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Guidance Updated for Assessing Allergy Risk of COVID-19 Vaccines

THURSDAY, April 22, 2021 -- In an editorial published online April 15 in the Journal of Allergy and Clinical Immunology: In Practice, an updated pre-COVID-19 vaccine risk stratification algorithm is presented for use in patients with reported allergic reactions.

Aleena Banerji, M.D., from Massachusetts General Hospital in Boston, and colleagues present updated evidence for allergic reactions to COVID-19 vaccinations and suggest an approach to guide safe vaccination in individuals with allergy histories.

The authors note that the mechanisms of allergic reactions to the COVID-19 vaccines are unclear, but excipients remain a possibility, with polyethylene glycol (PEG) the common excipient in both mRNA COVID-19 vaccines and polysorbate 80 the excipient in the Janssen (Johnson & Johnson) adenovirus type 26 vectored vaccine. Individuals with a contraindication to the mRNA COVID-19 vaccines due to a history of possible allergy to PEG may be considered for the Janssen COVID-19 vaccine. Similarly, individuals with a contraindication to the Janssen COVID-19 vaccine due to a history of possible allergy to polysorbate may be considered for an mRNA COVID-19 vaccine. In case of a severe allergic reaction to one dose of the mRNA COVID-19 vaccine, use of the Janssen COVID-19 vaccine may be considered, provided there is a delay of 28 days between the mRNA and Janssen vaccines; however, no efficacy data are available on this approach. As part of an updated prevaccine risk stratification algorithm, individuals with any history of anaphylaxis should be monitored for 30 minutes after mRNA COVID-19 vaccination. Individuals who self-report a PEG allergy can be considered for Janssen vaccination if available, while those reporting polysorbate-only allergy can be considered for mRNA COVID-19 vaccination.

"The potential life-saving benefit of vaccination makes it essential that allergists continue to carefully evaluate and advise all patients with allergy histories and prevent denying access to the vaccine unnecessarily," the authors write.

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