COVID-19 Vaccines and Allergies

Provided by: Roger Friedman, MD and Philip Rancitelli, MD (Allergist / Immunologist)

The recent FDA emergency use authorization of two mRNA COVID-19 vaccines (Pfizer-BioNTech and Moderna) has increased optimism that an end to the pandemic is within reach.  However, reports of anaphylactic reactions following vaccine administration have caused concern, especially among allergy sufferers.

Significant reactions to vaccines in general are very rare.  The incidence of anaphylaxis, the most severe type of allergic reaction, is estimated to occur in 1.31 per 1 million doses.  Thus far, there have only been a handful of apparent severe allergic reactions reported following COVID vaccination among the millions of doses already administered.

This is a rapidly evolving issue that the Food and Drug Administration (FDA), the Centers for Disease Control (CDC), the American Academy of Allergy, Asthma, and Immunology (AAAAI), and the American College of Allergy, Asthma, and Immunology (ACAAI) are following very closely.  The CDC recently issued the following guidance with regards to the mRNA COVID-19 vaccines and allergic reactions:

  • Do not get the COVID-19 vaccine if you have experienced a severe reaction to one of its ingredients. The cause of apparent allergic reactions hasn’t been confirmed, but the leading candidate is polyethylene glycol (PEG).
  • If you’ve had a severe allergic reaction to another vaccine or injectable therapy, you should discuss with your doctor if you should get the COVID-19 vaccine. Most likely, you’ll still be able to get vaccinated.
  • You CAN be vaccinated if you have a history of:
    • Severe allergic reactions to foods, venom, latex, or environmental allergens (pets, pollen, dust, mold, etc.)
    • Allergies to oral medications
    • Family members who have had severe allergic reactions
    • Milder reactions (not anaphylaxis) to vaccines.
  • If you have a severe allergic reaction to the first dose of the COVID-19 vaccine, you should not get the second dose.

A good way to assess your risk is to answer the following questions:

  1. Do you have a history of a severe allergic reaction to an injectable medication (intravenous, intramuscular, or subcutaneous)?
  2. Do you have a history of a severe allergic reaction to a prior vaccine?
  3. Do you have a history of a severe allergic reaction to another allergen (food, venom, or latex)?
  4. Do you have a history of a severe allergic reaction to polyethylene glycol (PEG), a polysorbate or polyoxyl 35 castor oil (paclitaxel) containing injectable or vaccine?

If you answer “no” to all four questions, you would be labeled “low risk” and can receive the vaccine with a 15-minute observation period.

If you answer “yes” to question #1, #2, or #3, you would be labeled as “medium risk” and can receive the vaccine with a 30-minute observation period.  However, if you answer “yes” to either #1 or #2, it should first be verified that the product in question did not contain PEG, polysorbate or polyoxyl 35.

If the answer to #4 is “yes”, you are considered “high risk” and should consult with a board certified allergist-immunologist prior to getting the vaccine.

These two COVID-19 vaccines appear to be very safe and effective, but keep in mind that all vaccines have the potential to cause side effects.  Rest assured that vaccine providers have been advised by the CDC to have certain safeguards in place to protect you.

  • You should be prepared to be monitored following vaccination (up to 30 minutes).
  • Vaccination providers will be equipped with appropriately trained staff and emergency medications (including epinephrine) to address potential allergic reactions.
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