TOLERABILITY OF GRADED CORONAVIRUS DISEASE 2019 MRNA VACCINE DOSING

Abstract

<h3>Introduction</h3> The rapid development of novel coronavirus disease 2019 (COVID-19) mRNA vaccines and their widespread use has raised concerns that they may cause allergic reactions at rates greater than conventional vaccines. Vaccine administration strategies in cases of prior COVID-19 vaccine reaction or patient hesitancy include full dose administration with close observation and graded dosing protocols. <h3>Methods</h3> Retrospective chart review of patients who were referred to an allergy clinic for observed COVID-19 vaccine administration with emphasis on demographic characteristics, atopic co-morbidities, prior vaccine reactions, and outcome of challenge. <h3>Results</h3> Data were available for 83 patients comprising 102 total COVID-19 vaccine challenges. All (n=102) challenges were successful; 21 experienced symptoms and 81 did not. The most reported symptoms were pruritus (n=5), headache (n=5), and chest tightness (n=3). No patient experienced vital sign changes during the protocol and there were no cases of anaphylaxis. The most common dosing protocols were either one-step (n=38) or two-step (n=36). The most common reasons for undergoing challenge were previous COVID-19 vaccine reaction (n=55) and concern for multiple drug allergies (n=21). <h3>Conclusion</h3> This review demonstrates that COVID-19 vaccine graded dosing protocols were highly tolerated and successful regardless of prior COVID-19 vaccine reactions or drug allergies. The presence of symptoms during the challenge did not preclude successful outcome, and no patients experienced anaphylaxis. Given the ongoing nature of the COVID-19 pandemic, it is important to recognize that graded challenge or full dose administration with observation may provide a safe means for patients who are hesitant to pursue COVID-19 vaccination.