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Observational Study
. 2021 Oct 1;4(10):e2131034.
doi: 10.1001/jamanetworkopen.2021.31034.

Association of Self-reported High-Risk Allergy History With Allergy Symptoms After COVID-19 Vaccination

Lily Li  1   2 , Lacey B Robinson  2   3   4 , Rajesh Patel  2   5 , Adam B Landman  2   6 , Xiaoqing Fu  3   4 , Erica S Shenoy  2   7 , Dean M Hashimoto  2   8 , Aleena Banerji  2   3 , Paige G Wickner  1   2 , Upeka Samarakoon  3   4 , Christian M Mancini  3   4 , Yuqing Zhang  2   3   4 , Kimberly G Blumenthal  2   3   4
Affiliations
Observational Study

Association of Self-reported High-Risk Allergy History With Allergy Symptoms After COVID-19 Vaccination

Lily Li et al. JAMA Netw Open. .

Abstract

Importance: Allergic history in individuals with confirmed anaphylaxis to a messenger RNA (mRNA) COVID-19 vaccine is common. However, the risk factors for allergy symptoms after receiving the vaccine are unknown.

Objective: To assess the association between self-reported history of high-risk allergy and self-reported allergic reactions after mRNA COVID-19 vaccination of health care employees.

Design, setting, and participants: This cohort study obtained demographic, medical, and vaccine administration data of employees of Mass General Brigham from the institutional electronic health record. Employees who received at least 1 dose of an mRNA COVID-19 vaccine between December 14, 2020, and February 1, 2021, and who completed at least 1 postvaccination symptom survey in the 3 days after vaccination were included.

Exposures: Self-reported history of high-risk allergy, defined as a previous severe allergic reaction to a vaccine, an injectable medication, or other allergen.

Main outcomes and measures: The primary outcome was 1 or more self-reported allergic reactions in the first 3 days after dose 1 or dose 2 of an mRNA COVID-19 vaccine. Multivariable log binomial regression was used to assess the association between allergic reactions and high-risk allergy status.

Results: A total of 52 998 health care employees (mean [SD] age, 42 [14] years; 38 167 women [72.0%]) were included in the cohort, of whom 51 706 (97.6%) received 2 doses of an mRNA COVID-19 vaccine and 474 (0.9%) reported a history of high-risk allergy. Individuals with vs without a history of high-risk allergy reported more allergic reactions after receiving dose 1 or 2 of the vaccine (11.6% [n = 55] vs 4.7% [n = 2461]). In the adjusted model, a history of high-risk allergy was associated with an increased risk of allergic reactions (adjusted relative risk [aRR], 2.46; 95% CI, 1.92-3.16), with risk being highest for hives (aRR, 3.81; 95% CI, 2.33-6.22) and angioedema (aRR, 4.36; 95% CI, 2.52-7.54).

Conclusions and relevance: This cohort study found that self-reported history of high-risk allergy was associated with an increased risk of self-reported allergic reactions within 3 days of mRNA COVID-19 vaccination. However, reported allergy symptoms did not impede the completion of the 2-dose vaccine protocol among a cohort of eligible health care employees, supporting the overall safety of mRNA COVID-19 vaccine.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Robinson reported receiving personal fees from Viatris outside the submitted work. Dr Landman reported receiving personal fees from Abbott (as a former member of the Abbott Medical Device Cybersecurity Council) outside the submitted work. Dr Shenoy reported receiving personal fees from Vertex Pharmaceuticals outside the submitted work. Dr Hashimoto reported serving as the chief medical officer of the Workplace Health and Wellness Division at Mass General Brigham. Dr Wickner reported being an employee at CVS Health and Brigham and Women's Hospital. No other disclosures were reported.

Figures

Figure.
Figure.. Study Cohort
A total of 140 individuals reported a severe reaction after messenger RNA vaccination, including 10 individuals with reactions to both doses.
See this image and copyright information in PMC

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