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Vaccination allergic reaction: Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine — United States, December 14–23, 2020

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Vaccine Reactions | Drug Allergy Program

Any time a person takes a medication, even a preventative one such as a vaccine, they can have an adverse reaction. Vaccines are made to activate the immune system and help the immune system become familiar and form protection against a potential threat. Because vaccines activate the immune system, mild reactions are common. 

Sometimes a person can have allergic reactions to ingredients of the vaccine. These allergic reactions can be to the active ingredients but are more often to the inactive ingredients (excipients) used to stabilize or produce the vaccine. These allergic reactions can range from mild to severe, including a life-threatening allergic reaction called anaphylaxis. 

Sometimes mild reactions resolve without treatment or may improve with antihistamines like diphenhydramine. 

Anaphylaxis has some of the same symptoms of mild allergic reactions, but the symptoms are more severe and occur in more than one system. Symptoms of anaphylaxis occur abruptly and require emergency medical treatment. They do not resolve on their own.

Vaccine-related Reactions

Reaction Type and Severity  Examples of Symptoms Timing
Non-allergic Rash, fever, chills, irritability, muscle and joint pain, stomach upset, headache, fatigue, pain, redness or swelling at injection site or same arm Within 1-7 days after vaccination
Allergic and mild Itchy rash such as hives, or flushing, and/or swelling of lips or eyes or extremities  Within
0-72 hours after vaccination
Anaphylaxis (allergic and severe) Symptoms of one or more systems: skin symptoms (itching, hives, flushing or facial swelling), breathing problems (shortness of breath, wheezing, cough), symptoms due to low blood pressure (confusion, disorientation, dizziness, lightheadedness, weakness, or fast heart rate), or gastrointestinal symptoms (nausea, vomiting, stomach cramps, or diarrhea). Occur abruptly, from 5 minutes to within 2 hours of vaccination

Study: Nearly all severely allergic people tolerate COVID vaccines

While healthcare workers at a Boston healthcare system with severe allergies reported more reactions after receiving a COVID-19 mRNA vaccine, nearly all were able to safely complete the series, according to an observational study yesterday in JAMA Network Open.

Researchers at Mass General Brigham and Harvard Medical School mined the electronic health records of 52,998 employees, of whom 97.6% received both doses of vaccine, and 0.9% reported a history of high-risk allergy. The study period was Dec 14, 2020, to Feb 1, 2021. Participants completed a prevaccination allergy risk assessment and at least one postvaccination symptom survey during the 3 days after vaccination.

Current contraindications to COVID-19 mRNA vaccination include a history of severe or immediate allergic reactions to any vaccine component or to a previous dose of an mRNA vaccine. The employees, however, were given the vaccine according to Centers for Disease Control and Prevention guidelines, allergist consultation, risk stratification, and shared decision-making.

Rate of severe reactions: 0.3%

Allergic symptoms emerged more often after the first rather than the second dose. Most symptoms were mild (eg, rash, itching), at 2.7%, but respiratory symptoms (1.3%), hives (0.9%), and angioedema (swelling of the face, lips, eyes, or tongue) (0.6%) were also reported.

Severe allergic reactions were rare (0.3%). Of the 140 participants who reported severe allergic symptoms after vaccination, 4.3% had a history of high-risk allergy. The risk of a severe allergic reaction after vaccination was 1.3% among workers with a high-risk allergy history and 0.3% among those who had never had a high-risk reaction.

Relative to workers without allergies, those with severe allergies had more reactions after receiving one or two vaccine doses (11.6% vs 4.7%). After adjustment, high-risk allergy was tied to increased risk of reactions (adjusted relative risk [aRR], 2. 46; 95% confidence interval [CI], 1.92 to 3.16). Risks were highest for hives (aRR, 3.81; 95% CI, 2.33 to 6.22) and angioedema  (aRR, 4.36; 95% CI, 2.52 to 7.54).

“However, reported allergy symptoms did not impede the completion of the 2-dose vaccine protocol among a cohort of eligible health care employees, supporting the overall safety of mRNA COVID-19 vaccine,” the study authors wrote.

Participants were, on average, 42 years old, and 72% were women. Women and Black participants made up much higher proportions of those with a history of severe allergy than those with no history of allergy (80.8% vs 71.9% and 9.5% vs 4.8%, respectively).

Severely allergic vaccinees were older than those with no allergy history (46 vs 42 years on average), had more atopic (allergic) skin conditions (16.7% vs 8.7%), anxiety (28.9% vs 23.9%), high blood pressure (14.6% vs 10.9%), and cancerous tumors (4.0% vs 2.4%).

Participants at highest risk of allergic reactions to the vaccine were Black (RR, 1. 69), had a higher Charlson comorbidity index score (RR, 1.04), and received the Moderna rather than the Pfizer vaccine (RR, 1.49). Compared with women, men were at decreased risk for a reaction (RR, 0.66).

Among 474 employees with a history of severe allergy, 46.6% had a previous reaction to an unknown or known allergen (eg, food, venom, drug, latex). Nearly 46% of these workers reported a previous severe allergic reaction to an injectable medication or vaccine. Only 1.9% had a previous severe allergic reaction to polyethylene glycol (PEG) (an inert vaccine ingredient) or PEG-containing products (eg, Miralax, injectable steroid).

People with history of reactions should consult allergist

Soon after the US Food and Drug Association issued an emergency use authorization for the mRNA COVID-19 vaccines from Pfizer/BioNTech and Moderna in December 2020, several severe allergic reactions were reported, raising concerns about vaccine safety, the researchers noted.

Since then, the reported rate of allergic reactions to these vaccines has been about 2%, and anaphylaxis (a severe, potentially life-threatening allergic reaction) has been estimated to occur in 0. 025 to 2.47 cases per 10,000 vaccinations—or a 0.02% risk on the high end of that range. Of vaccinees who experienced anaphylaxis after vaccination, about a third had a history of the reaction.

Whether severe allergies are linked to allergic reactions after mRNA vaccination is still unclear, the authors noted, because the observed reactions may not be true allergies. People with a history of severe allergy to PEG should consult their allergist or immunologist before seeking COVID-19 vaccination; such an allergy may not be a contraindication for vaccination.

“Identification of risk factors for allergy symptoms after COVID-19 vaccination will guide safe vaccination practices for individuals at the highest risk and inform strategies that target vaccine hesitancy that is associated with allergy concerns,” the researchers wrote.

Overall, the results are reassuring for people who have a history of severe allergy, senior author Kimberly Blumenthal, MD, said in a Massachusetts General Hospital news release.

“We hope these data will help inform ongoing conversations with patients who are hesitant to receive COVID-19 vaccination due to allergy concerns,” she said. “At our institutions, nearly all individuals with and without a history of high-risk allergy were able to complete the two-dose vaccine series.”

U.S. begins study assessing allergic reactions to Pfizer and Moderna shots

Pfizer-BioNTech COVID-19 (left) and Moderna COVID-19 (right) vaccines.

Matic Zorman | Getty Images

The National Institutes of Health said Wednesday it has begun looking at why some people have suffered from severe allergic reactions shortly after receiving the Pfizer-BioNTech and Moderna Covid-19 vaccines.

“The public understandably has been concerned about reports of rare, severe allergic reactions to the Moderna and Pfizer-BioNTech COVID-19 vaccines,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which is part of the NIH, said in a statement.

“The information gathered during this trial will help doctors advise people who are highly allergic or have a mast cell disorder about the risks and benefits of receiving these two vaccines. However, for most people, the benefits of COVID-19 vaccination far outweigh the risks,” he said.

Medical experts say allergic reactions from vaccines are rare but can sometimes happen. Most of the rare, severe allergic reactions to the vaccines have occurred in people with a history of allergies, public health officials have said. An immediate allergic reaction usually happens within 4 hours of getting vaccinated and may include symptoms such as hives, swelling and wheezing, according to the Centers for Disease Control and Prevention.

The CDC said in January allergic reactions are occurring at a rate of 11.1 per 1 million vaccinations for the Pfizer shot and 2.5 per 1 million for the Moderna shot.

The NIH study will enroll 3,400 adults ages 18 to 69 at up to 35 academic allergy-research centers nationwide, the agency said. Participants will be divided into groups and be assigned at random to receive either the Pfizer-BioNTech vaccine, the Moderna vaccine, a placebo followed by the Pfizer-BioNTech vaccine or a placebo followed by the Moderna vaccine.

Alkis Togias, chief of the NIAID’s allergy, asthma and airway biology branch, told CNBC in December that researchers at the U.S. agency became interested in the rare phenomenon after reports that a few people had reactions to Pfizer’s vaccine that qualified as anaphylaxis, a severe and potentially life-threatening allergic reaction.

The CDC has been asking health-care providers to monitor patients for 15 minutes after vaccination and 30 minutes for those who have a history of allergic reactions.

If someone has a severe allergic reaction after getting the first dose of a Covid-19 vaccine, the CDC recommends that they do not get the second dose of that vaccine, even if the allergic reaction was not severe enough to require emergency care.

A Systematic Review, Meta-Analysis, GRADE Assessment, and International Consensus Approach

aSection of Allergy and Clinical Immunology, Food Challenge and Research Unit, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo

bDepartment of Pediatrics and Child Health, Section of Allergy and Immunology, The University of Manitoba, Winnipeg, Man, Canada

cDartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon; Dartmouth Geisel School of Medicine, Hanover, NH

dDepartment of Medicine, McMaster University Department of Health Research Methods, Evidence and Impact, McMaster University; The Research Institute of St. Joe’s Hamilton; Evidence in Allergy Group, McMaster University, Hamilton, Ont, Canada

eDivision of Allergy and Immunology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas

fDivision of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan School, Ann Arbor, Mich

gDepartment of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ont, Canada

hLydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK

iDivision of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Center–Montreal Children’s Hospital, Montreal, Quebec, Canada

jDivision of Immunology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio

kDivision of Allergy, Immunology, and Rheumatology, University of Rochester School of Medicine and Dentistry, Rochester, NY

lDepartment of Paediatric and Adolescent Medicine, Paediatric Pneumology, Allergology, and Cystic Fibrosis, University Hospital Frankfurt, Frankfurt am Main, Germany

mChildren’s Health Ireland at Crumlin, Crumlin, Ireland

nDepartment of Health Research Methods, Evidence and Impact, Evidence in Allergy Group, McMaster University, Hamilton, Ont, Canada

oThe Children’s Hospital at Westmead, Sydney, New South Wales, Australia

pDepartment of Emergency Medicine, Mayo Clinic, Rochester, Minn

qDivision of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ont, Canada

rBC Children’s Hospital, Division of Allergy and Immunology, The University of British Columbia, Vancouver, BC, Canada

sDepartment of Emergency Medicine, Southlake Regional Medical Center, Newmarket, Ont, Canada

tDepartment of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy, Department of Clinical Immunology and Allergology, I. M. Sechenov First Moscow State Medical University, Moscow, Russia

uDivision of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio

vDivision of Allergy and Immunology, Department of Medicine, Queen’s University, Kingston, Ont, Canada

wGuy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom

xLaboratory of Allergic Diseases, Food Allergy Research Section, National Institutes of Allergy and Infectious Diseases, the National Institutes of Health, Bethesda, Md

yClinique Spécialisée en Allergie de la Capitale, Quebec, Quebec, Canada

zDivision of Allergy and Immunology, Department of Clinical Pediatrics, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, Ohio

aaDivision of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Mo

bbDepartment of Paediatrics, Royal College of Surgeons, Dublin, Ireland

ccCampbelltown Hospital, Western Sydney University, New South Wales, Australia

ddWestern University, Londo, McMaster University, Hamilton, Ont, Canada

eeDivision of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif

ffDepartment of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio

ggDivision of Allergy and Immunology, Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla

hhDivision of Paediatric Allergology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

iiDivision of Allergy and Immunology, The University of Tennessee, Memphis, Tenn

jjImmunology Department, Perth Children’s Hospital, Perth, Western Australia, Australia

kkMcMaster University Hamilton, Halton Pediatric Allergy, Burlington, Ont, Canada

llDivision of Pulmonary, Allergy, and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill

mmDepartment of Paediatrics and Paediatric Infectious Diseases, Institute of Child’s Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia, Inflammation, Repair, Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK

nnRochester Regional Health, University of Rochester School of Medicine and Dentistry, Rochester, NY

ooAsthma and Allergy Center, Lewisville and Flower Mound, Texas, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas

ppUMDMJ Rutgers University School of Medicine, New Brunswick, NJ

qqMurdoch Children’s Research Institute, Department of Paediatrics, University of Melbourne, Royal Children’s Hospital, Parkville, Victoria, Australia

rrDivision of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, Division of Pulmonology, Phoenix Children’s Hospital, Phoenix, Ariz

ssDivision of Clinical Immunology and Allergy, St. Joseph’s Health Care, the Schulich School of Medicine and Dentistry, Western University, London, Ont, Canada

ttKaiser Permanente Los Angeles Medical Center, Los Angeles, Calif

uuDivision of Allergy and Immunology, Children’s Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa

vvMurdoch Children’s Research Institute, University of Melbourne, Royal Children’s Hospital, Department of Allergy and Immunology, Royal Children’s Hospital, Parkville, Victoria, Australia

wwAllergy, Asthma, and Immunology Associates, PC, Associate Professor of Pediatrics, University of Nebraska School of Medicine, Omaha, Neb

xxImperial College Healthcare NHS Trust and Royal Brompton and Harefield NHS Foundation Trust, London, UK

yyDivision of Clinical Immunology and Allergy, Department of Medicine, Evidence in Allergy Group, McMaster University, Hamilton, Ont, Canada

zzNova Southeastern University College of Allopathic Medicine, Fort Lauderdale, Fla

aaaDivision of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, the Jaffe Food Allergy Institute, New York, NY

bbbDepartment of Medicine, Clinical Immunology, and Allergy, McMaster University, Hamilton, Ont, Canada

cccDivision of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio

dddDivision of Allergology and Immunology, Department of Dermatology, Venereology, and Allergology, Charité- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany

eeePediatric Allergy and Asthma, Department of Pediatrics, University of Alberta, Edmonton, Alta, Canada

fffDivision of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Md

Corresponding author: Matthew Greenhawt, MD, MBA, MS, Section of Allergy and Clinical Immunology, Food Challenge and Research Unit, Children’s Hospital Colorado, University of Colorado School of Medicine, 13123 E. 16th Ave., Aurora, CO 80045.

Vaccine allergies

Clin Exp Vaccine Res. 2014 Jan; 3(1): 50–57.

Eun Hee Chung

Department of Pediatrics, National Medical Center, Seoul, Korea.

Department of Pediatrics, National Medical Center, Seoul, Korea.

Corresponding author.
Corresponding author: Eun Hee Chung, MD, PhD. Department of Pediatrics, National Medical Center, 245 Euljiro, Jung-gu, Seoul 100-799, Korea. Tel: +82-2-2260-7301, Fax: +82-2-2260-7306, [email protected]

Received 2013 Sep 21; Revised 2013 Oct 10; Accepted 2013 Oct 30.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.This article has been cited by other articles in PMC.

Abstract

Currently, the increasing numbers of vaccine administrations are associated with increased reports of adverse vaccine reactions. Whilst the general adverse reactions including allergic reactions caused by the vaccine itself or the vaccine components, are rare, they can in some circumstances be serious and even fatal. In accordance with many IgE-mediated reactions and immediate-type allergic reactions, the primary allergens are proteins. The proteins most often implicated in vaccine allergies are egg and gelatin, with perhaps rare reactions to yeast or latex. Numerous studies have demonstrated that the injectable influenza vaccine can be safely administered, although with appropriate precautions, to patients with severe egg allergy, as the current influenza vaccines contain small trace amounts of egg protein. If an allergy is suspected, an accurate examination followed by algorithms is vital for correct diagnosis, treatment and decision regarding re-vaccination in patients with immediate-type reactions to vaccines. Facilities and health care professionals should be available to treat immediate hypersensitivity reactions (anaphylaxis) in all settings where vaccines are administered.

Keywords: Vaccine, Allergy, Influenza, Egg, Anaphylaxis

Introduction

Similar to other drugs, vaccines have the potential to cause allergic reactions [1-3]. Vaccines, specifically individual components of the vaccine, are known to, although rarely, cause serious complications. Even after an allergic reaction after vaccination, it is difficult to ascertain whether the allergic reaction was caused by the vaccine itself or other factors. Recently, mild allergic reactions caused by vaccinations have become common in practice due to an increased amount of vaccinations, however, these mild allergic reactions can still lead to serious complications and therefore require attention.

The vaccine components include active immunizing antigens, conjugating agents, preservatives, stabilizers, antimicrobial agents, adjuvants and culture media used in the preparation of the vaccine, as well as inadvertent contaminants that are introduced during vaccine handling (). Almost all the vaccine components can be considered as potential triggers of an allergic reaction. Of particular importance are culture derived proteins from egg, gelatin and yeast. Other sources of allergic reaction are antibiotics and vaccination antigens.

Table 1

Type of vaccine components

Mechanisms of Allergic Responses to Vaccines

The immune-mediated reactions caused by individual components of the vaccines are outlined in . Allergic responses caused by vaccines are generally of Type I and IV hypersensitivity reactions.

Table 2

Synopsis of potential immune-mediated reactions to vaccines

The most immediate reactions are Type I hypersensitivity reactions that are mediated by the interaction of IgE antibodies against a particular vaccine component. These reactions typically occur within minutes of exposure to the relevant allergen and almost always occur within 4 hours of exposure to the relevant allergen, however, possible exceptions for delayed-onset reactions do occur [4]. The most common symptoms of IgE-mediated allergic reactions are urticaria and angioedema, with less common symptoms including nasal congestion, cough, stridor, wheezing, shortness of breath, vomiting, abdominal pain, diarrhea and hypotension. Anaphylaxis, an acute hypersensitivity reaction with multi-organ system involvement can present as a severe life-threatening reaction, or can occur after vaccination.

It has been reported that the average rate for immediate type reactions in children and adolescents is 0.22 per 100,000 doses of vaccinations [2]. A total of 31% of these patients reported immediate type reactions after the first vaccination. This observation suggests either a pre-sensitization to a component of the vaccine or a non-immunologically mediated reaction [1]. In contrast, according to Bohlke et al. [3], the reported cases of potential anaphylaxis after vaccination amount to 0.065 per 100,000 given doses of vaccines.

Type IV hypersensitivity delayed reactions have also been reported, however, these reactions are generally considered to be harmless. Type IV hypersensitivity reactions generally begin 48 hours after vaccination and peak between 72 and 96 hours [5]. These reactions are typically observed following vaccines containing thimerosal, aluminum and anti-microbial agents. The occurrence of such an event is not a contraindication for further vaccinations. Type IV reactions are becoming less frequent as mercury is being removed from modern vaccines. Another reported hypersensitivity reaction includes erythema multiforme. This reaction can be quite severe in children and is triggered by a number of allergens, including vaccine components [5].

The majority of delayed reactions are classified as Type III hypersensitivity and are attributed primarily to the formation of immune complexes, however, less well-defined mechanisms, including T cell-mediated processes, may also play a role [4]. The most common signs of delayed-type reactions include rashes, which may include as urticaria, erythema multiforme, and/or maculopapular eruptions. Angioedema may also occur, paritcularly in association with urticaria or erythema multiforme eruptions. Although uncommon, arthralgia, arthritis, joint swelling, serum sickness, and Henoch-Schönlein purpura may occur, in conjunction with a variety of other hematologic, renal and gastrointestinal manifestations. Some delayed reactions, however, may not be immunologically mediated. Persistent hard nodules at the injection site may involve irritant reactions, usually induced by adjuvants such as aluminum and do not necessarily reflect immunologic hypersensitivity to vaccine constituents.

Rarely, hyperimmunized patients by previous injections of a vaccine (e.g., tetanus vaccination) developed a local immune complex mediated by a Arthus-type reaction at the site of vaccine injection [6,7]. T-cell mediated reactions usually manifest in the form of local eczema, starting from 2-8 hours up to 2 days after vaccination. Sometimes the reaction may extend beyond the injection area and may even become generalized [8,9].

Idiopathic and autoimmune responses are other immune related reactions. Self-reactive antibodies, created by molecular mimicry between the vaccine antigen and endogenous epitope, may be induced by vaccination. For example, idiopathic thrombocytopenic purpura may be produced by several viral infections that may induce autoantibodies to platelet surface glycoprotein [5]. Such reported cases are 1 in 3,000 for rubella virus, 1 in 30,000 for measles, mumps, and rubella (MMR) vaccine and 1 in 6,000 for the measles virus [10]. The Guillain-Barré syndrome (GBS) outbreak in 1976-1977, as a result of a swine influenza vaccine campaign, is the most well documented example of an autoimmune reaction to vaccinations. Briefly, in fear of an influenza pandemic, an ‘immunization campaign’ took place throughout 1976-1977. Many people immunized with the swine influenza vaccine during the campaign period (approximately 0.04 per 100,000 vaccinations) developed GBS within 6 weeks following immunization. At the end of the ‘immunization campaign’, however, there were no further reported cases of GBS [11]. Recently the estimated rate of influenza vaccination-related GBS in Korea was reported to be 0-0.025 per 100,000 distributed doses which is considerably lower than 0.04 to less than one case per 100,000 vaccinations reported in previous studies [11-13]. Despite strong epidemiological data of an association between swine flu vaccination and GBS, the biological mechanisms remain to be demonstrated and thus require further research.

Allergic Reactions to Vaccine Components

A list of vaccine components that can potentially cause allergic reactions are continually updated and are accessible on the website of the Institute for Vaccine Safety: http://www.vaccinesafety.edu. Below is a brief review of the vaccine components that can potentially result in allergic reactions.

Stabilizer

In order to protect vaccines from unfavorable conditions such as excessive heat or the freeze-drying process, stabilizers such as sugar (sucrose and lactose), amino acids (monosodium salt of glutamic acid or glycine) and protein (gelatin or human serum albumin) are added. Gelatin is commonly found in every day food, pharmaceuticals, photography, cosmetics, etc. When used in vaccines, gelatin is extensively cross-reactive and is of bovine or porcine origin [14-16]. Gelatin is used as a stabilizer in attenuated viral-containing vaccines such as Japanese encephalitis virus, varicella and MMR () and causes the most allergic reactions compared with other vaccine components [17]. In Japan, after the introduction of vaccines not containing gelatin, the incidence of allergic reactions sharply declined [18,19].

Table 3

Gelatin containing vaccine and its contents

Patients allergic to vaccines containing gelatin should be checked for IgE antibody to gelatin using a serum specific IgE test to gelatin (commercially available) or a skin prick test extract which is not yet approved by the Food and Drug Administration (FDA). People with a food allergy to gelatin may develop an anaphylactic reaction following injection with a vaccine containing gelatin, however, it has been reported that people without a gelatin food allergy may also develop an anaphylactic reaction in response to a vaccine containing gelatin [15]. This can be explained by the differing routes of vaccine administration, that is, ingestion versus injection.

If a patient has a history of Type I immediate allergic reaction to gelatin and this allergic reaction is confirmed by a skin test or a serum specific IgE test, a skin test should be performed using specifically the gelatin containing vaccine [4, 17]. If the result is positive, the vaccine should be injected in graded doses under observation (). If the result is negative, the injection should be carried out normally with observation of the patient continued for another 30 minutes after injection.

Table 4

Administration of a vaccine in graded doses to patients with positive skin test

Preservatives

To prevent the growth of microorganisms, preservatives such as 2-phenoxyethanol and thimerosal are often added to vaccines. Thimerosal is a neurotoxic organic mercurial compound (50% mercury by weight), however, it has been reported that low concentrations of thimerosal in vaccines does not result in any adverse reactions [20]. Nonetheless, the U.S. Public Health Service and the American Academy of Pediatrics (AAP) urged the removal of thimerosal in vaccines routinely used for infants by the year 1999. Consequently, with the exception of some vaccines, thimerosal has been completely removed or reduced to trace amounts in vaccines for children.

In general, the majority of patients hypersensitive to thimerosal do not experience any adverse reactions to vaccines containing and consequently the administration of vaccines containing thimerosal remains non contraindicative to future vaccination.

Antimicrobial agents

To avoid contamination during the manufacturing process, several vaccines include trace amounts of neomycin, streptomycin, and/or polymyxin B.

Currently, only limited reports of allergic reactions due to vaccines containing antibiotics exist. Some patients may experience a Type IV delayed type allergic reaction such as injection site papule 48 to 96 hours following vaccination [21]. Patients who experience an anaphylactic reaction to a specific kind of antibiotic, however, should avoid vaccines containing that specific antibiotic.

Yeast proteins

Hepatitis B vaccines and human papilloma virus vaccines are created using antigens from the culture of recombinant Saccharomyces cerevisiae (bakers’ yeast), thus the vaccines consist of a small amount of yeast protein (up to 5%) [22].

Allergic reactions as a result of the presence of yeast protein in vaccines appear to be extremely rare. After reviewing 180,000 allergic reports in the Vaccine Adverse Event Reporting System, only 15 appeared to result from a reaction to yeast proteins in the vaccines. Furthermore, these 15 cases may have resulted from other variables rather than the presence of yeast protein in the vaccine alone [23]. If a patient is suspected of yeast protein allergy, an IgE antibody to yeast should be measured. Commercially available skin test reagents and skin tests are available and should be performed. If the result is positive, the vaccine should be injected in graded doses under constant observation. If the results of the tests are negative, the vaccinations should be carried out normally and observation of the patient continued for another 30 minutes following vaccination ().

Adjuvants

Adjuvants, such as aluminum salts, are often added to vaccines to enhance an immune response. Persistent palpable nodules at the injection site may form as a result of aluminum containing vaccines most likely due to a delayed type hypersensitivity [24,25].

Latex

Latex, used to create a natural rubber latex and dry natural rubber, contains naturally occurring impurities. Such impurities are often responsible for recipient allergic reactions. In contrast, synthetic latex does not contain such impurities and therefore should be considered as an alternative when administering vaccinations. Contact type allergy is the most common type of latex sensitivity [26]. Several cases of latex anaphylaxis have been reported during operations [27,28]. Injection related latex allergies have been reported, however such allergies rarely occur after vaccination. Only one anaphylactic reaction after vaccination has been reported [29].

Allergic Reactions to Egg Protein

MMR vaccines

MMR vaccines are created by cell cultures using a chicken embryo fibroblast. These vaccines contain minimal to negligible amounts of egg protein. Consequently, even in children with mild or severe egg allergies, MMR vaccinations result in a low risk of anaphylaxis [30,31].

Mild adverse reactions to MMR may occur regardless of skin test results in children with egg allergies. MMR skin tests do not predict an allergic reaction [32,33]. Interestingly, the majority of other hypersensitivity reactions following MMR vaccination are caused by components other than egg protein.

Influenza vaccines

The influenza vaccine is grown in an allantoic fluid in embryonated chicken eggs. The vaccine contains measurable quantities of egg proteins that vary broadly from 0. 2 to 42 µg/mL [34]. In theory, the influenza vaccine may result in systemic reactions when injected into egg-allergic patients. The safe administration of other vaccines containing egg protein has been investigated. Egg-allergic patients administered with either several graded doses of the influenza vaccine [35], or a two-dose protocol with the influenza vaccine presented with no negative vaccine reactions [36]. In the former study (several graded doses of the influenza vaccine), the egg content of the vaccine was not stated; in the latter study (a two-dose protocol with the influenza vaccine), the egg content was less than or equal to 1.2 µg/mL [36]. When the egg content of the vaccine could not be determined, it appeared that the appropriate clinical tests are the prick (full strength) and intradermal (1:100) skin tests for the appropriate vaccine. If the skin test results are positive, a more cautious (several dose) protocol for vaccine administration must be administered [34].

Recently, 28 studies have reported that more than 4,300 egg-allergic individuals who received influenza vaccines presented with no serious reactions (including respiratory distress or hypotension) and that only a low rate percentage of patients presented with minor reactions (hives and mild wheezing). Such results did not significantly differ from the rate in non-egg-allergic controls [17,37,38]. The majority of these studies specifically included patients with histories of severe anaphylaxis (n=656) as a result of egg ingestion. These patients did not experience hypersensitivity due to trace amounts of egg protein.

In 2011, the United States Centers for Disease Control (USCDC) reported that the amount of ovalbumin in an influenza vaccine circulated in the US was less than 1 µg per 0.5 mL vaccination dose since 2011 [39,40]. The USCDC reported that all influenza vaccines distributed in the US contains low amounts of ovalbumin.

Both the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices and the American Academy of Pediatrics’ Committee on Infectious Diseases have recently concluded that egg allergy of any severity (including anaphylaxis) is not a contraindication to the administration of further influenza vaccine, but rather a precaution () [33,40].

Recommendations regarding influenza vaccination for persons who report allergy to eggs according to the Advisory Committee on Immunization Practices, United States, 2012-13 influenza season. TIV, trivalent inactivated vaccine. a)Persons with egg allergy may tolerate egg in baked products (for example bread or cake). Tolerance to egg-containing foods does not exclude the possibility of egg allergy. Adapted from Centers for Disease Control and Prevention [40].

Whilst the intranasally administration of live attenuated influenza vaccine (LAIV) contains a low amount of ovalbumin, the majority of published studies support the injectable trivalent inactivated vaccine (TIV), and thus support TIV rather than LAIV for egg-allergic recipients.

From 2004 to 2006, 9 different influenza vaccines were distributed in Korea by either domestic and/or foreign companies. These 9 different influenza vaccines were measured for albumin content. Each of the 9 different influenza vaccines were below 1. 2 µg per 1 mL dose of albumin content () [41]. The domestic vaccination guideline, however, did not list the amount of egg protein in all influenza vaccines being circulated in Korea.

The range of ovalbumin content in the different manufacturing companies (A-I) in Korea. Adapted with Roh et al. [41], with permission from The Korean Academy of Pediatric Allergy and Respiratory Disease.

The risk of not vaccinating remains a greater risk than that of vaccinating. Patients who report that they are egg allergic should be referred to an allergist, who can assess the current status of the patient’s egg allergy as previously diagnosed by history and skin tests or blood tests for IgE antibody to egg. Importantly, this should not delay influenza vaccination [17]. Skin testing of egg-allergic persons with the influenza vaccine before administration is not recommended due to low sensitivity of the test and specificity in predicting serious reactions to vaccine administration. Dividing the dose of vaccine is also not required because even the most severely egg-allergic patients can tolerate the full vaccine dose without reaction [33,39,40].

The primary precaution of adverse influenza vaccination to those who are egg allergic, include: that the vaccine be administered in a clinical setting whereby anaphylaxis can be recognized and immediately treated should it occur, and that patients should remain under observation for at least 30 minutes after vaccination. The current guidelines indicate that egg-allergic patients with a history of hives only after egg ingestion, can receive influenza vaccine in a primary care physician’s office provided that the appropriate personnel and equipment are available. Patients with a history of more severe reactions to egg ingestion, however, should receive their vaccine in an allergist’s office [39,40].

Egg protein containing vaccination candidates are routinely asked if they are allergic to soft-bolied eggs such as “scrambled eggs” [39,40]. The influenza vaccine is not heated during manufacturing and therefore still contains egg proteins that would otherwise be destroyed by heat. It should be noted, however, that a patient has shown to be allergic to a heat-labile egg protein [42]. Thus, it may be difficult to identify all persons allergic to egg proteins present in influenza or other vaccines purely by patient clinical history.

Yellow fever vaccines

Whilst the Yellow fever vaccine is grown in chicken embryos and contains residual egg protein, the amount of residual egg protein remains unavailable to the manufacturer. Patients with allergic reactions to egg-containing vaccines should be evaluated for IgE antibody to eggs. There are commercially available skin test reagents and serum specific IgE tests to eggs. Individuals who react to egg ingestion should be evaluated prior to administration of yellow fever vaccine. If the history is consistent with an immediate-type allergic reaction to egg and is confirmed by skin tests or serum specific IgE, skin testing should be performed with yellow fever vaccine before administration [4,17]. If the result is positive, the vaccine should be injected in graded doses under observation. If negative, the injection should be carried out normally with close observation for another 30 minutes following vaccination.

Conclusion

Patients with suspected allergies to vaccines or vaccine components should be evaluated by an allergist. A meticulous medical history of the patient should be recorded to determine the nature and timing of the reaction to the vaccine in question and vaccine constituents, such as gelatin, egg, latex and yeast.

All suspected anaphylactic reactions to vaccines should ideally be evaluated in an attempt to determine the culprit allergen. It is disturbing that a patient who experiences an IgE-mediated reaction following immunization is often labeled as being “allergic” to the vaccine and is thus advised against receiving future doses without further investigation. This approach should be avoided as it may leave patients inadequately immunized if they unnecessarily avoid the vaccines to which they are not allergic to, or if the vaccine can be administered safely without causing an allergic reaction. In addition, not knowing the particular constituents of a vaccine to which the patient is allergic to may pose a risk to future doses of other vaccines that contain similar constituents.

The approach to a patient who may be allergic to eggs and require the influenza vaccine should be distinguished from the approach to a patient who has had an apparent allergic reaction to the influenza vaccination. Domestic vaccination guidelines in Korea should list the amount of egg protein in all influenza vaccines to provide further information about vaccines being administered domestically.

Footnotes

No potential conflict of interest relevant to this article was reported.

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Allergies to mRNA-based COVID-19 vaccines rare, generally mild, Stanford-led study finds | News Center

For a more complete understanding of allergic reactions to the new vaccines — how common they are, as well as how severe — the research team examined the medical records of health care workers who received 38,895 doses of mRNA-based COVID-19 vaccines at Stanford Medicine between Dec. 18, 2020, and Jan. 26, 2021. The vaccinations included 31,635 doses of the Pfizer vaccine and 7,260 doses of the Moderna vaccine.

The researchers searched vaccine recipients’ medical records for treatment of allergic reactions and identified which reactions were linked to the vaccines. Twenty-two recipients, 20 of them women, had possible allergic reactions, meaning specific symptoms starting within three hours of receiving the shots. The researchers looked for the following symptoms in recipients’ medical records: hives; swelling of the mouth, lips, tongue or throat; shortness of breath, wheezing or chest tightness; or changes in blood pressure or loss of consciousness. Only 17 of the 22 recipients had reactions that met diagnostic criteria for an allergic reaction. Three recipients received epinephrine, usually given for stronger anaphylaxis. All 22 fully recovered.

Of the 22 recipients, 15 had physician-documented histories of prior allergic reactions, including 10 to antibiotics, nine to foods and eight to nonantibiotic medications. (Some recipients had more than one type of allergy.)

What’s important is what we didn’t find, as much as what we did find.

The researchers performed follow-up laboratory testing on 11 individuals to determine what type of allergic reaction they had, as well as what triggered their allergy: Was it one of the inert sugar or lipid ingredients in the bubble, or something else in the vaccine?

The study participants underwent skin-prick tests, in which a clinician injected small amounts of potential allergens — the lipids, sugars (polyethylene glycol or polysorbates) or entire vaccine — into the skin. Skin-prick testing detects allergic reactions mediated by a form of antibody known as immunoglobin E, or IgE; these reactions are generally associated with the severest allergies.

None of the recipients reacted on skin-prick tests to the inert ingredients in the vaccines, and just one recipient’s skin reacted to the whole COVID-19 vaccine. Follow-up blood tests showed that the vaccine recipients did not have significant levels of IgE antibodies against the vaccine ingredients.

Since the skin tests did not explain the mechanism of recipients’ allergic reactions, the investigators proceeded to another type of diagnostic test. Vaccine recipients provided blood samples for tests of allergic activation of immune cells known as basophils. The blood samples from 10 of the 11 participants showed a reaction to the inert ingredient polyethylene glycol (PEG), which is used in both the Pfizer and Moderna vaccines. In addition, all 11 recipients had basophil activation in response to the whole mRNA vaccine when it was mixed with their own basophils.

All 11 subjects had high levels of IgG antibodies against PEG in their blood; IgG antibodies help activate basophils under some conditions, and this finding suggests the individuals were likely sensitive to PEG before receiving their vaccines.

“What’s important is what we didn’t find, as much as what we did find,” Nadeau said. “It does not seem that the mRNA itself causes the allergic reactions.”

In addition, the data suggest that reactions to the COVID-19 vaccines were generally not the most severe form of allergic reaction, which is good news in terms of vaccine safety, she said. Allergic reactions mediated by IgG and basophils can be managed with antihistamines, fluids, corticosteroids and close observation, meaning that many individuals who have had a reaction to their first vaccine dose can safely receive a second dose under medical supervision.

PEG is widely used as a stabilizer in household products, cosmetics and medications, with women more likely to be exposed to large quantities of the substance, possibly explaining why more vaccine allergies have been seen among women. (Repeated exposures to a substance can sometimes sensitize the immune system and provoke allergies.) Because most reactions were to PEG rather than the vaccine’s active ingredients, it is likely that vaccine manufacturers can reformulate the vaccines with different stabilizers that are less likely to cause allergies, Nadeau said.

The study’s other Stanford authors are research assistants Theo Snow, Alexandra Lee, Mihir Shah, Eric Smith, Evan Do and Iris Chang; Andra Blomkalns, MD, professor of emergency medicine; Brooke Betts, PharmD, clinical pharmacist; medical student Anthony Buzzanco; graduate student Joseph Gonzalez; Sharon Chinthrajah, MD, associate professor of medicine and of pediatrics; lab manager Diane Dunham; Grace Lee, MD, professor of pediatrics; Ruth O’Hara, MD, PhD, dean of research and professor of psychiatry and behavioral sciences; Helen Park, PharmD, clinical pharmacist at the Veterans’ Affairs Palo Alto Health Care System; Lisa Schilling, RN, MPH, vice president of quality, safety and clinical effectiveness and chief quality officer with Stanford Health Care; Sayantani Sindher, MD, clinical associate professor of medicine and of pediatrics; Deepak Sisodiya, PharmD, administrative director of pharmacy services at Stanford Health Care; Mindy Tsai, DMSc, senior research scientist in pathology; and Stephen Galli, MD, professor of pathology and of microbiology and immunology.

Nadeau is a member of the Stanford Institute for Immunology, Transplantation and Infection; senior fellow at the Stanford Woods Institute for the Environment; a fellow at the Stanford Center for Innovation and Global Health; and member of the Bill Lane Center for the American West at Stanford. Nadeau and Galli are members of Stanford Bio-X. Nadeau, O’Hara and Galli are members of the Stanford Cardiovascular Institute. Nadeau and O’Hara are members of the Wu Tsai Neurosciences Institute at Stanford. O’Hara, Nadeau, Chinthrajah, Grace Lee, Sindher and Galli are members of the Stanford Maternal and Child Health Research Institute. Galli is a member of the Stanford Cancer Institute.

Researchers from the Swiss Institute of Allergy and Asthma Research at the University of Zurich; the Department of National Heart and Lung Institute at Imperial College London; and the Centre in Allergic Mechanisms of Asthma, London, also contributed to this research.

The research was supported by the Asthma and Allergic Diseases Cooperative Research Centers (grant U19AI104209), the National Institutes of Health (grant R01AI140134), the National Institute of Allergy and Infectious Disease SARS Vaccine study (grant UM1AI10956508), the Parker Foundation, the Crown Foundation and the Sunshine Foundation.

What You Should Know – Cleveland Clinic

If you’re living with some type of allergy, you’re already on high alert daily to prevent allergic reactions. So, when you hear that some people have experienced allergic reactions after receiving COVID-19 vaccines, you might be wondering if you should get the shot.

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David M. Lang, MD, allergist and Chair of Cleveland Clinic’s Department of Allergy and Clinical Immunology, has a few reasons why you shouldn’t hesitate to get vaccinated against COVID-19.

What we know so far about allergic reactions to COVID-19 vaccines

Between December 14-23, 2020, monitoring by the Vaccine Adverse Event Reporting System detected 21 cases of anaphylaxis after 1,893,360 first doses of the Pfizer-BioNTech COVID-19 vaccine. This evened out to about 11.1 cases per million doses. Seventy-one percent of these cases also occurred within 15 minutes of vaccination.

Since then, the Centers for Disease Control and Prevention (CDC) has stated that anaphylaxis after COVID-19 vaccination is rare. In the U.S., about two to five people per million vaccinated have experienced anaphylaxis so far. But this isn’t exclusive to COVID vaccines. Severe allergic reactions can occur after any vaccination.

“Even though there is a risk of anaphylaxis, it’s still very small — and the potential benefit from the COVID-19 vaccination clearly exceeds the potential for harm,” says Dr. Lang. “The situation is evolving, however, and we’ll learn more as we continue to work with these vaccines.”

Reasons to avoid the vaccine

It’s recommended that if you’ve had an allergic reaction to any of the ingredients in the available vaccines, talk to your healthcare provider first. For instance, if you’ve had an allergic reaction to an ingredient in one of the mRNA vaccines (Moderna and Pfizer-BioNTech), your provider might suggest Johnson & Johnson’s COVID-19 vaccine. Or, if you’re allergic to any ingredient in Johnson & Johnson’s COVID-19 vaccine, your provider might recommend an mRNA vaccine. This can also apply if you had an allergic reaction to the first dose of a COVID-19 vaccine.

But having seasonal allergies or a shellfish allergy doesn’t mean that you can’t get vaccinated.

What ingredients are in the COVID-19 vaccines?

Here’s a breakdown of what’s in the three COVID-19 vaccines that have either been FDA-approved or approved for emergency use.

Pfizer BioNTech’s COVID-19 vaccine ingredients

According to Pfizer, the Pfizer BioNTech COVID-19 vaccine is a messenger RNA (mRNA) vaccine that was made with synthetic and chemically produced components as well as enzymatically produced components from naturally occurring substances like proteins. This vaccine does not have a live virus in it.

Inactive ingredients in the Pfizer BioNTech COVID-19 vaccine include:

  • Potassium chloride.
  • Monobasic potassium.
  • Phosphate.
  • Sodium chloride.
  • Dibasic sodium phosphate dehydrate.
  • Sucrose (sugar).
  • Small amounts of other ingredients.
Moderna’s COVID-19 vaccine ingredients

Moderna’s vaccine is similar to Pfizer BioNTech’s and also has no live virus in it. Its ingredients include:

  • Messenger ribonucleic acid (mRNA).
  • Lipids, or fatty substances, including: SM (sphyngomyelin)-102, Polyethylene glycol (PEG) 2000 dimyristoyl glycerol (DMG), 1, 2-distearoyl-sn-glycero-3-phosphocholine (DSPC), and cholesterol.
  • Tromethamine.
  • Tromethamine hydrochloride.
  • Acetic acid.
  • Sodium acetate.
  • Sucrose (sugar).
Johnson & Johnson’s COVID-19 vaccine ingredients

Unlike the other vaccines, the Johnson & Johnson vaccine is a single-dose viral vector vaccine, which uses an adenovirus (the kind of virus that typically causes colds) to harmlessly deliver the DNA code into your cells. Besides those virus particles, the ingredients of this vaccine include:

  • Sodium chloride.
  • Citric acid monohydrate.
  • Trisodium citrate dihydrate.
  • Polysorbate-80.
  • (2-Hydroxypropyl)-β-cyclodextrin.
  • Ethanol.

What can cause allergic reactions to COVID-19 vaccines?

“It’s believed that COVID-19 vaccine-related allergic reactions are caused by polyethylene glycol (PEG), an ingredient in the vaccines,” says Dr. Lang. “Whether some of the reactions are occurring via another mechanism is unclear at this time.”

How vaccination myths can cause hesitation

While hearing about allergic reactions to COVID-19 vaccines can be worrisome, Dr. Lang believes educating patients about the infrequency of adverse reactions and breaking down common vaccination myths can help put more people at ease.

“Many times, patients claim they got sick from a vaccine when they’re really referring to a natural immune response from the vaccine. Fever, chills and muscle aches can occur within 36 hours of vaccination because a patient’s immune system is responding appropriately in developing immunity after receiving the vaccine. It’s not an allergic reaction.”

He adds that delayed reactions due to immune response, as well as fatigue, soreness at the injection site and vasovagal reactions(drop in blood pressure, fainting episodes), are not cause for avoiding COVID-19 vaccines. This is especially important to keep in mind if a reaction occurs after the first dose of a two-dose COVID-19 vaccination regimen.

Can you get a COVID-19 vaccine if you had an allergic reaction to another vaccine?

If you’ve had a severe allergic reaction to another vaccine or injectable medication — or have experienced anaphylaxis from any cause — you can still receive the COVID-19 vaccine. However, your vaccination should be followed by a 30-minute observation period in a setting where personnel, equipment and supplies are present to manage anaphylaxis.

“Anaphylaxis commonly occurs within 30 minutes of exposure and would be unusual after 60 minutes,” says Dr. Lang.

Can you get a COVID-19 vaccine if you have food allergies or medication allergies?

Patients with allergies to other medications, foods or inhalants can receive the COVID-19 vaccine with normal precautions. This typically includes a 15-minute observation period after the injection based on CDC guidelines.

Can you get vaccinated against COVID-19 if you’re allergic to penicillin?

While about 10% of the population has reported a penicillin allergy, less than 1 in 10 of those people are truly allergic. About 80% of those who were once allergic to penicillin lose their sensitivity to it after 10 years. Dr. Lang says that you can still get vaccinated even if you’re allergic to penicillin. Since December of 2020, more than 390 million doses of COVID-19 vaccines have been given in the United States. And the CDC says the vaccines are safe and effective. If you’re not sure about what you should do, talk to your provider.

Can you take allergy medicines before getting a COVID-19 vaccine?

It’s not recommended to take pain relievers or allergy medications before you receive a COVID-19 vaccine. Doing so could interfere with the body’s immune response to the vaccine. So if you’re thinking about taking allergy medicine before your appointment, Dr. Lang says it’s not necessary.

90,000 Allergy to vaccines | Remedium.ru

This section is only for specialists in the field of medicine, pharmacy and healthcare!

Contents

  1. Types of vaccine allergy
  2. Clinical manifestations of allergy to vaccines
  3. Allergy to vaccine components
  4. Can a person with allergies be injected with the vaccine?
  5. How is vaccine allergy diagnosed?
  6. The procedure for vaccination of patients with allergy to vaccines
  7. References

Vaccines play a huge role in preventing a range of bacterial and viral diseases, including COVID-19, a new viral infection caused by SARS-CoV-2 that has caused a global pandemic.A number of vaccines have been created in Russia against COVID-19 – Sputnik V, Sputnik Light, Kovivak, Epivakkorona, but people often fear severe side effects, including allergy to vaccines. Severe allergic reactions to vaccines are rare but difficult to predict, and their existence makes it difficult to advance the idea of ​​vaccination.

The World Allergy Organization has recommended that immunologic reactions to drugs (including vaccines) be classified according to the timing of the onset of symptoms].This system defines two main types of reactions: immediate and delayed. This approach aims to distinguish immunoglobulin E (IgE) mediated (type I immunological reactions), which cause many immediate reactions, from other types, as these reactions carry the risk of life-threatening anaphylaxis if the patient is repeatedly exposed.

  • Immediate reactions begin within the first hour after administration and may manifest within the first few minutes.IgE-mediated reactions are most likely during this time period.
  • Delayed reactions appear several hours or days after ingestion. These reactions can be triggered by several different mechanisms, but they are rarely IgE-related.

An immediate, IgE-mediated allergic reaction can include various combinations of 40 potential symptoms and signs.

The most common symptoms and signs are:

  • Skin symptoms including redness, itching, hives, and angioedema.
  • Respiratory symptoms, including nasal discharge, nasal congestion, change in voice quality, throat closing or choking sensation, stridor, cough, wheezing and shortness of breath.
  • Cardiovascular symptoms, including syncope, syncope, mental status change, palpitations, and hypotension. Anaphylaxis (anaphylactic shock after vaccination) is the most severe form of an IgE-mediated allergic reaction.

Anaphylaxis is defined as a systemic allergic reaction that develops rapidly and can lead to death.Anaphylactic reactions to vaccines are rare; their frequency, according to active surveillance studies, ranges from 0.65 to 1.31 per 1 million doses of vaccine.

Anaphylactic shock occurs most often within the first 30 minutes after the vaccine is given, although the onset can sometimes be delayed by up to several hours. Later onset reactions are usually less severe. Reactions that occur several hours or days after vaccine administration may be associated with delayed absorption of the allergenic component.Some of these late reactions may not be causally related to vaccination, but to another allergen that the person has encountered after the vaccine was given.

Vaccine reactions . Not to be confused with complications after vaccine administration (post-vaccination complications, PVO). They can be both immunological and non-immunological.

  • Fever, increased body temperature are common after vaccine administration and do not interfere with the administration of further doses of the same drug (revaccination, booster).
  • Local reactions to vaccinations, such as swelling and redness at the injection site, are common and will go away on their own. This should not be seen as a reason to refuse further doses of the vaccine.
  • Local reactions can be treated with cool compresses within the first hours after symptom onset, paracetamol, or non-steroidal anti-inflammatory drugs (NSAIDs) if pain or swelling is bothersome. However, antipyretics should not be given prophylactically, “just in case,” as several studies have shown that these drugs can reduce the immune response to vaccinations.

  • Serum sickness and reactions , similar to serum sickness , includes rash, fever, malaise,
  • joint pain or polyarthritis that occurs one to two weeks after vaccination or earlier if the patient has received the vaccine more than once.

  • Other rare reactions – delayed immunological reactions include rare cases of persistent itchy nodules at the injection site of aluminum-containing vaccines, which may be associated with delayed-type hypersensitivity to aluminum.Another rare reaction is encephalopathy. Some of these more serious reactions may be contraindications to further doses of specific vaccines.

The vaccine can cause vasovagal reaction (loss of consciousness), especially in patients prone to this reaction. Vasovagal reactions are characterized by hypotension, pallor, sweating, weakness, nausea, vomiting, bradycardia, and in severe cases, loss of consciousness.

Vasovagal reactions can mimic anaphylaxis, as both conditions can include hypotension and collapse.However, the skin signs and symptoms are completely different. Fainting is usually preceded by pallor, whereas anaphylaxis often begins with hot flushes and may also include pruritus, urticaria, and angioedema. In anaphylaxis, tachycardia is more common than bradycardia. For patients who report past fainting in response to vaccinations, it is advisable to administer the vaccines in the future while in the supine position.

This phrase is listed as a contraindication in the medical instructions for many vaccines.But what exactly does it mean, what substances can we talk about? Important: the listed list is general for the vaccine industry, this does not mean that all the listed substances and compounds are present in absolutely all vaccines, a specific list of excipients in each vaccine is reflected in its instructions for medical use.

Gelatin . It is added to many vaccines as a stabilizer; it can cause anaphylactic reactions to vaccines containing it.Often, these people are sensitized to alpha-gal (galactose-alpha-1,3-galactose), a carbohydrate allergen that causes allergies to mammalian meat. Some patients had clinically significant allergies to beef and pork.

Before the administration of any gelatin-containing vaccine, it is necessary to find out if there is a history of allergies to taking gelatin and foods containing gelatin (for example, marshmallows and marmalade candies). However, a negative allergic history does not exclude the possibility of developing anaphylaxis, so testing for gelatin allergy may be required.

Individuals who react to gelatin by ingestion should be evaluated by an allergist prior to administration of the vaccine. If there is a history of an immediate allergic reaction to gelatin and this is confirmed by skin tests or IgE serum tests to gelatin, it is advisable to perform a skin test of such patients with gelatin-containing vaccines before their administration. If a skin test for the vaccine is negative, it can be administered in the usual way, but the patient must then remain monitored for at least 30 minutes.If a skin test of the vaccine is positive, the vaccine can be given in graduated doses. Alternatively, it is recommended to use gelatin-free vaccines, if available.

The incidence of allergic reactions to gelatin in vaccines was particularly high in Japan, and this phenomenon was subsequently attributed in part to the genetic characteristics of the population. Japanese manufacturers have removed gelatin from some vaccines and switched to more thoroughly hydrolyzed gelatin in others, dramatically reducing the frequency of reactions.These strategies have been applied differently in other countries, so reactions to gelatin in vaccines still occur.

Egg white is present in yellow fever vaccines, MMR, and some flu and rabies vaccines. However, this amount is only potentially of clinical significance in yellow fever vaccine. MMR and rabies vaccines can be safely administered in the usual manner to egg allergy patients.

Before the administration of the yellow fever vaccine, a history of allergies after eating eggs, raw or cooked, should be ascertained, and those with a positive history should be examined by an allergist.Such patients should undergo a skin test with yellow fever vaccine prior to administration. If a skin test for the vaccine is negative, the vaccine can be administered as usual, but the patient must then remain under observation for at least 30 minutes. If a skin test of the vaccine is positive, the vaccine can be given in graduated doses.

Cow’s milk . Casein, an allergenic protein found in cow’s milk, has previously been implicated in anaphylaxis against diphtheria, tetanus and pertussis vaccines (DTaP or Tdap) in a small number of children with severe milk allergies.Such vaccines are prepared in a medium prepared from cow’s milk protein, and in these formulations, the amount of residual casein in nanograms has been demonstrated. However, the vast majority of patients with severe milk allergies are not allergic to such vaccines.

Thimerosal, aluminum and phenoxyethanol are added to some vaccines as preservatives, although the use of thimerosal (which contains mercury) in vaccines has dropped dramatically due to theoretical concerns about cumulative exposure to mercury in children.These preservatives have not been documented to cause immediate allergic reactions to vaccines, and immediate skin tests are generally not indicated.

Some antimicrobials can be added in trace amounts to vaccines, most commonly neomycin, polymyxin B, and streptomycin. Although there are no specific reports of vaccine-induced anaphylaxis with these drugs, it is rare for patients who have confirmed anaphylactic reactions caused by these antibiotics should not receive vaccines containing them without prior evaluation by an allergist.

Latex . The “rubber” in vaccine vial stoppers or syringe plungers can be either dry natural rubber latex (DNR) or synthetic rubber. Those made from latex carry a theoretical risk for latex allergic patients, either as a result of the liquid vaccine solution extracting the latex allergens from the plug on physical contact, or as a result of passing a needle through the plug and holding the latex allergen inside or on the needle.One report of anaphylactic reaction following administration of hepatitis B vaccine to a latex allergic patient has been associated with rubber in a cork. A review of> 160,000 reports from the United States Vaccine Side Effects Reporting System (VAERS) identified only 28 cases of possible immediate allergic reactions after receiving a vaccine containing DNR and could have been caused by other components. The latex content of the vaccine packaging can be found in the leaflet for medical use.

Patients with latex anaphylaxis can safely receive vaccines from vials with non-DNR stoppers.If the only available product has a latex stopper, the stopper should be removed and the vaccine drawn directly from the vial without passing the needle through the stopper. If the only vaccine available contains latex in a package that cannot be avoided, such as in a pre-filled syringe, the vaccine can still be administered, but the patient should then be observed for at least 30 minutes.

Unlike patients with latex-induced anaphylaxis, patients with contact allergies to latex, such as hand dermatitis, can safely receive vaccines from latex stopper vials.

Yeast . Some vaccines contain yeast protein, including hepatitis B vaccines (up to 25 mg per dose) and 4- and 9-valent human papillomavirus vaccines (

Dextran causes allergic reactions to a specific brand of MMR vaccine previously used in Italy and Brazil. Reactions have been associated with the presence of anti-dextran IgG, and it has been suggested that the mechanism is activation of the complement system and release of anaphylatoxin.This brand of vaccine has been withdrawn from the market, although dextran is sporadically found in other vaccines (for example, in some rotavirus vaccines).

The diagnostic approach is different for a patient who has reacted to a vaccine component such as gelatin, eggs, latex or yeast, but not to the active ingredient itself. A common situation is that a patient with an egg allergy is vaccinated against the flu and is successful and without complications.

What clinical questions should be answered before vaccinating an allergic patient?

  • Is the nature of the manifestations and the time of onset of anaphylactic anaphylaxis consistent? Does this look like a clinical picture mediated by IgE?
  • Is there a history of a similar reaction? It is important to obtain this information and to understand whether it was caused by the vaccine antigenic material or excipients.The various components of the vaccine are clearly listed in the manufacturer’s directions for use. If the reaction occurs after the first dose of vaccine, the likelihood that the immunizing agent itself is an allergen is greatly reduced. In this clinical situation, healthcare providers should also be aware of allergic reactions to food, especially gelatin.
  • Is there a need for future doses of this vaccine or other vaccines with common ingredients? After a history of a vaccine response that occurs shortly after administration that is consistent with an IgE-mediated response, the clinician should determine if future doses of the suspected vaccine or other vaccines with common constituents are required.Given the potential for cross-reaction with common components in other vaccines and with food, careful evaluation is warranted, even if additional doses of a potentially allergenic vaccine are not required.

If the patient is about to receive additional doses of the vaccine, skin testing using that same vaccine should be done. Correct performance and interpretation of skin tests requires experience in this procedure, including the use of appropriate positive and negative controls.In addition, skin tests themselves rarely cause anaphylactic reactions in severely allergic people. Therefore, skin testing should only be performed by individuals, such as allergists, who are trained in interpreting and treating potential test reactions, and only in conditions where anaphylactic reactions can be recognized and quickly controlled.

The vaccine must first be tested using the skin prick method. A complete vaccine can be used if the history of the reaction was not truly life-threatening; in this case, it is advisable to dilute the vaccine before the skin injection.

If the complete injection is negative, an intradermal test should be performed with the vaccine diluted 1: 100 in 0.9% (isotonic) saline, again with the corresponding positive and negative controls.

Interpretation of vaccine skin tests. An allergic history is critical to the interpretation of vaccine skin tests. Clinically irrelevant positive skin tests are possible, as with skin tests for any allergen.A positive skin test for a vaccine does not necessarily indicate a subsequent reaction, although this should be considered a significant risk factor.

Vaccines can induce IgE production in the first days or weeks after vaccination, although the clinical significance of this is unclear. Specific IgE for diphtheria (DT) and tetanus toxoids has been induced by vaccination and has been shown to persist for at least two years after immunization. This specific IgE was not associated with allergic reactions with subsequent vaccinations.

Irritant (false positive) reactions to skin tests are also possible, especially with intradermal skin tests at a concentration of 1:10 or undiluted. One study of 20 adult volunteers with no history of vaccine reactions evaluated skin prick response and intradermal testing with 10 common vaccines. Irritant reactions were not observed when tested for skin pricks and were unusual after intradermal testing at a concentration of 1: 100.However, they were common at higher intradermal concentrations (1:10 or undiluted). Therefore, intradermal vaccine testing should only be done at a 1: 100 concentration.

Delayed reactions. Delayed-type hypersensitivity reactions were observed at the site of a skin test (especially intradermal) with a vaccine. These reactions are not relevant to the diagnosis of IgE-mediated vaccine allergy.

Testing of vaccine components.If the suspected vaccine contains eggs, gelatin, latex, or Saccharomyces cerevisiae yeast, the patient should also have skin testing for the following ingredients:

Skin injections:

  • Extracts of eggs and yeast Saccharomyces cerevisiae for skin tests.
  • Gelatin extract can be prepared by dissolving 1 teaspoon of any color or flavor of candied gelatin powder in 5 ml saline to create a skin test solution.
  • Standardized Natural Rubber Latex Extracts (NRL).

Measurement of allergen-specific IgE in serum:

  • Specific IgE for eggs, gelatin, latex and yeast can be measured in serum using immunoassays. The sensitivity of the ImmunoCAP and Immulite latex tests is approximately 80%.

Most patients with previous vaccine reactions can be safely vaccinated in the future with appropriate precautions.

General strategy: If the intradermal vaccine test is negative, then the likelihood that the patient has IgE to any vaccine is negligible and the vaccine can be administered in the usual way. However, it is advisable to observe such patients for at least 30 minutes and have a styling close by to assist with anaphylactic shock.

If a skin test of the vaccine or vaccine component is positive, and if the vaccine is deemed necessary, it can still be administered using a graduated dose protocol (divided by the Frequently method).The successful administration of vaccines to patients with positive skin tests using differentiated protocols has been described for several different vaccines.

Administration of the vaccine to an allergic person, even with this differential dose protocol, still carries a risk of anaphylactic reaction and should only be undertaken with written informed consent. In addition, administration should be performed with personnel and equipment available to recognize and treat anaphylaxis.


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  68. 90,021 90,000 Doctors tell you how to prevent allergy to COVID-19 vaccine

    Allergic reactions to components of coronavirus vaccines can lead to urticaria, edema, fainting and anaphylactic shock, doctors told Gazeta.Ru. Moreover, such an outcome is unlikely, and generally people with chronic allergies may be hypersensitive to the drug. Despite this, before vaccination, doctors advise to pass tests for allergens, and the drug itself should be administered under the supervision of health workers.

    In New York, a healthcare worker developed a severe allergy after the introduction of the coronavirus vaccine from the American company Pfizer. Local newspaper Newsweek reports.

    According to the newspaper, this is the first such case in more than 30 thousand vaccinations. Immediately after the onset of symptoms, the patient received medical attention, and his condition is assessed as stable. At the same time, the exact place and time of vaccination is not specified.

    “Vaccines do have side effects and can cause allergic reactions, although these are rare,” said the New York City Department of Health and Mental Hygiene.

    The US National Institute of Allergy and Infectious Diseases is investigating the causes of vaccine allergies from Pfizer and BioNTech. They also intend to test the drug of the Moderna company.

    Meanwhile, it was reported that two medical workers in the US state of Alaska needed help after receiving the first dose of BioNTech and Pfizer’s vaccine. One of them went to the hospital. According to media reports, his reaction to the vaccine was similar to that which appeared earlier, presumably, in two doctors after being vaccinated in the UK.

    As the doctor-immunologist Maria Polner explained to Gazeta.Ru, it is quite difficult to predict an allergic reaction to a drug in advance, and often impossible.

    “It is for this reason that routine screening for drug allergens is not recommended. For example, there is a possibility that according to blood tests, antibodies to the drug will be normal, but a reaction will develop when it is used.

    There are also difficulties with skin and provocative testing. Indeed, with the initial use of the drug, an allergic reaction does not develop, but it can happen with any subsequent use of the drug, ”the specialist explains.

    To diagnose allergies to vaccine components, according to her, first of all, it is necessary to carefully study the patient’s history, take into account the reactions to previous medications.

    “As a rule, an acute allergic reaction occurs no later than 15-20 minutes after the injection, and often almost immediately. During this time, the person is under the supervision of medical personnel, ”says Polner.

    Doctor-allergist Galina Evdokimova adds that an allergic reaction to vaccinations is a rather rare occurrence.Basically, it manifests itself immediately and is characterized by the same symptoms as when in contact with other allergens.

    “A person may develop, for example, skin abnormalities: edema, urticaria, and itching. With a stronger reaction, coughing, wheezing, shortness of breath, and even fainting. If a physician notices this, then it is urgently necessary to inject adrenaline, and then send the patient for examination to an allergist, “she says to Gazeta.Ru.

    Allergist Olga Grishkova specifies that hypersensitivity and post-vaccination complications can be observed in anyone.In this case, a true allergy manifests itself to such a component as protein. “Any vaccine can be allergic, because at least some of the protein is used everywhere. But no one will document it like that, because it is impossible to prove that a person reacted specifically to a certain component. They will always write that this is a hypersensitivity to this or that vaccine, ”she points out.

    In this case, allergy sufferers may also develop late allergic reactions, which begin a few hours after vaccination or even the next day.

    According to Evdokimova, in such cases the injection site becomes inflamed – redness and soreness appear.

    “These symptoms cannot be called an acute allergic reaction, so there is no need to worry that there may be complications. In addition, the next time the vaccine is given, there will be no immediate risk of allergy.

    If a person is worried that an allergic reaction to the vaccine may occur, an allergist or immunologist may conduct a skin injection or blood test to determine if there is an allergy to the components of the vaccine, ”the doctor continues.

    People who are allergic to the vaccine can use an allergy-free alternative form. You can also take antihistamines or corticosteroids before vaccinations to prevent or reduce an allergic reaction, the allergist advises.

    “In any case, before giving the vaccine, the physician collects a complete history of the patient. All components of the drug are listed and, if a person does not know if he has an allergy, then adrenaline is prepared immediately so that he does not die from anaphylactic shock or Quincke’s edema.For about 20 minutes after the injection, they are watching him, ”the doctor concludes.

    Earlier, the head of the Center. Gamalei Alexander Gintsburg said on the air of the Russia 24 TV channel that people with chronic allergies, before being vaccinated with the Russian vaccine against coronavirus, should study C-reactive protein (a complications.

    He clarified that if these two indicators are normal, then, “of course, people with allergic diseases need to be vaccinated, and people with allergic diseases can be vaccinated.”

    90,000 Coronavirus vaccination for allergies – Real time

    Is the coronavirus vaccine safe if there is an allergy

    How to get vaccinated against coronavirus and then not get into a hospital bed if there is a history of allergies? The head of the city center of allergology and immunology of GAUZ “GKB No. 7″Kazan Guzel Zakirova. The immunologist also explained why it is a bad idea to take antihistamines to protect yourself from a reaction to the vaccine. Realnoe Vremya has collected the main recommendations of a doctor for allergy sufferers.

    It is better for those suffering from hay fever with vaccination not to rush

    The head of the city center of allergology and immunology of the 7th city hospital of Kazan Guzel Zakirova advises all allergy sufferers to be vaccinated only during remission.

    The doctor recalled that an allergic disease has two stages: a stage of remission without exacerbation and a stage of exacerbation.For people with a proven allergic disease, which manifests itself in the form of a reaction to house dust, animals, flowering plants: trees, cereals, weeds or, for example, insect bites, medications, vaccination is indicated and is possible only during the period of remission.

    Guzel Zakirova does not advise at the moment to vaccinate those suffering from hay fever and postpone vaccination until the beginning of October.

    – Now the third wave of bloom is coming. People with hay fever can react to flowering weeds: wormwood, quinoa, wheatgrass, ragweed.Patients may have a runny nose, watery eyes, itchy eyes, and asthma attacks. This group of people is now not subject to vaccination, because the disease is worsening. At the beginning of October, around the time the exacerbation passed, people recovered, and you can get vaccinated.

    If there is an allergic reaction to insect bites, the doctor still recommends vaccinating, but try to avoid bites and, as a result, manifestations of allergies: “No bite – no allergic reaction. This means that a person can be vaccinated. “

    The same rule for those who are allergic to drugs: “If there is a drug allergy, but this person does not take the drug, he has no complaints, he can also be vaccinated.”

    Guzel Zakirova advises all allergy sufferers to be vaccinated only during remission. Photo: inkazan.ru

    According to the doctor, people with an immunodeficiency state, anaphylactic shock, a history of acute severe reactions to drugs – with systemic organ damage – have a permanent medical withdrawal from vaccination.

    Also, the second dose of the vaccine will not be received by a person who, after the first vaccination, had a strong reaction to the first dose of a particular vaccine – with a high temperature of 40 ° C and convulsive syndrome.

    What reactions of the body during vaccination can scare, but in fact are not dangerous

    Guzel Zakirova spoke about the frequent symptoms that people get during vaccination, but are not a dangerous condition.

    – There are many conditions that resemble anaphylactic shock.Not every condition that is accompanied by a drop in blood pressure and dizziness is a shock. The introduction of the vaccine is quite painful, and some patients react in response to pain with a drop in blood pressure, this is a vegetative reaction of the body, this is not a shock.

    The doctor explained that real anaphylactic shock does not develop instantly.

    – In order for the body to react to a drug as an allergen, it must be familiar with it – the immune system must develop antibodies specifically to this drug.And if he has never met this drug, then there are no antibodies and there can be no real allergic anaphylactic shock.

    However, if a person is hypersensitive to any chemical or reacts with stress, cold, overheating or the sun, for example, with hives, they may develop hives when vaccinated. But she does not appear instantly, the doctor added.

    Any vaccine is stress for the body, the doctor reminded. Photo: mos.Common crawl en

    The simplest rules to easily transfer vaccination

    Any vaccine is stress for the body, the doctor reminded.

    In this regard, Guzel Zakirova gave simple recommendations, following which, you can minimize the possible unpleasant consequences of vaccination: the room should not be stuffy, hot. After vaccination, you need to stay in a medical facility for half an hour, do not expose yourself to physical exertion, insolation.

    To be vaccinated or not to people with autoimmune diseases

    In the case of a severe uncompensated disease, when the patient is under the supervision of rheumatologists, endocrinologists, neuropathologists, other doctors, takes medications, there is a risk of exacerbation of the underlying disease against the background of vaccination, the doctor believes.

    – You need to be careful about vaccination in this case, maybe make a medical withdrawal. But if an autoimmune disease – the same autoimmune perioditis, which is very common – is in the stage of compensation and correction, then there are no contraindications against vaccination.

    Guzel Zakirova, believes that it is safest for allergy sufferers to vaccinate with “Sputnik V” (“Gam-COVID-Vac”), since, according to the doctor, there are no peptides, no protein inclusions, the vaccine is low-component. Photo: mos.ru

    Which vaccine is best for allergy sufferers

    Guzel Zakirova believes that it is safest for allergy sufferers to be vaccinated with Sputnik V (Gam-COVID-Vac), since, according to the doctor, there are no peptides there, no protein inclusions, low-component vaccine.

    – For allergy sufferers, the simpler the composition, the fewer the ingredients, the better.

    The KoviVac vaccine has stricter contraindications for people who have had a history of anaphylactic shock to any medications, a complicated allergic history of vaccinations, the doctor said.

    All three vaccines: “CoviVac”, “Sputnik V”, “EpiVacCorona” have contraindications for the introduction of the second dose – this is a reaction to the first dose in the form of hyperthermia: temperature up to 40 degrees, convulsive syndrome, local reaction in the form of redness is more than 8 cm in diameter.

    In this case, the doctor recommends contacting an allergist, and already with him decide the issue of switching to another vaccine after a time interval.Guzel Zakirova emphasized that in this case, it is not necessary to be vaccinated with another vaccine immediately – after 3 weeks.

    – The doctor must find out if the patient has had a true reaction to the vaccine, because there are many false positives.

    Guzel Zakirova drew attention to the fact that in this case it is not necessary to be vaccinated with another vaccine immediately – after 3 weeks. Photo: mos.ru

    As an example, Guzel Zakirova cited three patients of the allergy department who were admitted with a diagnosis of “post-vaccination reaction”.

    The first patient had a history of weed hay fever – an exacerbation stage, and he did not need to be vaccinated at that time. After being vaccinated, he developed hives. The second patient has an exacerbation of herpes infection, and in the acute period he again should not have been vaccinated. And the third patient had been in the sun for a long time the day before and also gave a reaction during vaccination.

    Why allergy pills won’t help to transfer the vaccination more easily

    Antihistamines do not need to be taken in advance, the doctor is convinced.

    – Antihistamines are believed to decrease the immune response. In addition, they act on a certain type of immune response, on a certain allergic reaction, and this may not coincide at all with what happens in the human body during vaccination, and the expected effect will not be obtained.

    However, according to the doctor, if a person suffers from an allergic disease and is prescribed basic therapy with antihistamines, then he should continue to take them.

    – But if a person takes antihistamines, then he is in an aggravation stage, and he cannot be vaccinated. It is necessary to achieve the abolition of these drugs, the stage of remission, and then get vaccinated.

    Ekaterina Guzanova

    SocietyMedicine Tatarstan

    Before vaccination

    Comprehensive laboratory blood examination with the determination of IgE antibodies to allergens of chicken eggs, cow’s milk, yeast, gelatin, as well as formaldehyde levels by the ImmunoCAP method in order to assess the possible risk of developing systemic anaphylactic reactions after vaccine administration.

    Synonyms Russian

    Determination of the level of formaldehyde, IgE antibodies to chicken eggs and baker’s yeast.

    Synonyms English

    Allergy testing before vaccination:

    ImmunoCAP f245, Egg, IgE;

    ImmunoCAP f45 (Yeast, Saccharomyces cerevisiae), IgE.

    Research method

    Solid phase immunofluorescence (ImmunoCAP).

    Units

    kU / l (kilo unit per liter).

    What kind of biomaterial can be used for research?

    Venous blood.

    How to properly prepare for the study?

    • Do not smoke for 30 minutes prior to examination.

    General information about the study

    Routine vaccination of populations around the world prevents millions of deaths. Regular monitoring of the safety of vaccines has confirmed that the risk of adverse reactions is minimal, and the benefits of their use are many times greater than the possible harm.However, like any medicine, vaccines have side effects. The most common side effects of vaccines are fever and soreness at the injection site, which occurs in 1 in 10 children and disappears within 1–2 days. More serious complications in the form of severe anaphylactic reactions occur in 0.5-1 cases per 100,000 doses of vaccines.

    Allergic reactions to vaccine preparations are usually associated not with the vaccine itself, but with the protein components remaining in the composition during the manufacturing process.The vaccine contains an active immunizing component, a conjugating component, a preservative, an adjuvant, a stabilizer, an antimicrobial agent, and traces of the nutrient medium used for the manufacture of vaccines. Almost any component can cause an allergic reaction. Among the possible allergenic proteins in the composition of vaccines, special attention is paid to chicken egg proteins, gelatin and yeast. However, many studies have shown the safety of administering even a flu vaccine containing trace amounts of chicken egg protein to sensitized individuals after competent medication.

    Allergy to vaccines often develops according to the mechanisms of reactions of immediate I (IgE-mediated) and delayed (IV) types, less often – II and III types. A type I reaction occurs within minutes or in the rare first 4 hours after immunization. The most common symptoms of an immediate reaction are urticaria and angioedema, less often swelling of the nasal mucosa, cough, bronchospasm, abdominal pain, diarrhea, decreased blood pressure, and in extremely rare but especially severe cases, anaphylactic shock is possible.Type IV reactions are more often associated with thiomersal, aluminum, or antimicrobials in vaccines and usually do not pose a health hazard.

    Baker’s yeast proteins ( Saccharomyces cerevisiae ) are detected in vaccines against hepatitis B viruses and human papillomavirus. Allergic reactions to them are extremely rare and can be confirmed by skin testing or the detection of specific IgE antibodies. Baker’s yeast sensitization is not a contraindication to vaccine administration, however, in patients hypersensitive to Saccharomyces cerevisiae , the vaccine should be given in divided doses under longer medical supervision.

    Chicken egg proteins are present in trace amounts in vaccines against measles, rubella, mumps, influenza, yellow fever, tick-borne encephalitis virus. Despite the potential danger of developing allergic reactions, even in patients with severe reactions to chicken egg proteins, vaccination with the above drugs rarely causes serious complications. Nevertheless, when planning the immunization of persons sensitized to the protein of hen’s egg, fractional administration of vaccines containing this protein, and prolonged medical supervision are recommended.In the absence of sensitization, vaccines are administered according to the standard scheme, and the patient remains under observation for 30 minutes after the administration of the drug.

    Bovine serum albumin is a heat-labile protein weighing 67 kDa. It is the major beef allergen and the minor milk allergen. This serum albumin makes up about 1% of all cow’s milk proteins and about 5% of whey proteins. It is very similar in physical and immunological properties to human whey protein.Heat treatment at home reduces, but does not completely remove, the allergenic properties of this protein.

    Formaldehyde is a fairly common organic substance well known as an air pollutant. Indoors, formaldehyde can be sourced from fumes from polyurethane foam, particle boards, panels, plywood, some carpets and furniture, and is also found in tobacco smoke and combustion exhaust gases. It is also used in cosmetics, household chemicals, paper products, paint coatings, and more.

    Reaction to formaldehyde may depend on the type of exposure. Besides sensitizing, it has a primary irritant effect, which should be distinguished in clinical practice. Vapors of formaldehyde can cause burning in the eyes, in the nasopharynx, dermatitis and urticaria, bronchospasm, headaches and severe fatigue.

    Important aspects of the prevention of complications are a medical examination before vaccination, a thorough collection of an allergic history, identification of contraindications, elimination of possible risks of side effects, proper preparation in the presence of adverse factors, as well as the possibility of performing competent therapeutic measures in the event of allergic reactions of an immediate type.Therefore, when planning immunization of persons with possible or confirmed sensitization to some components of the vaccine, an additional laboratory examination by an allergist-immunologist is necessary to resolve questions about drug preparation for vaccination (for example, antihistamines), vaccination in specialized medical centers, fractional administration of vaccines and with close supervision for the patient in the first hours after immunization.

    What is the research used for?

    • To assess the possible risk of developing allergic reactions to vaccine components;
    • for proper preparation for immunization of patients with possible development of allergic reactions.

    When is the study scheduled?

    • Before planned immunization with certain vaccines in persons with a history of allergic reactions;
    • in the presence of manifestations of allergic reactions after the administration of vaccines in the anamnesis.

    What do the results mean?

    Reference values ​​

    For each indicator included in the complex:

    90,000 residents of the Republic of Tatarstan explained when allergy sufferers get vaccinated against Covid-19

    For which allergies and autoimmune diseases is vaccination prohibited?

    Seasonal allergies are not an obstacle to vaccination against a new coronavirus infection, you just need to wait until remission comes, and then you can schedule an injection.The head of the City Center of Allergology and Immunology of the Kazan Clinical Hospital No. 7 Guzel Zakirova spoke about this live.

    In addition, the allergist noted that Tatarstan residents often confuse symptoms similar to urticaria, Quincke’s edema, sneezing, a reaction to insect bites, with allergies, but not always a person has a true allergic disease.

    Illustration: Ekaterina Semenova

    There is a narrow range of diseases that provide a permanent medical objection to vaccination against a new coronavirus infection.

    “There is a small group of diseases that provide permanent medical treatment. This is an immunodeficiency state, anaphylactic shock, a history of acute drug reactions, when organs are damaged and a reaction to the first vaccination, but this is extremely rare, ”the speaker noted.

    Also, the vaccination should be interrupted if after the first dose there was a serious reaction of the body: convulsions, temperature above 40 degrees and the injection site increased by 8 centimeters. In this case, it is worth contacting allergists, they will determine whether there was an allergic reaction to the vaccine.

    The doctor noted that people who are now suffering from an exacerbation of hay fever after the third wave of flowering should not be vaccinated either. It is necessary to wait until the end of the active form of the disease, that is, until the fall.

    Photo: Salavat Kamaletdinov

    “If we are talking about an allergic reaction to an insect bite, then there is no insect bite – there is no allergic reaction, which means that a person can be vaccinated. If he has a drug allergy, but is not currently taking this particular drug, he has no complaints, he can get vaccinated, just like all other people who do not suffer from allergies, ”the doctor added.

    In case of allergic bronchial asthma in remission, it is possible to vaccinate. In severe autoimmune diseases, if there is a risk of serious consequences, it is better to postpone the vaccination. This decision must be made with your doctor.

    “There are autoimmune diseases in the stage of compensation, the same autoimmune thyroiditis that is very common among our population. And he is in compensation and correction. Then there are no contraindications against vaccination, ”said the head of the Kazan Center for Allergology and Immunology.

    Why did three citizens of Kazan turn to allergists after vaccination?

    Only three people with an allergic reaction after being vaccinated against a new coronavirus infection applied to the Center for Allergology and Immunology of Kazan Clinical Hospital No. 7.

    The first of them was grafted into the acute stage of hay fever, he is allergic to weeds, and the vaccination gave a reaction in the form of urticaria, Guzel Zakirova said.

    Illustration: Ekaterina Semenova

    The second patient received an injection during an exacerbation of herpes.In these two cases, they could not be vaccinated.

    The third, on the eve of the vaccination, was in the sun for a long time and overheated, this caused a nonspecific reaction in his body.

    Let us remind you that more than 688 thousand people were vaccinated in Tatarstan.

    Do allergy sufferers need to drink antihistamines when vaccinated?

    Guzel Zakirova explained that it is not necessary to take allergy medications just like that before vaccination.

    “They are believed to decrease the immune response,” the doctor explained.

    Illustration: Ekaterina Semenova

    However, if a person has an allergy and there is a permanent therapy clearly prescribed by a doctor, the pills should be continued to drink. According to the allergist, there are very few such patients. And if a person is taking drugs because of symptoms, most likely he has an acute stage of allergy, and in this case it is impossible to vaccinate at all.

    Which vaccine is best for allergy sufferers?

    “The most suitable for our patients with allergic diseases will be“ GamKovidVak ”(“ Sputnik V ”), because there are no peptides, protein inclusions.There are few components, ”the doctor said.

    Photo: Vladimir Vasiliev

    The doctor explained that for allergy sufferers the fewer components in the composition of the drug, the better and safer.

    For example, “KoviVac” has more contraindications for people with a history of allergic reactions.

    90,000 Serious allergies and hypersensitivity must be added to the side effects list of AstraZeneca vaccine – EMA

    This content was posted on March 12, 2021 – 15:12

    Brussels.March 12. INTERFAX – The European Medicines Agency (EMA) recommends including anaphylactic reactions and hypersensitivity to the side effects list of AstraZeneca’s COVID-19 vaccine.

    “Following an assessment of reported safety concerns regarding cases of anaphylaxis (severe allergic reaction) from COVID-19 vaccine, the PRAC (EMA Pharmacological Risk Assessment Committee – IF) recommends updating the product information to include anaphylaxis and hypersensitivity (allergic reactions) in a list of side effects (occurring) with an unknown frequency, “reads an EMA document released following the March 8-11 PRAC meeting.

    In addition, the agency recommended updating the “existing warning” about vaccine use to reflect reported cases of anaphylaxis following the AstraZeneca vaccine.

    According to the EMA, this claim is based on “reviewing 41 reports of possible anaphylaxis among approximately 5 million people vaccinated” in the UK. Thus, the pharmacological risk assessment committee concluded that at least some of these cases are associated with vaccination with AstraZeneca.

    EMA clarifies that anaphylaxis is a known side effect that can occur intermittently with some vaccines.

    AstraZeneca’s anaphylactic reaction for COVID-19 vaccine is already listed as a potential risk.

    The agency notes that the information “highlights the need to ensure access to appropriate medical treatment” in the event of an anaphylactic reaction.

    EMA recalls that there is a recommendation, applicable to all EU-approved coronavirus vaccines, that a second dose of vaccine should not be given to people who develop this side effect after the first dose of the drug.

    At the same time, it is reported that the information on the AstraZeneca vaccine already contains a warning about anaphylactic reactions. Also included is a recommendation that “people who are vaccinated should be monitored for at least 15 minutes” after the procedure.

    The day before, it was reported that the authorities of Denmark, Norway, Thailand and Bulgaria have suspended the vaccination campaign against COVID-19 with the drug AstraZeneca and due to the formation of blood clots in several Danish patients after vaccination.

    The European Medicines Agency (EMA) later advised that vaccination with AstraZeneca did not increase the risk of blood clots and the vaccine could continue.A similar announcement was made by Health Canada.

    At the end of January, the EU authorities decided to admit the vaccine developed by AstraZeneca to the EU market. However, experts in some countries have previously concluded that the company’s vaccine is suitable only for people between the ages of 18 and 64.

    The AZD1222 vaccine was developed by specialists of the pharmaceutical company AstraZeneca in cooperation with scientists from the University of Oxford. It is a vector vaccine.The principle of operation of vector vaccines is that they contain an attenuated, non-hazardous virus and a new type of coronavirus gene.

    1vi ar

    Russian doctors named two reasons for medical withdrawal from vaccination against coronavirus

    Experts emphasized that other indications in the instructions for drugs and the recommendations of the Ministry of Health of the Russian Federation make it possible to temporarily postpone vaccination.

    Therapist Andrei Kondrakhin noted that severe allergic reactions include: Quincke’s edema or anaphylactic shock when similar situations arose during a previous vaccination against any other disease.Allergist-immunologist Vladimir Bolibok emphasized that allergy to food, pollen or dust is not a basis for a medical elimination of vaccinations. According to RIA Novosti, domestic vaccines against covid do not cause allergic reactions for the reason that their components “do not overlap” with possible allergens.

    – They do not contain antibiotics, preservatives, chicken eggs, yeast, lipopolysaccharides of bacteria, that is, what happens in other vaccines and can cause cross-allergies, the expert said.

    Urticaria is also not a contraindication. This was stated by Oksana Drapkina, a freelance specialist in therapy of the Ministry of Health of Russia.

    Doctors noted that a severe reaction to previously administered vaccines is a high fever or redness and swelling at the injection site with a diameter of more than 8 cm. Collaptoid reactions, febrile convulsions are also included in the number of severe side effects.

    – A strong general reaction is an increase in body temperature above 40 ° C in the post-vaccination period.It occurs up to three days after vaccination with inactivated drugs and in the period from the fifth to the 15th day after the introduction of the live vaccine, – said Andrey Kondrakhin.

    Vladimir Bolibok said that before vaccination against covid, it is necessary to check which vaccines and their components a person has already had an allergic reaction to, to analyze each individual case.

    Recall that the coronavirus vaccination center in the Gallery-Krasnodar shopping center will be able to receive 1,000 people a day.On July 12, the largest mobile vaccination station in the region was opened in the center of the Kuban capital.

    Also, in 93 medical institutions of the Krasnodar Territory, it is possible to undergo medical examination for those who have had coronavirus.