As several forms of the highly anticipated COVID-19 vaccine make their way into communities around the globe, the news is abuzz with updates — which, let’s face it, can sometimes be a bit overwhelming and confusing. Among hot topics are allergic reactions, leading to questions and concerns from many. However, “while anaphylaxis can occur after vaccination, it is very rare,” assures Stephanie Leonard, MD, director of the Rady Children’s Hospital-San Diego Food Allergy Center and an associate clinical professor for the Division of Allergy-Immunology-Rheumatology within the UC San Diego School of Medicine Department of Pediatrics.
To help put those considering the vaccine at ease and to support area health care providers through vaccine allergy education, Dr. Leonard and 11 fellow allergist-immunologists from UC San Diego Health, Sharp HealthCare, Kaiser Permanente and Naval Hospital Camp Pendleton have formed the San Diego COVID-19 Vaccine Allergy Group. “Our main objective is to be a resource for the county and our community when it comes to issues of possible allergy surrounding the mRNA COVID-19 vaccines,” explains Dr. Leonard. “The group started after news from the UK reported two severe allergic reactions (e.g., anaphylaxis) after administration of the mRNA COVID-19 vaccine when they started mass vaccinations. The UK Medicines and Healthcare Products Regulatory Agency recommended that ‘Any person with a history of anaphylaxis to a vaccine, medicine or food should not receive the Pfizer-BioNTech vaccine.’ This was misleading since there are no food or latex allergens in the vaccines. In addition, the vaccines are not contraindicated in people with a history of allergy to oral medication. There are precautions for people who have a history of allergy to other vaccines and injectable medication, but even most of these people can still get the vaccine safely with additional monitoring.”
Dr. Leonard notes that unless individuals had an immediate allergic reaction to a prior COVID-19 vaccine or one of its components, those with a history of anaphylaxis — including to other vaccines or similar medications — can still receive a COVID-19 shot and be monitored afterward for 30 minutes rather than the standard 15 minutes, based on Centers for Disease Control and Prevention guidelines. “Allergic symptoms may include hives, swelling, throat tightness, shortness of breath, cough, wheeze, dizziness or feeling faint, vomiting, or diarrhea occurring within four hours of vaccine administration,” she says. “Abnormally fast heart rate or abnormally low blood pressure may also be present. Those who have developed immediate allergic symptoms within 4 hours of the vaccines should seek immediate medical attention. These people should not receive a second dose and we recommend that they consult an allergist-immunologist.
“It is important to distinguish allergic symptoms from common side effects, such as fever, body aches, chills and headache that may occur in the first few days of a vaccine,” she continues, “as well as from delayed local symptoms such as pain, redness and swelling at the vaccine injection site. These side effects may be uncomfortable, but they typically go away within a few days and are not expected to be dangerous or life-threatening. These symptoms tell us that the vaccine is working and that the immune system is learning how to protect you from to the virus that causes COVID-19. People who develop these common side effects or delayed local symptoms … can safely receive a second dose.”
The San Diego COVID-19 Vaccine Allergy Group has partnered with the San Diego County Medical Society and the San Diego County COVID Vaccine Advisory Workgroup for physician and nurse education outreach, and is also acting as a consultant to the Western States Scientific Safety Review Workgroup, which brings experts from California, Oregon, Washington and Nevada together to evaluate the safety and viability of emerging vaccine options. Highlighting the importance of preparing health care professionals for any allergic reactions that may arise, Dr. Leonard and her colleagues “have developed clinical pathways adapted from CDC guidelines to help … screen potential COVID-19 vaccine recipients for contraindications and precautions, as well as determine is someone who develops symptoms after the first dose of an mRNA COVID-19 vaccine can receive the second dose. Second doses are important because the 94 to 95% efficacy results come after the second dose,” she emphasizes.
In short, the group aims for readiness and peace of mind. “We want to put the reports of allergic reactions after COVID-19 vaccines that people hear about in the news into context and reassure the public. Currently, the CDC is reporting that between 2.8 and 5.0 cases of anaphylaxis have been reported for every million doses of mRNA COVID-19 vaccines given. That means that more than 99.9999% of people receiving an mRNA COVID vaccine do not develop anaphylaxis,” Dr. Leonard explains. “Currently, there has been no death directly associated to receiving the COVID-19 vaccine. We want to provide reassurance that the vaccine is safe and that there are procedures in place to screen, monitor and treat the small group of people who may develop allergic symptoms.”
For those who still have concerns related to their own allergies or those of a loved one, Dr. Leonard advises speaking with their health care provider or allergist. She also encourages vaccine recipients to participate in the CDC’s V-safe program, which allows the public to easily track; report; and, in some cases, get direct follow-up for; related symptoms and side effects. “The vaccine is part of our fight against this pandemic,” she says. “We encourage people to get the vaccine when it becomes available to them because it is safe, effective and saves lives — not only their own lives but those of their loved ones around them. The potential risks of receiving the vaccines are far lower than the risk of getting sick with COVID-19.”