Coronovirus disease 2019 (COVID-19) has been rampaging across the globe for almost 2 years and completely altered how everyone is living their lives. Fortunately, we now have three vaccines in America available for everyone older than 12, and the Pfizer-BioNTech vaccine has full FDA approval for everyone over 16. However, there is a lot of confusion and misinformation about the vaccines and who can receive them.
The vaccines have been widely administered and found to be safe with already millions of shots administered globally. The vaccine's most common side effects are pain, redness, and swelling in the injection area as well as other fatigue, nausea, and chills. Allergic reactions have been reported post vaccine but are exceedingly rare. There have been no vaccine-related anaphylaxis deaths from COVID to date. (source) In addition, the reactions generally self resolve, and second doses after the initial doses are also well tolerated.
The only current contraindications (reasons to not get the vaccine) from the CDC are the following: 1. Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a component of the COVID-19 vaccine. 2. Immediate allergic reaction of any severity to a previous dose or known (diagnosed) allergy to a component of the vaccine. (from the CDC)
A recent review article by Banerji et al provided current evidence and guidelines on evaluation and management of possible allergic reactions to COVID vaccines. The following tables regarding risk assessment and management steps taken directly from the article.
The patient is stratified as high, medium, or low risk based on responses to the following questions:
- Have you had severe allergic reactions to injectable medications?
- Have you had severe allergic reactions to prior vaccine
- Have you had severe allergic reactions another allergen like food, venom, etc.
- Do you have a history of an immediate (<4 hr) or severe allergic reaction to polyethylene gylcol, a polysorbate, or polyoxyl 35 castor oil (eg paclitaxel) containing injectable or vaccine?
If the answer is NO to all questions, the patient can receive their vaccine with a standard 15 minute wait for observation. If the answer is yes to questions 1 through 3, then they can receive the vaccine with a 30 minute observation time unless they did have a reaction to vaccine or one of the ingredients. If question 4 is a yes, they are considered high risk and should be evaluated by an allergist for further evaluation and possible skin testing.
It is also important to note that the questions ask if there were allergic reactions. This reaction should be confirmed with a doctor as many reactions may not actually be from an allergic cause.
Skin testing entails taking items that have polyethyelene glycol (like the laxative Miralax) and polysorbate-80 (like Refresh eye drops) and poking the skin with them. If skin testing is negative, small amounts of the item are injected intradermally (like a TB test) to observe for reaction. If that is also negative, the vaccine can be administered with a 30 minute period of observation.
If testing is reactive to polyethyelene glycol, you should not get an mRNA vaccine (Pfizer-BioNTech or Moderna). If polysorbate-80 causes a reaction, you should not receive the Johnson and Johnson/Janssen vaccine.
The majority of patients that qualify for any of the vaccines should be able to receive one safely. Side effects may still occur, even if you don't have an allergic reaction but are generally manageable. Please consult your doctor if you have more concerns about receiving the vaccine.