Note: This issue is evolving. We will update this post as news comes out. This post was updated on January 8, 2021.
What is the current guidance for administering COVID-19 vaccines in the U.S. for people with allergies?
The U.S. Centers for Disease Control and Prevention (CDC) has issued guidance for people with allergies and whether they should receive either the Pfizer/BioNTech vaccine or the Moderna vaccine for COVID-19. Both are Messenger RNA (mRNA) vaccines and come in two doses. They are designed to trigger an immune response that produces antibodies and protects people from getting infected when exposed to the real virus.
The guidance states the following:
People who should receive the Pfizer/BioNTech or Moderna vaccine
- Anyone with a history of food, insect venom, oral medications, environmental or latex allergies
- Anyone with a family history of anaphylaxis not related to mRNA vaccines
Must undergo a 15-minute observation period (30 minutes if there’s a history of anaphylaxis) after receiving the vaccine to ensure there’s no allergic reaction.
People who should first consult with their doctor before getting either of the vaccines
- Anyone with a history of anaphylaxis or non-severe immediate allergic reactions to other vaccines
Discuss risks of vaccine and whether to wait to receive the vaccine. If it’s decided you can receive the vaccine, you must undergo a 30-minute observation period after receiving it to ensure there’s no allergic reaction.
People who should not receive either of the vaccines
- Anyone with a history of anaphylaxis to any component of the Pfizer/BioNTech or Moderna vaccines (anyone who experiences anaphylaxis after getting the first dose of the vaccine should not get the second dose)
- Anyone with a history of non-severe immediate allergic reactions to any component of the vaccines (anyone who experiences non-severe immediate allergic reaction to the first dose should not get the second dose)
- Anyone who is allergic to polyethylene glycol (PEG) or polysorbate. PEG is a component in both vaccines; polysorbate is not in the vaccine but is closely related to PEG
What process is used to determine if a person is at risk for an allergic reaction from a COVID-19 vaccine?
The CDC updated its guidance on December 30 with this chart on how patients should be triaged when they present for a mRNA COVID-19 vaccination.
An article in press December 28, 2020 in the The Journal of Allergy and Clinical Immunology: In Practice includes this flow chart. It’s useful for healthcare professionals and patients.
Both the Pfizer/BioNTech and Moderna vaccines are administered in two doses. If you experience an allergic reaction to the first dose of the vaccine you may be ineligible for the second dose. The following flow chart from JACI: In Practice shows how healthcare professionals determine if a person should receive a second dose.
What are the ingredients to the COVID-19 vaccines?
What is known about cases of allergic reactions to COVID-19 vaccines?
The CDC guidance came after health officials in the United Kingdom issued a warning for the Pfizer/BioNTech vaccine in December. Two healthcare workers experienced anaphylaxis after receiving the vaccine. Both had a history of allergic reactions and used epinephrine to treat symptoms. UK health officials subsequently warned that people with a significant history of allergic reactions to food, vaccines or medicines should not be given the vaccine.
In the United States, there were 21 reported cases of anaphylaxis out of 1,893,360 first dose vaccines given from Dec. 12-23. This amounts to 11.1 cases of anaphylaxis per 1 million vaccines given, according to CDC.
Among the 21 reported cases, 17 occurred in people who have a history of allergies or allergic reactions. The 21 cases resulted from a first dose of the Pfizer/BioNTech vaccine, with 70% of the reactions occurring within 15 minutes after the vaccine was given. Each of the people who experienced anaphylaxis recovered or were discharged. None resulted in death.
The cases of anaphylaxis should not deter anyone from seeking out the COVID-19 vaccine. Always keep with you two epinephrine auto-injectors if you are at risk for anaphylaxis.
The National Institute of Allergy and Infectious Diseases (NIAID), CDC and the U.S. Food and Drug Administration (FDA) are working with vaccine manufacturers this year on research addressing severe allergies and COVID-19 vaccines.
People with a history of severe allergic reactions to vaccines were not part of Pfizer/BioNTech clinical trials earlier this year, notes allergist Purvi Parikh, MD, national spokesperson for Allergy & Asthma Network. “People with other types of allergies participated in the clinical trials and likely tolerated the vaccine with no issue,” she says.
How common is anaphylaxis to a vaccine?
Anaphylaxis to vaccines are extremely rare. They can occur due to the presence of a particular ingredient or preservative, such as egg or gelatin, however, the amount is so tiny that it is unlikely to trigger a severe allergic reaction.
Do the COVID-19 vaccines contain egg?
No. Further, there is no link to the vaccines and concerns of egg allergy and flu vaccine, as has been falsely reported by some media outlets.
Do the COVID-19 vaccines contain any preservatives?
Neither of the COVID-19 vaccines contain any preservatives that may trigger an allergic reaction.
Do the COVID-19 vaccine stoppers contain any natural rubber latex?
The vial stoppers are not made with natural rubber latex, so the vaccines are safe for people with latex allergy.
What are normal side effects to the COVID-19 vaccines?
People who receive either of the Pfizer/BioNTech and Moderna vaccines may experience the following:
- Swelling or pain at the point of injection
- Muscular or joint pain
These side effects are considered normal as your body builds protection to the coronavirus.
Do the COVID-19 vaccines contain PEG?
Both the Pfizer/BioNTech and Moderna vaccines contain polyethylene glycol (PEG), a compound that helps the vaccine access cells. Allergic reactions to PEG are considered rare. The American College of Allergy, Asthma & Immunology (ACAAI) recommends that people with a known history of severe allergic reactions to PEG should not receive the vaccine.
Are other COVID-19 vaccines available?
COVID-19 vaccines from other pharmaceutical companies are expected to arrive soon. Similar allergy concerns may arise with these new vaccines. We urge people with a history of severe allergic reactions to consult with a board-certified allergist if they are concerned about the COVID-19 vaccine.