Anaphylaxis to the first dose of mRNA SARS‐CoV‐2 vaccines: Don't give up on the second dose!

Krantz, Matthew S.; Bruusgaard‐Mouritsen, Maria A.; Koo, Grace; Phillips, Elizabeth; Stone, Cosby A.; Garvey, Lene Heise

doi:10.1111/all.14958

Cited by 61 publications

(77 citation statements)

References 4 publications

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“…However, many cases of successful revaccination of the second dose with the same platform after experiencing an immediate hypersensitivity reaction to the first dose have been reported. [17][18][19][20][21] We provide the recommendation for individuals with anaphylactic reactions to the CoronaVac COVID19 vaccine, summarized in Figure 2.…”

Section: Discussionmentioning

confidence: 99%

CoronaVac COVID-19 Vaccine-Induced Anaphylaxis: Clinical Characteristics and Revaccination Outcomes

Laisuan¹,

Wongsa²,

Chiewchalermsri³

et al. 2021

JAA

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Section: Discussionmentioning

confidence: 99%

CoronaVac COVID-19 Vaccine-Induced Anaphylaxis: Clinical Characteristics and Revaccination Outcomes

Laisuan¹,

Wongsa²,

Chiewchalermsri³

et al. 2021

JAA

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“…17 We were able to successfully revaccinate the vast majority of patients, including the patients from Brighton level 2 through 3, indicating, that the majority of patients with reported severe reactions, did not had a true allergic reaction, which is in line with recently published data. 18 For example, tachycardia, flushing, and subjective transient respiratory symptoms may also be signs of anxiety.…”

Section: Past Medical Historymentioning

confidence: 99%

“…22 Similar differences have been obtained between the Brighton, Ring and Messmer, and NIAID/FAAN validated scales. 18 Maybe in the future both scoring systems should be applied for evaluating anaphylaxis to vaccines. The main take home message is however, that the value of diagnostic work up including interview and testing remains superior to written reports.…”

Section: Past Medical Historymentioning

confidence: 99%

Patients with suspected allergic reactions to COVID‐19 vaccines can be safely revaccinated after diagnostic work‐up

Rasmussen

Mørtz

Georgsen

et al. 2021

Clinical & Translational All

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Background: When initiating the Danish vaccination program against COVID-19, the incidence of anaphylaxis was estimated to be 10 times higher compared to other virus-based vaccines. In this study, we present data on patients referred with suspected allergic reactions to COVID-19 vaccines. The main purpose of the study is to investigate the incidence and severity of the allergic reactions, and to evaluate the safety of revaccination. Methods: All patients in the region of Southern Denmark with case histories of allergic reactions to COVID-19 vaccines in a defined period are included in this study. Diagnostic work up consisted of a detailed case history, evaluation of Brighton level of diagnostic certainty and World Allergy Organization grade of anaphylaxis and skin prick testing-and basophil histamine release testing with COVID-19 vaccines and relevant drug excipients. Patients were revaccinated at the Allergy Center when possible.Results: Sixty-one patients are included in this study. In 199,377 doses administered, nine patients fulfilled the criteria of anaphylaxis when using the Brighton Criteria (incidence being 45 per million). Of 55 patients with reactions to the first dose, 52 patients were revaccinated without adverse reactions. We found no proven cases of immediate anaphylaxis due to COVID-19 vaccines. By skin prick test, we diagnosed three patients with drug excipient allergy and further a patient with mastocytosis was found.Conclusions: Anaphylactic reactions to COVID-19 vaccines are rare and the incidence is similar to what is seen with other virus-based vaccines. Revaccination is safe in the majority of patients; however, allergological evaluation is important since some prove to have drug excipient allergy.

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“…In the event where a second vaccine is required and there is evidence of allergic sensitization, allergists may also proceed with a graded administration of the vaccine [ 37 ]. The decision to pretreat with antihistamines prior to repeat vaccination varies amongst allergists [ 38 , 39 ].…”

Section: Allergy Testing and Repeat Vaccination In Adults Suffering Immediate Allergic Reactions (<4 Hours) After Covid-19 Mrna Vaccinatimentioning

confidence: 99%

COVID-19 mRNA vaccine allergy

Risma

2021

Current Opinion in Pediatrics

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Purpose of review A known history of a severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine is the only contraindication to coronavirus disease 2019 (COVID-19) mRNA vaccination. It is important for pediatricians to understand the likelihood of an allergic reaction to COVID-19 mRNA vaccines, including its excipients. Recent findings Episodes concerning for anaphylaxis were immediately reported following early administration of COVID-19 mRNA vaccines to adults. Although allergic type symptoms were reported equally in recipients of placebos and test vaccines in phase 3 clinical trials, post-authorization prospective studies state that 0.2–2% of vaccine recipients have experienced allergic reactions. Subsequent allergy testing of affected individuals has focused largely on evaluation of allergic sensitization to a novel vaccine excipient, polyethylene glycol (PEG). PEG is a polymer incorporated in numerous pharmaceutical products because of its favorable, inert properties. The results of allergy testing in adults to date indicate that IgE mediated anaphylaxis to PEG allergy is rarely identified after COVID-19 mRNA vaccine reactions. Numerous individuals with presumed anaphylaxis have tolerated a second vaccine after evaluation and testing by an allergist, suggesting either misdiagnosis or a novel immune mechanism. Summary Confirmed anaphylactic reactions to COVID-19 mRNA vaccines are rare, likely due to a lack of preexisting IgE against the vaccine components, including PEG.

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Anaphylaxis to the first dose of mRNA SARS‐CoV‐2 vaccines: Don't give up on the second dose!

Cited by 61 publications

References 4 publications

CoronaVac COVID-19 Vaccine-Induced Anaphylaxis: Clinical Characteristics and Revaccination Outcomes

CoronaVac COVID-19 Vaccine-Induced Anaphylaxis: Clinical Characteristics and Revaccination Outcomes

Patients with suspected allergic reactions to COVID‐19 vaccines can be safely revaccinated after diagnostic work‐up

COVID-19 mRNA vaccine allergy

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