Updated advice for safe COVID-19 vaccination in people with high-risk allergy histories

"Our main goal is to enable as many individuals as possible to receive a COVID-19 vaccine safely and avoid unnecessary vaccine hesitancy due to a lack of knowledge around allergic reactions to vaccines," says lead author Aleena Banerji, MD, clinical director of the Allergy and Clinical Immunology Unit at MGH.

In addition to updated guidance on the Pfizer-BioNTech and Moderna COVID-19 vaccines, this guidance also includes the Janssen COVID-19 vaccine, which had not yet been authorized for emergency use at the end of 2020.

With additional clinical data and authorization of the third COVID-19 vaccine in the United States, the investigators propose modified approaches to the evaluation of patients with a history of allergies. This includes clear and simple initial questions to identify individuals who are eligible for all COVID-19 vaccines without needing an allergist evaluation.

"With more time and experience, we have been able to significantly narrow the group of patients with prior allergies who require an allergist assessment before COVID-19 vaccination," says senior author Kimberly G. Blumenthal, MD, MSc, co-director of the Clinical Epidemiology Program within MGH's Division of Rheumatology, Allergy and Immunology. "We now advise that only the rare individuals who have had a recent severe allergic reaction to polyethylene glycol, an ingredient in the vaccines, see an allergist or immunologist for evaluation, which may include skin testing." Individuals with severe allergies to foods, oral drugs, latex, bee stings or venom can safely receive the COVID-19 vaccines.

The team noted that severe allergic reactions to the vaccines remain exceedingly rare. Vaccine clinics should continue to observe higher-risk individuals for 30 minutes after vaccination, and they should have staff trained in recognizing and managing allergic reactions that may occur.