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Editorial
. 2021 Jun;9(6):2135-2138.
doi: 10.1016/j.jaip.2021.03.053. Epub 2021 Apr 15.

COVID-19 Vaccination in Patients with Reported Allergic Reactions: Updated Evidence and Suggested Approach

Aleena Banerji  1 , Anna R Wolfson  2 , Paige G Wickner  3 , Amelia S Cogan  4 , Aubree E McMahon  4 , Rebecca Saff  2 , Lacey B Robinson  2 , Elizabeth Phillips  5 , Kimberly G Blumenthal  6
Affiliations
Editorial

COVID-19 Vaccination in Patients with Reported Allergic Reactions: Updated Evidence and Suggested Approach

Aleena Banerji et al. J Allergy Clin Immunol Pract. 2021 Jun.
No abstract available

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Figures

Figure 1
Figure 1
Prevaccine high risk patients and dose 1 vaccination outcome (n = 16). Among the 16 individuals skin tested after risk stratification, only 1 individual was skin test positive (oral PEG severe allergic reaction, tolerated Janssen vaccine). Thirteen of the 15 skin test negative individuals tolerated the initial dose of COVID-19 vaccine. ∗Two skin test negative individuals are awaiting dose 1 of the COVID-19 vaccine: 1 employee with a history of severe allergic reaction to vaccine or injectable containing PEG/polysorbate and 1 employee with a history of severe allergic reaction to vaccine or injectable. †One employee experienced pruritus on lower back immediately after Pfizer dose 1 was given 10 mg cetirizine with complete resolution of symptoms in 30 minutes. Tolerated Pfizer dose 2 without any allergic symptoms.
Figure 2
Figure 2
Risk stratification pathways for COVID-19 vaccination in patients with possible PEG or polysorbate allergy. The primary role of the allergist is to enable patients to safely receive the first vaccine available to them. This may require allergist evaluation for PEG and/or polysorbate allergy depending on vaccine availability. Individuals with any history of anaphylaxis, per CDC guidance, would be monitored for 30 minutes after mRNA COVID-19 vaccination. Individuals without a PEG or polysorbate allergy are eligible to receive all COVID-19 vaccines and observation time would depend on which vaccine was being given and whether there was a previous history of anaphylaxis. Individuals with a polysorbate 80 only allergy would be further assessed by asking “Did you tolerate a polysorbate 80 vaccine after your initial reaction” to a polysorbate 80 injectable or vaccine. Individuals with PEG-only allergy are eligible to receive Janssen COVID-19 vaccine without allergy evaluation. ∗mRNA COVID-19 vaccines from Pfizer-BioNTech and Moderna. †See Table I. ‡Consider allergy evaluation of polysorbate allergy history if patient preference is for the Janssen vaccine and it is available. §Polysorbate allergy evaluation may be useful in guiding the future use of injectables and vaccines with polysorbate.
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Comment on

  • doi: 10.1016/j.jaip.2020.12.047

References

    1. Coronavirus Resource Center COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University & Medicine. https://coronavirus.jhu.edu/map.html Available from:
    1. Banerji A., Wickner P.G., Saff R., Stone C.A., Jr., Robinson L.B., Long A.A., et al. mRNA vaccines to prevent COVID-19 disease and reported allergic reactions: current evidence and suggested approach. J Allergy Clin Immunol Pract. 2020;9:1423–1437. - PMC - PubMed
    1. Centers for Disease Control and Prevention COVID-19 vaccinations in the United States. https://covid.cdc.gov/covid-data-tracker/#vaccinations Available from:
    1. Gee J., Marquez P., Su J., Calvert G.M., Liu R., Myers T., et al. First month of COVID-19 vaccine safety monitoring— United States, December 14, 2020-January 13, 2021. MMWR Morb Mortal Wkly Rep. 2021;70:283–288. - PMC - PubMed
    1. CDC COVID-19 Response Team; Food and Drug Administration Allergic reactions including anaphylaxis after receipt of the first dose of Pfizer-BioNTech COVID-19 vaccine—United States, December 14-23, 2020. MMWR Morb Mortal Wkly Rep. 2021;70:46–51. - PMC - PubMed

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