At Grand Rapids Allergy, we are encouraged by the availability of the COVID-19 vaccine for adolescents age 12 and older. We recognize that you may have questions. It is always appropriate to consult with a primary care provider/pediatrician about vaccine questions as they should have your most complete health history and current health status. People with a known history of a severe allergic reaction to any component of the COVID-19 vaccine should not get the vaccine. People with a history of reactions to other vaccines/vaccine components or injectable medications should use caution and are encouraged to consult with an allergist to discuss potential risk. Those who have allergies (such as allergies to pollen/mold/pets, food, venom, latex, and non-injectable drugs) are not considered more likely to have an allergic reaction to the vaccine than the general public. An appointment with a provider is an appropriate next step if there are additional questions or need documentation authorizing vaccination. We have linked online resources about the vaccine program and benefits of being vaccinated.
We advise 24-48 hours before or after COVID vaccination to have your routine immunotherapy dose. However, there may be exceptions to this guidance and we welcome a visit to review your individual situation. Side effects for the coronavirus vaccine may be more frequent than influenza vaccine and other vaccines. A longer period between vaccine and allergy immunotherapy is suggested until more data is available.
Below is an updated statement by the American College of Allergy, Asthma, and Immunology (ACAAI) that addresses other common concerns. Previous statements are available on our site. Here is a link with information about safety, efficacy and vaccine administration from the American Academy of Pediatrics (AAP).
Guidance now includes information on the adenovirus vector Johnson & Johnson vaccine
UPDATED: April 26, 2021
The American College of Allergy, Asthma and Immunology (ACAAI) COVID-19 Vaccine Task Force continues to closely monitor information from sources reporting on allergic reactions to the COVID-19 vaccines. As such, ACAAI has updated its guidance to reflect the most recent recommendations from the CDC and the FDA.
Reactions to vaccines, in general, are rare with the occurrence of anaphylaxis estimated at 1.31 in 1 million doses given. Subsequent to the FDA emergency use authorization of the mRNA-based Pfizer-BioNTech COVID-19 vaccine on Dec. 11, 2020, and the Moderna vaccine on Dec. 18, 2020, anaphylaxis rates as of Jan. 29, 2021 are reported by the CDC to be five per million with Pfizer-BioNTech and 2.5 per million with Moderna. The anaphylaxis rate for the Johnson & Johnson COVID-19 vaccine has not been reported.
The ACAAI COVID-19 Vaccine Task Force recommends the following guidance related to risk of an allergic reaction on vaccination.
These recommendations are based on best knowledge to date but could change at any time, pending new information and further guidance from the FDA, CDC.
Patients with allergic reactions to PEG should not be immunized with the mRNA COVID-19 vaccines. Consideration may be given to vaccination with adenovirus vector COVID-19 vaccine.
The CDC recommends that the adenovirus vector vaccine may be an option instead of a second dose of an mRNA vaccine for patients who had an adverse reaction to the mRNA product. People who have received one mRNA COVID-19 vaccine dose but for whom the second dose is contraindicated should wait at least 28 days after the mRNA vaccine dose to receive the adenovirus vector COVID-19 vaccine. These patients should have the vaccine in a setting able to treat anaphylaxis and observed a minimum of 30 minutes after the injection.
In patients with a contraindication to adenovirus vector COVID-19 vaccine (including due to a known polysorbate allergy), there should be consideration of administering the mRNA COVID-19 vaccination.
Per CDC guidance, polysorbate allergy is no longer a contraindication to mRNA COVID-19 vaccination, it is a precaution. However, because of potential cross-reactive hypersensitivity between ingredients in mRNA and adenovirus vector COVID-19 vaccines, consultation with an allergist-immunologist should be considered to help determine if the patient can safely receive vaccination.If the mRNA vaccine is given in a patient with polysorbate allergy, it should be done in a setting able to treat anaphylaxis and the patient observed a minimum of 30 minutes after the injection.
Banerji A, Wickner PG, Saff R, Stone CA Jr, Robinson LB, Long AA, Wolfson AR, Williams P, Khan DA, Phillips E, Blumenthal KG, mRNA Vaccines to Prevent COVID-19 Disease and Reported Allergic Reactions: Current Evidence and Suggested Approach, The Journal of Allergy and Clinical Immunology: In Practice (2021)
CDC: Information about COVID-19 Vaccines for People with Allergies
CDC: What to Do if You Have an Allergic Reaction After Getting A COVID-19 Vaccine
McNeil MM, Weintraub ES, Duffy J, et al. Risk of anaphylaxis after vaccination in children and adults. J Allergy Clin Immunol. 2016; 137(3):868-878.
Dreskin et al. International Consensus (ICON): allergic reactions to vaccines. World Allergy Organization Journal 2016; 9:32.
Wylon, K., Dölle, S. & Worm, M. Polyethylene glycol as a cause of anaphylaxis. J Allergy Asthma Clin Immunol. 12, 67 (2016).
Stone CA, Liu Y, et al. Immediate Hypersensitivity to Polyethylene Glycols and Polysorbates: More Common Than We Have Recognized. J Allergy Clin Immunol Pract. 2019; 7(5): 1533–1540.
Insights from American College of Allergy, Asthma and Immunology COVID-19 Vaccine Task Force: Allergic Reactions to mRNA SARS-COV-2 Vaccines. Annals of Allergy, Asthma & Immunology, January 2021.