensitization
appears to be higher with the higher molecular weight PEGs you know pegs are a classification
of different types of molecules the higher the number bigger the molecular weight the more likely
there appears to be some ability to sensitize anaphylaxis has been associated with bowel prep
containing PEG 3350 to PEG 4000 it's been noted in case reports again it's not been seen
with much regularity it's just case reports for drugs with PEG 3350 like methyl prednisolone or
injectable steroids it appears that the PEG component is more likely than the active drug
to be the cause of the anaphylaxis and again steroids are usually given to reverse anaphylaxis
a patient developed anaphylaxis when first exposed to a PEGLip 5000 ECG contrast which is labeled
with a warning about immediate hypersensitivity reactions while there are already reports of
anaphylaxis with the Pfizer vaccine the risk of anaphylaxis with the Moderna vaccine has it's
still been rare enough to not have a good number on it yet both Pfizer and Moderna vaccines use PEG
2000 but the two vaccines have different mixtures on this implications for vaccines with adenovirus
and protein subunits which is commonly based on polysorbate 80 are currently unknown polysorbate
80 and PEG have a similar structure and again those are vaccines that are coming down the pike
haven't been authorized yet but they have a slightly different set of excipients so what to do
here's the thing I go back to the discussions I had with my own family members that had allergies
first of all for all of us understanding these issues is important in terms of deciding about
the vaccine you know at the end of the day there's some pick your poison component to this
if there were no such thing as coronavirus why get the vaccine you wouldn't need to
but there is a coronavirus out there and here's the thing over the next few months I don't know
if it's six months or 18 months but they're going to be very few people that don't get
exposure to that spike protein on the outside of the coronavirus here's where the pick your
poison comes in when you get your exposure to that spiked protein do you want it to be
associated with live virus or do you want it to be associated with the vaccine that's your choice
continue to get great feedback regarding the webinars and here's why you know on the
internet when you hear a webinar you expect for somebody to try to sell you something
we're not doing that we're trying to tell you something people are coming in with their labs
from Quest inflammation panel OGTT insulin survey response and then they're finding out do I have
inflammation do I have insulin resistance and where does that fit in terms of other folks
we're getting ready to start one for CIMT as well so again people are really
excited about finding out their own status looking forward to seeing you there thanks