COVID-19 vaccine-related presumed allergic reactions and second dose administration by using a two-step graded protocol

Gayatri B. Patel; Krishan D. Chhiba; Michael M. Chen; Amina Guo; Melissa M. Watts; Jane Cullen; Bruce S. Bochner; Leslie C. Grammer; Paul A. Greenberger; Carol A. Saltoun; Whitney W. Stevens; Fei Li Kuang; Anju T. Peters

doi:10.2500/aap.2021.42.210075

COVID-19 vaccine-related presumed allergic reactions and second dose administration by using a two-step graded protocol

Gayatri B. Patel, Krishan D. Chhiba, Michael M. Chen, Amina Guo, Melissa M. Watts, Jane Cullen, Bruce S. Bochner, Leslie C. Grammer, Paul A. Greenberger, Carol A. Saltoun, Whitney W. Stevens, Fei Li Kuang, Anju T. Peters^*

^*Corresponding author for this work

Medicine, Allergy Division

Research output: Contribution to journal › Article › peer-review

13 Scopus citations

Abstract

Background: Acute allergic reactions to messenger RNA (mRNA) vaccines are rare but may limit public health immunization efforts. Objectives: To characterize suspected allergic reactions to the first dose of coronavirus disease 2019 (COVID-19) mRNA vaccine and to assess the safety and utility of a two-step graded-dose protocol for the second dose of the Pfizer-BioNTech vaccine in patients with a history of low suspicion of anaphylaxis to their first dose. Methods: This was a retrospective evaluation of referrals to the allergy and immunology clinic for a presumed allergic reaction to the first dose of the COVID-19 mRNA vaccine (Pfizer-BioNTech or Moderna) between December 17, 2020, and February 28, 2021. Recommendations for the second dose and outcomes were evaluated by trained board-certified allergists. Results: Seventy-seven patients presented with a Pfizer-BioNTech reaction (56 [72.7%]) or with a Moderna reaction (21 [27.3%]). Most patients (69.7%) had symptom onset within 4 hours. Most commonly reported symptoms were cutaneous (51.9%), cardiovascular (48.1%), and respiratory (33.8%) symptoms. Recommendations included to proceed with the single dose (70.1%), two-step graded dose (19.5%), or deferral (10.4%). Twelve of 15 patients completed the second dose with a graded-dose protocol. Of these patients, five reported at least one or more similar symptoms as experienced with their first dose. Conclusion: Of the patients with presumed allergic reactions to their first dose of COVID-19 mRNA vaccine, most were able to safely receive the second dose. For those with a low suspicion of anaphylaxis, the two-step graded protocol with the Pfizer-BioNTech vaccine was well tolerated. A graded-dose protocol could be an effective strategy for second-dose vaccination in those who may otherwise defer the second dose.

Original language	English (US)
Pages (from-to)	515-521
Number of pages	7
Journal	Allergy and asthma proceedings
Volume	42
Issue number	6
DOIs	https://doi.org/10.2500/aap.2021.42.210075
State	Published - Nov 1 2021

Funding

From the 1Division of Allergy and Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and 2Occupational Medicine, Northwestern Memorial Hospital, Chicago, Illinois This work was supported by National Institutes of Health grant T32AI083216 and the Ernest Bazley Foundation The authors have no conflicts of interest to declare pertaining to this article Supplemental data available at www.IngentaConnect.com Address correspondence to Anju T. Peters, M.D., Division of Allergy and Immunology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611 E-mail address: [email protected] Copyright © 2021, OceanSide Publications, Inc., U.S.A.

ASJC Scopus subject areas

Pulmonary and Respiratory Medicine
Immunology and Allergy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.2500/aap.2021.42.210075

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Patel, G. B., Chhiba, K. D., Chen, M. M., Guo, A., Watts, M. M., Cullen, J., Bochner, B. S., Grammer, L. C., Greenberger, P. A., Saltoun, C. A., Stevens, W. W., Kuang, F. L., & Peters, A. T. (2021). COVID-19 vaccine-related presumed allergic reactions and second dose administration by using a two-step graded protocol. Allergy and asthma proceedings, 42(6), 515-521. https://doi.org/10.2500/aap.2021.42.210075

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title = "COVID-19 vaccine-related presumed allergic reactions and second dose administration by using a two-step graded protocol",

abstract = "Background: Acute allergic reactions to messenger RNA (mRNA) vaccines are rare but may limit public health immunization efforts. Objectives: To characterize suspected allergic reactions to the first dose of coronavirus disease 2019 (COVID-19) mRNA vaccine and to assess the safety and utility of a two-step graded-dose protocol for the second dose of the Pfizer-BioNTech vaccine in patients with a history of low suspicion of anaphylaxis to their first dose. Methods: This was a retrospective evaluation of referrals to the allergy and immunology clinic for a presumed allergic reaction to the first dose of the COVID-19 mRNA vaccine (Pfizer-BioNTech or Moderna) between December 17, 2020, and February 28, 2021. Recommendations for the second dose and outcomes were evaluated by trained board-certified allergists. Results: Seventy-seven patients presented with a Pfizer-BioNTech reaction (56 [72.7%]) or with a Moderna reaction (21 [27.3%]). Most patients (69.7%) had symptom onset within 4 hours. Most commonly reported symptoms were cutaneous (51.9%), cardiovascular (48.1%), and respiratory (33.8%) symptoms. Recommendations included to proceed with the single dose (70.1%), two-step graded dose (19.5%), or deferral (10.4%). Twelve of 15 patients completed the second dose with a graded-dose protocol. Of these patients, five reported at least one or more similar symptoms as experienced with their first dose. Conclusion: Of the patients with presumed allergic reactions to their first dose of COVID-19 mRNA vaccine, most were able to safely receive the second dose. For those with a low suspicion of anaphylaxis, the two-step graded protocol with the Pfizer-BioNTech vaccine was well tolerated. A graded-dose protocol could be an effective strategy for second-dose vaccination in those who may otherwise defer the second dose.",

author = "Patel, {Gayatri B.} and Chhiba, {Krishan D.} and Chen, {Michael M.} and Amina Guo and Watts, {Melissa M.} and Jane Cullen and Bochner, {Bruce S.} and Grammer, {Leslie C.} and Greenberger, {Paul A.} and Saltoun, {Carol A.} and Stevens, {Whitney W.} and Kuang, {Fei Li} and Peters, {Anju T.}",

note = "Publisher Copyright: Copyright {\textcopyright} 2021, OceanSide Publications, Inc., U.S.A.",

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month = nov,

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doi = "10.2500/aap.2021.42.210075",

language = "English (US)",

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journal = "Allergy and asthma proceedings",

issn = "1088-5412",

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Patel, GB, Chhiba, KD, Chen, MM, Guo, A, Watts, MM, Cullen, J, Bochner, BS , Grammer, LC , Greenberger, PA , Saltoun, CA , Stevens, WW , Kuang, FL & Peters, AT 2021, 'COVID-19 vaccine-related presumed allergic reactions and second dose administration by using a two-step graded protocol', Allergy and asthma proceedings, vol. 42, no. 6, pp. 515-521. https://doi.org/10.2500/aap.2021.42.210075

TY - JOUR

T1 - COVID-19 vaccine-related presumed allergic reactions and second dose administration by using a two-step graded protocol

AU - Patel, Gayatri B.

AU - Chhiba, Krishan D.

AU - Chen, Michael M.

AU - Guo, Amina

AU - Watts, Melissa M.

AU - Cullen, Jane

AU - Bochner, Bruce S.

AU - Grammer, Leslie C.

AU - Greenberger, Paul A.

AU - Saltoun, Carol A.

AU - Stevens, Whitney W.

AU - Kuang, Fei Li

AU - Peters, Anju T.

PY - 2021/11/1

Y1 - 2021/11/1

N2 - Background: Acute allergic reactions to messenger RNA (mRNA) vaccines are rare but may limit public health immunization efforts. Objectives: To characterize suspected allergic reactions to the first dose of coronavirus disease 2019 (COVID-19) mRNA vaccine and to assess the safety and utility of a two-step graded-dose protocol for the second dose of the Pfizer-BioNTech vaccine in patients with a history of low suspicion of anaphylaxis to their first dose. Methods: This was a retrospective evaluation of referrals to the allergy and immunology clinic for a presumed allergic reaction to the first dose of the COVID-19 mRNA vaccine (Pfizer-BioNTech or Moderna) between December 17, 2020, and February 28, 2021. Recommendations for the second dose and outcomes were evaluated by trained board-certified allergists. Results: Seventy-seven patients presented with a Pfizer-BioNTech reaction (56 [72.7%]) or with a Moderna reaction (21 [27.3%]). Most patients (69.7%) had symptom onset within 4 hours. Most commonly reported symptoms were cutaneous (51.9%), cardiovascular (48.1%), and respiratory (33.8%) symptoms. Recommendations included to proceed with the single dose (70.1%), two-step graded dose (19.5%), or deferral (10.4%). Twelve of 15 patients completed the second dose with a graded-dose protocol. Of these patients, five reported at least one or more similar symptoms as experienced with their first dose. Conclusion: Of the patients with presumed allergic reactions to their first dose of COVID-19 mRNA vaccine, most were able to safely receive the second dose. For those with a low suspicion of anaphylaxis, the two-step graded protocol with the Pfizer-BioNTech vaccine was well tolerated. A graded-dose protocol could be an effective strategy for second-dose vaccination in those who may otherwise defer the second dose.

AB - Background: Acute allergic reactions to messenger RNA (mRNA) vaccines are rare but may limit public health immunization efforts. Objectives: To characterize suspected allergic reactions to the first dose of coronavirus disease 2019 (COVID-19) mRNA vaccine and to assess the safety and utility of a two-step graded-dose protocol for the second dose of the Pfizer-BioNTech vaccine in patients with a history of low suspicion of anaphylaxis to their first dose. Methods: This was a retrospective evaluation of referrals to the allergy and immunology clinic for a presumed allergic reaction to the first dose of the COVID-19 mRNA vaccine (Pfizer-BioNTech or Moderna) between December 17, 2020, and February 28, 2021. Recommendations for the second dose and outcomes were evaluated by trained board-certified allergists. Results: Seventy-seven patients presented with a Pfizer-BioNTech reaction (56 [72.7%]) or with a Moderna reaction (21 [27.3%]). Most patients (69.7%) had symptom onset within 4 hours. Most commonly reported symptoms were cutaneous (51.9%), cardiovascular (48.1%), and respiratory (33.8%) symptoms. Recommendations included to proceed with the single dose (70.1%), two-step graded dose (19.5%), or deferral (10.4%). Twelve of 15 patients completed the second dose with a graded-dose protocol. Of these patients, five reported at least one or more similar symptoms as experienced with their first dose. Conclusion: Of the patients with presumed allergic reactions to their first dose of COVID-19 mRNA vaccine, most were able to safely receive the second dose. For those with a low suspicion of anaphylaxis, the two-step graded protocol with the Pfizer-BioNTech vaccine was well tolerated. A graded-dose protocol could be an effective strategy for second-dose vaccination in those who may otherwise defer the second dose.

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COVID-19 vaccine-related presumed allergic reactions and second dose administration by using a two-step graded protocol

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UN SDGs

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