Allergy specialists have loosened up recommendations on who can safely be vaccinated against COVID-19 and how that is assessed.

For pharmacists, that means determining which vaccine-seekers have had recent severe allergic reaction to a specific ingredient in the vaccine and, if that is the case, holding off administering the shot and referring them to an allergist or immunologist, according to recent guidance.

“We now advise that only the rare individuals who have had a recent severe allergic reaction to polyethylene glycol, an ingredient in the vaccines, see an allergist or immunologist for evaluation, which may include skin testing,” said lead author Aleena Banerji, MD, clinical director of the Allergy and Clinical Immunology Unit at Massachusetts General Hospital (MGH). “Individuals with severe allergies to foods, oral drugs, latex, bee stings or venom can safely receive the COVID-19 vaccines.”

At the end of last year, MGH researchers and colleagues examined all information related to possible allergic reactions to COVID-19 vaccinations. Updated insights based on information from fully vaccinating 65,000 employees since that time have now been published in the Journal of Allergy and Clinical Immunology: In Practice.

"Our main goal is to enable as many individuals as possible to receive a COVID-19 vaccine safely and avoid unnecessary vaccine hesitancy due to a lack of knowledge around allergic reactions to vaccines," Dr. Banerji said.

Unlike the first version, which only discussed the Pfizer-BioNTech and Moderna vaccines, the latest version includes information on the Janssen (Johnson & Johnson) COVID-19 vaccine, which has since been given Emergency Use Authorization by the FDA.

The authors’ modified approach involves clear and simple initial questions to identify individuals who are eligible for all COVID-19 vaccines without needing an allergist evaluation.

“With more time and experience, we have been able to significantly narrow the group of patients with prior allergies who require an allergist assessment before COVID-19 vaccination,” noted senior author Kimberly G. Blumenthal, MD, MSc, codirector of the Clinical Epidemiology Program within MGH’s Division of Rheumatology, Allergy and Immunology. “We now advise that only the rare individuals who have had a recent severe allergic reaction to polyethylene glycol, an ingredient in the vaccines, see an allergist or immunologist for evaluation, which may include skin testing.”

While severe allergic reactions to the vaccines have been shown to be extremely rare, the allergists still recommend that vaccine clinics observe higher risk individuals for 30 minutes after vaccination, and that staff trained in recognizing and managing allergic reactions should be readily available.

“The vast majority of individuals with high-risk allergy histories will not need excipient skin testing prior to vaccination,” the authors conclude. “As our experience and knowledge with COVID-19 variants vaccines increases, we must continue to remain flexible with our approach. Our updated pre-vaccine risk stratification algorithm can be used in conjunction with the previously published skin testing guidance. In the meantime, 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 content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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