Anaphylaxis to vaccinations: A review of the literature and evaluation of the COVID-19 mRNA vaccinations

Margaret M. Kuder; David M. Lang; Deepa D. Patadia

doi:10.3949/ccjm.88a.ccc075

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TABLE 1

Current CDC recommendations on COVID-19 vaccination

	Clinical history	Action recommended
Contraindications	History of immediate allergic reaction of any severity (including anaphylaxis) to mRNA COVID-19 vaccine or any component of the vaccine (including polyethylene glycol) History of immediate allergic reaction of any severity to polysorbate	Vaccine should not be administered Refer to allergist/immunologist for further evaluation and to determine if the patient can safely receive the vaccine

Precautions	History of immediate allergic reaction to any other vaccine or injectable therapy (not related to COVID-19 vaccine component or polysorbate)	Discuss risks/benefits with the patient, consider: Risk of COVID-19 exposure Risk of COVID-19–related complications or death Prior history of COVID-19 infection Risk of anaphylaxis and availability of vaccination site equipped to treat anaphylaxis Consider deferring vaccination until further information is known or refer to allergist/immunologist If vaccine is given, the patient should be observed for 30 minutes after administration

No Contraindications or precautions	History of allergic reactions unrelated to vaccines or injectable therapy, COVID-19 vaccine components including polyethylene glycol, or polysorbate. This includes those with allergies to foods, latex, gelatin, venom, pets, environmental allergens, or oral medications	Administer the vaccine Patients with history of anaphylaxis from any cause should be observed for 30 minutes after administration All other patients should be observed for 15 minutes after administration