Dear Colleagues & Community,
With the FDA emergency use authorization of the Pfizer-BioNTech COVID-19 vaccine on December 11, 2020 and the Moderna vaccine on December 18, 2020, the Allergy Group recommends the following guidance for physicians and other providers related to risk of an allergic reaction on vaccination.
Significant allergic reactions to vaccines occur in about 1 in a million vaccines given.
In the USA, there have been at least 6 documented allergic reactions to the Pfizer vaccine out of nearly 300,000 given (now likely over 1 million given). That is obviously a higher rate than 1 in a million. Time will tell if that is an anomaly or if there really is a higher risk from this vaccine.
The most likely culprit based on current evidence is polyethylene glycol, a stabilizing molecule used in the vaccine. It is found in other medicinal products, cosmetics and even as a food additive.
Current recommendations, based on CDC and the American College of Allergy, Asthma and Immunology guidelines, include the following:
- All patients should receive the vaccine in a location equipped to treat an allergic reaction should it occur.
- Patients with a history of anaphylaxis should remain under observation for 30 minutes after being vaccinated. Others should wait 15 minutes.
- Those with an allergy to a component of the vaccine (such as polyethylene glycol) should not get vaccinated. Polyethylene glycol (PEG) is also found in the Moderna COVID-19 vaccine. We have read about 1 allergic reaction to that vaccine. Again, we do not know that PEG is the cause but it is the leading candidate. Testing to PEG is available at our office, if needed.
- Intramuscular epinephrine is the treatment of choice for a significant allergic reaction.
- Those with common allergies to medications, foods, inhalants, insects, and latex are no more likely than the general public to have an allergic reaction to the vaccine.
- Patients experiencing a severe allergic reaction after getting the first shot should not get the second shot.
Please do not hesitate to call us with any questions or concerns at 208-377-4000.
Drs. Talreja, Webb and Waldram