• Katie Phillips, MD

Should I get the COVID Vaccine if I have a history of allergies?

The long-awaited vaccine against SARS-CoV-2 is here and hopefully will be available to our population over the next several months. One question that may arise in patients with a history of allergies, is should I get the new vaccine?

The short answer is likely YES, unless you have a history of severe allergic reaction (anaphylaxis, angioedema, respiratory distress or severe hives) to the COVID vaccine or components of the COVID vaccine (most commonly polyethylene glycol).

The long answer is - there are many considerations you and your doctor should discuss to ensure you are as safe as possible when you receive the vaccine.

The first thing to know is that anaphylaxis (an allergic reaction which causes extreme swelling in your airway which can lead to difficulty breathing and even death) caused by vaccines is an extremely rare event. For most vaccines, anaphylaxis occurs approximately 1 per 1,000,000 doses administered and usually develops within minutes of receiving the vaccine. The Moderna and Pfizer trials did not report any episodes of anaphylaxis following vaccine administration, but in the first week the vaccine was available there were 2 cases of documented anaphylaxis that did occur after the COVID vaccine was administered in the UK. For this reason, the CDC recommends that you be observed for 15-30 minutes after receiving your shot so that healthcare officials can monitor you for a possible anaphylaxis reaction and administer epinephrine immediately if you develop symptoms.

So for those patients with a history of allergies - should you get COVID vaccine?

The current guidance from the CDC states:

-If you have a history of severe allergic reaction to foods, pets, venom, environmental allergens or latex, you should proceed with vaccination. You are no more likely than the general public to have a severe reaction to the COVID vaccine.

-If you have a history of mild allergic reaction (no anaphylaxis) to an injectable medicine or vaccine, you should proceed with vaccination.

-If you have a history of severe allergic reaction (anaphylaxis) to a vaccine or an injectable medicine, you should discuss the risks and benefits with your doctor. We learn more every day as more people get the vaccine and therefore this recommendation is always evolving. After discussion with your doctor, if you do decide to go forward with vaccination, you should wait the full 30 minutes after injection to be monitored for anaphylaxis.

-If you have a history of severe allergic reaction (anaphylaxis) to the COVID vaccine itself or components of the COVID vaccine (ex. polyethylene glycol), you should not proceed with vaccination and instead follow up with an allergist or immunologist.

For further details on this chart, please visit https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fcovid-19%2Finfo-by-product%2Fpfizer%2Fclinical-considerations.html

What about receiving other vaccines?

Given the lack of research into if the COVID vaccine remains safe and effective when given with other vaccines, the CDC is currently recommending waiting 14 days between COVID vaccine administration and other vaccinations. Although, the CDC does say other vaccines can be administered closer than the 14 day window if benefits outweigh the risks (ie. tetanus toxoid-containing vaccination as part of wound management)

What about immunotherapy?

If you are currently on allergy shots, the recommendation of the ENT and Allergy national societies (AAO-HNS and AAOA) is to not receive your COVID vaccine and allergy shot within a 24-hour period. This is to avoid uncertainty if there happens to be an adverse effect after receiving either the allergy shot or COVID vaccine.

If you are currently taking allergy drops under your tongue or taking sublingual tablets, you do not need to stop taking these medications if you get the COVID vaccine.

In a similar manner if you are currently taking a biologic medication (such as Dupixent (dupilumab) or Xolair (omalizumab)), you do not need to stop taking these medications to get your COVID vaccine. These medications are immune system modifying agents and do not cause immunodeficiency. Moreover, if you are immunodeficient, the COVID vaccine is not a live virus vaccine and is safe to use in those patients with immunodeficiency.

This post is a summary of the guidelines put forth by the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS) and the American Academy of Otolaryngic Allergy (AAOA). Please see this link (https://www.entnet.org/content/allergic-reactions-related-covid-19-vaccinations-allergic-patients)for further details.

As always, the content in this blog is meant to be informational and not serve as a substitute for a medical evaluation with a physician.

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