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COVID-19 vaccine-related presumed allergic reactions and second dose administration by using a two-step graded protocol.
Patel, Gayatri B; Chhiba, Krishan D; Chen, Michael M; Guo, Amina; Watts, Melissa M; Cullen, Jane; Bochner, Bruce S; Grammer, Leslie C; Greenberger, Paul A; Saltoun, Carol A; Stevens, Whitney W; Kuang, Fei Li; Peters, Anju T.
  • Patel GB; From the Division of Allergy and Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and.
  • Chhiba KD; From the Division of Allergy and Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and.
  • Chen MM; From the Division of Allergy and Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and.
  • Guo A; From the Division of Allergy and Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and.
  • Watts MM; From the Division of Allergy and Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and.
  • Cullen J; Occupational Medicine, Northwestern Memorial Hospital, Chicago, Illinois.
  • Bochner BS; From the Division of Allergy and Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and.
  • Grammer LC; From the Division of Allergy and Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and.
  • Greenberger PA; From the Division of Allergy and Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and.
  • Saltoun CA; From the Division of Allergy and Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and.
  • Stevens WW; From the Division of Allergy and Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and.
  • Kuang FL; From the Division of Allergy and Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and.
Allergy Asthma Proc ; 42(6): 515-521, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-1607107
ABSTRACT

Background:

Acute allergic reactions to messenger RNA (mRNA) vaccines are rare but may limit public health immunization efforts.

Objectives:

To characterize suspected allergic reactions to the first dose of coronavirus disease 2019 (COVID-19) mRNA vaccine and to assess the safety and utility of a two-step graded-dose protocol for the second dose of the Pfizer-BioNTech vaccine in patients with a history of low suspicion of anaphylaxis to their first dose.

Methods:

This was a retrospective evaluation of referrals to the allergy and immunology clinic for a presumed allergic reaction to the first dose of the COVID-19 mRNA vaccine (Pfizer-BioNTech or Moderna) between December 17, 2020, and February 28, 2021. Recommendations for the second dose and outcomes were evaluated by trained board-certified allergists.

Results:

Seventy-seven patients presented with a Pfizer-BioNTech reaction (56 [72.7%]) or with a Moderna reaction (21 [27.3%]). Most patients (69.7%) had symptom onset within 4 hours. Most commonly reported symptoms were cutaneous (51.9%), cardiovascular (48.1%), and respiratory (33.8%) symptoms. Recommendations included to proceed with the single dose (70.1%), two-step graded dose (19.5%), or deferral (10.4%). Twelve of 15 patients completed the second dose with a graded-dose protocol. Of these patients, five reported at least one or more similar symptoms as experienced with their first dose.

Conclusion:

Of the patients with presumed allergic reactions to their first dose of COVID-19 mRNA vaccine, most were able to safely receive the second dose. For those with a low suspicion of anaphylaxis, the two-step graded protocol with the Pfizer-BioNTech vaccine was well tolerated. A graded-dose protocol could be an effective strategy for second-dose vaccination in those who may otherwise defer the second dose.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Vaccines, Synthetic / COVID-19 Vaccines / COVID-19 / Hypersensitivity / Anaphylaxis Type of study: Experimental Studies / Observational study / Prognostic study Topics: Vaccines Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Allergy Asthma Proc Journal subject: Allergy and Immunology Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Vaccines, Synthetic / COVID-19 Vaccines / COVID-19 / Hypersensitivity / Anaphylaxis Type of study: Experimental Studies / Observational study / Prognostic study Topics: Vaccines Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: English Journal: Allergy Asthma Proc Journal subject: Allergy and Immunology Year: 2021 Document Type: Article