Vaccine Allergy Research Articles

Intradermal fractional dose vaccination as a method to vaccinate individuals with suspected allergy to mRNA COVID-19 vaccines

Suspected allergic reactions after mRNA COVID-19 vaccination withheld multiple individuals from getting fully vaccinated during the pandemic. We vaccinated adults who had experienced possible allergic symptoms after their first intramuscular dose of a COVID-19 mRNA vaccine with a 1/5th fractional intradermal test dose of the mRNA-1273 (Moderna) COVID-19 vaccine. No anaphylactic reactions were observed after intradermal vaccination (n = 56). Serum anti-S1 IgG concentrations were measured using a bead-based multiplex assay four weeks after vaccinations. Antibody concentrations were compared with a previously collected nationwide cohort that had received two intramuscular doses of mRNA-1273. Antibody responses in all subjects tested (n = 47) were comparable to standard of care intramuscular dosing. Fractional intradermal dosing of mRNA COVID-19 vaccines may provide a pragmatic solution that is safe, time efficient compared to skin prick testing, dose sparing and immunogenic in individuals with suspected vaccine allergy.

Risk Factors Associated with Cutaneous Reactions Following COVID-19 Vaccine Immunisation: A Registry-Based Case-Control Study.

In Malaysia, following extensive COVID-19 vaccination, Hospital Kuala Lumpur reported an increase in cutaneous reactions post-immunisation. To understand this, a case-control study was initiated to identify potential risk factors. This registry-based, unmatched case-control study encompasses all adverse event following immunisation (AEFI) reports associated with COVID-19 vaccines, received by the Department of Pharmacy at Hospital Kuala Lumpur through the Malaysian Adverse Drug Reactions Advisory Committee (MADRAC) AEFI reporting forms. Twenty-four potential risk factors were evaluated, including demographic information, medical history, food allergies, COVID-19 vaccination history and prior SARS-CoV-2 infection, were evaluated using MADRAC AEFI reporting forms. Odds ratio (OR) with 95% confidence interval (CI) were estimated using univariable and multivariable logistic regression. Cutaneous reactions were more frequent in middle-aged females, especially after the first COVID-19 vaccine dose. These reactions, primarily mild and generalised, included pruritus and urticaria. Notably, 52% were delayed reactions (more than 4 h post-vaccination). Factors associated with increased risk of cutaneous reaction following COVID-19 immunisation included history of seafood and shellfish allergy (adjusted odds ratio [adjOR]: 2.11; 95% CI: 1.12, 3.96; P = 0.020), history of vaccine allergy (adjOR: 4.07; 95% CI: 1.44, 11.54; P = 0.008), past dermatological diseases (adjOR: 5.48; 95% CI: 2.03, 14.78; P = 0.001), and past medication allergy (adjOR: 2.12; 95% CI: 1.36, 3.31; P = 0.001). Self-reported histories of allergies to vaccines, foods or medications were found to increase the likelihood of cutaneous reactions following COVID-19 vaccination. These reactions, which were predominantly mild, did not hinder the administration of the second vaccine dose. The majority of reactions occurred after the first dose, manifesting as generalised pruritus and urticaria. They were effectively managed with oral antihistamines and low-dose corticosteroids, thereby avoiding the need for hospitalisation.

How Real Are Allergic Reactions to Vaccine Components in Children? − Experiences of Clinicians

Objective − Vaccine components have the potential to induce allergic reactions, although such reactions are infrequent, especially anaphylactic reactions, which are very rare (occurring at a rate of 1 per million vaccine doses). The objective of this study was to assess objectively the frequency of allergic reactions to vaccine components in children with suspected allergic reactions to vaccine components. Materials andMethods − We retrospectively analyzed the medical records of 209 patients aged 1 to 18 years with suspected allergic reactions to vaccine components, who underwent the standardized diagnostic procedures and tests to common allergens and vaccine components at Srebrnjak Children`s Hospital, Zagreb, Croatia. Results − Of the 209 children vaccinated in the hospital setting, only two (0.95%) developed side effects during their hospital stay, and 2.63% with a positive history of IgE mediated vaccine allergy were positive for one of the components of the vaccine. Local reactions to the vaccine were the most frequent adverse events in our patients. 62.6% of them were referred due to a positive history of egg protein allergy. Conclusion − Allergic reactions to vaccine components are rare and mild in most cases. In patients with a suggestive history, it is important to choose appropriate diagnostic tests to determine if vaccination can be performed safely. Only patients at risk of egg protein anaphylaxis generally require medically supervised vaccination in a hospital facility. Patients with a history or a documented and immediate allergic reaction (<4 h) require an allergy workup to avoid the risk of repeated anaphylaxis after further administration.

Vaccine allergy – excuse for not vaccinating?

Vaccine allergy – excuse for not vaccinating?

Recent findings on drug hypersensitivity in children.

Drug hypersensitivity reactions (DHR) in children have a significant impact on clinical practice and public health. Both under-diagnosis (due to under-reporting) and over-diagnosis (due to the overuse of the term "allergy") are potential issues. The aim of this narrative review is to describe the most recent findings of DHR in children/adolescents and gaps regarding epidemiology, antibiotic allergy, antiepileptic hypersensitivity, vaccine allergy, and severe cutaneous adverse reactions (SCAR) in this age group.

The impact of COVID-19 vaccine reactions on secondary vaccine hesitancy

BackgroundPrimary and booster vaccinations are critical for mitigating COVID-19 transmission, morbidity, and mortality. Future booster vaccine campaigns rely on an increased understanding of vaccine hesitancy. ObjectiveTo evaluate self-reported allergic and skin vaccine reactions as factors potentially associated with vaccine hesitancy in a nationwide vaccine allergy registry. MethodsResponses to survey questions concerning COVID-19 vaccine perceptions, coded from free text by 2 independent reviewers. Multivariable logistic regression models were used to determine the association between changed negative perception and respondent demographics, vaccination history, and reaction characteristics. ResultsA total of 993 individuals (median of 46 years [IQR, 36-59], 88% female, 82% White) self-reported reactions to COVID-19 vaccination. Reactions included the following: delayed large local skin reaction (40%), hives/urticaria (32%), immediate large local skin reaction (3%), swelling (3%), anaphylaxis (2%), and other or unspecified (20%). Most respondents were initially unconcerned about the safety of COVID-19 vaccines (56%). After reactions, 401 of 993 (40%) report negative change in perception of vaccination, with more than half of these respondents (n = 211, 53%) citing their reasoning as a negative experience with adverse effects. Of 102 individuals asked about future vaccination, 79 (77%) indicated that they were unlikely or very unlikely to receive future COVID-19 vaccinations. Increased negative perception after reaction was associated with younger age, later COVID-19 vaccination dose number, and reaction type. ConclusionOur findings reveal that an individual's experience with allergic or cutaneous adverse effects after COVID-19 vaccination affects attitudes and decision-making regarding future vaccination, even in initially non-hesitant individuals. Further investigation of secondary vaccine hesitancy is necessary for adapting public health messaging to this important population.

Evaluation of vaccine allergy safety track program to assess potential COVID-19 vaccine allergy: a cost-effectiveness analysis

Evaluation of vaccine allergy safety track program to assess potential COVID-19 vaccine allergy: a cost-effectiveness analysis

Modification and Validation of the Vaccine Hesitancy Scale for Turkish Adult Vaccination.

Background and Purpose: For public health, it is important to investigate vaccine hesitancy, determine populations reluctant for vaccines, and investigate barriers and facilitators for vaccination in these groups. This study aims to modify and validate the Vaccine Hesitancy Scale specific to adults in Turkish society. Methods: The study, which was designed as a methodological and survey type, was conducted using a Google questionnaire with 720 participants who met the inclusion criteria with a convenient sampling method. Results: After factor and reliability analysis, a 2-factor, 10-item scale with an acceptable and perfect range of fit index values emerged. It has been observed that individuals who are young, single, do not have children, have vaccine allergy, and do not believe that the vaccine will protect the society are adversely affected by the environment, and those who do not have COVID-19 and flu have a high level of hesitancy to vaccine. Conclusions: The Vaccine Hesitancy Scale is a valid and reliable tool to detect vaccine hesitation in adults in Turkish society.

Overdiagnosis of vaccine allergy: Skin testing and challenge at a public specialized unit (CRIE) in Rio de Janeiro, Brazil.

Vaccination is an extremely safe public health intervention, but rare IgE-mediated adverse events must be identified to avoid the risk of anaphylaxis in the event of reexposure. However, using only clinical history to diagnose previous allergic reactions may lead to overdiagnosis of vaccine allergy and even to the use of medical exemptions as a subterfuge to mandatory vaccination. We conducted a retrospective study to describe the outcomes of patients with a history of vaccine or vaccine component allergy who were evaluated at our unit from 2011 to 2017. Data on allergy history, skin test results, vaccines prescribed, and adverse events were retrieved from the medical records at the Centro de Referência para Imunobiológicos Especiais (Reference Center of Special Immunobiologicals)-Fiocruz, in Rio de Janeiro, Brazil. Of 34 adults with history of allergy to vaccine or vaccine components, 32 (94.1%) were successfully vaccinated without serious adverse events after our evaluation. In 12 patients (35%), the time elapsed between the allergy symptoms and evaluation in the Centro de Referência para Imunobiológicos Especiais-Fiocruz was more than 10 years. Specialized care and use of skin tests allowed safe vaccination of the majority of patients. An objective, systematic evaluation of a history of vaccine allergy can prevent its improper use to avoid mandatory vaccination and reduce missed opportunities for immunization.

Increasing the COVID-19 immunization rate through allergy testing.

Vaccination of the population is required to combat the COVID-19 pandemic. Allergy testing could reduce anxiety towards COVID-19 vaccination and thereby may increase vaccination rate, however, its effectiveness remains unclear. One hundred and thirty prospective real-life patients in need of but not daring to get vaccinated asked for allergy workup for COVID-19 vaccine hypersensitivity in 2021/2022. Characterization of patients, identification of anxieties, decrease of patient's anxiety levels, overall vaccination rate and adverse reactions after vaccination were assessed. Tested patients were characterized by being female (91.5%) and having a high rate of previous allergies (e.g. to food 55.4%, drugs 54.6%, or previous vaccinations 50%) and dermatological disease (29.2%) but not always had medical contraindications for COVID-19 vaccination. Sixty one patients (49.6%) were highly concerned (4-6, Likert scale 0-6) about vaccination and 47 (37.6%) expressed resolving thoughts about vaccinaion anaphylaxis (3-6, Likert scale 0-6). However only 35 patients (28.5%) were scared of getting COVID-19 within 2 months (4-6, Likert scale 0-6) and only 11 (9%) patients had high expectations of getting COVID-19 (4-6, Likert scale 0-6). Allergy testing significantly (p< 0.01 to p< 0.05 respectively) reduced the median anxiety of allergic symptoms following vaccination: dyspnoea (4.2-3.1), to faint (3.7-2.7), long-term consequences (3.6-2.2), pruritus (3.4-2.6), skin rash (3.3-2.6) and death (3.2-2.6). After allergy testing, most patients (108/122, 88.5%) let themselves be vaccinated within 60 days. Revaccinated patients with previous symptoms experienced a reduction of symptoms (p< 0.05) upon revaccination. Patients not daring to get vaccinated have more anxiety towards vaccination than to acquire COVID-19. For those, allergy testing excludes vaccine allergy, and is a tool to increase vaccination willingness and thereby helps to combat vaccination hesitancy.

National assessment strategy for adults and children with a history of vaccine allergy shows low utility of COVID‐19 vaccine skin testing

National assessment strategy for adults and children with a history of vaccine allergy shows low utility of <scp>COVID</scp>‐19 vaccine skin testing

COVID-19 Vaccine Allergy Safety Track (VAS-Track) pathway: real-world outcomes on vaccination rates and antibody protection.

Misdiagnosed vaccine-related "allergies" lead to unnecessary vaccine deferrals and incomplete vaccinations, leaving patients unprotected against COVID-19. To overcome limitations and queues for Allergist assessment, the "VAS-Track" pathway was developed to evaluate patients via a multi-disciplinary triage model including nurses, non-specialists, and Allergists. We assessed the effectiveness and safety of VAS-Track and evaluate its real-world impact in terms of vaccination rates and COVID-19 protection. Patients referred to VAS-Track between September 2021 and March 2022 were recruited. Subgroup analysis was performed with prospective pre- and post-clinic antibody levels. Nurse-assisted screening identified 10,412 (76%) referrals as inappropriate. 369 patients were assessed by VAS-Track. Overall, 100% of patients were recommended to complete vaccination and 332 (90%) completed their primary series. No patients reported any significant allergic reactions following subsequent vaccination. Vaccination completion rates between patients seen by non-specialists and additional Allergist review were similar (90% vs. 89%, p = 0.617). Vaccination rates were higher among patients with prior history of immediate-type reactions (odds ratio: 2.43, p = 0.025). Subgroup analysis revealed that only 20% (56/284) of patients had seropositive COVID-19 neutralizing antibody levels (≥ 15 AU/mL) prior to VAS-Track, which increased to 92% after vaccine completion (pre-clinic antibody level 6.0 ± 13.5 AU/mL vs. post-clinic antibody level 778.8 ± 337.4 AU/mL, p > 0.001). A multi-disciplinary allergy team was able to streamline our COVID-19 VAS services, enabling almost all patients to complete their primary series, significantly boosting antibody levels and real-world COVID-19 protection. We propose similar multidisciplinary models to be further utilized, especially in the settings with limited allergy services.

COVID-19 vaccine allergy advice and guidance: The experience of a UK tertiary referral centre

ObjectiveThe objective was to review COVID-19 vaccine allergy advice and guidance requests received and assess the impact of advice outcome on vaccination outcome. DesignA retrospective analysis of requests for advice and guidance regarding COVID-19 vaccine allergy was completed using an electronic referral system from February 2021 to January 2022. ParticipantsA total of 1265 independent patient requests for advice were received from primary care. Full vaccination information was available on 1210 patients who were included in the analysis. Main outcome measuresWe evaluated the specific outcome of request for advice (written advice versus allergy consultation), rate of vaccination, vaccination combinations, and tolerance of vaccination. ResultsOf the 1210 patients included, 959 (79%) were female. Eight hundred and ninety-six (74%) requests were managed with written advice only and of these 675 (75%) patients went on to be vaccinated. Overall, 891 (74%) of the population were vaccinated with 2 or more doses.Two hundred and nineteen patient consultations were undertaken with 109 (50%) prior to the first vaccination. Forty-nine (45%) consultations prior to vaccination were undertaken due to a label of anaphylaxis to vaccination in the past. Vaccination was recommended for all patients, and 78 (72%) of these received a first dose. Eight of these patients (10%) had symptoms within 1 h of vaccine administration.One hundred and ten (50%) consultations were undertaken for adverse reactions post COVID-19 vaccination, with 84 (76%) concerning immediate symptoms. Thirty patients (27%) who had a consultation had had adrenaline administered post vaccination. One patient had biopsy confirmed Stevens Johnson Syndrome and was referred to Dermatology. All others due for further doses (107 patients) were recommended to have subsequent doses with 49 (45%) offered the same vaccine. Eighty-nine patients had a vaccine administered post adverse reaction and 79 (88%) tolerated the dose.Skin testing and challenge to polyethylene glycol were negative in the 8 patients tested. ConclusionsOver 1000 requests for advice and guidance were received during the review period, managed mainly with written advice. The overwhelming majority of requests for advice and consultations were for females, with equal distribution both pre- and post-COVID-19 vaccine administration. Vaccination was recommended in all but 1 patient (with biopsy confirmed Stevens Johnson Syndrome). Polyethylene glycol allergy was not confirmed in any patient, nor did any patient have confirmed anaphylaxis when the vaccine was administered under our supervision, suggesting that type 1 mediated hypersensitivity is uncommon even in this "high risk" population.

Ethical Considerations Surrounding Employment Mandated Coronavirus Disease 2019 Vaccination and Allergy Skin Testing for the Coronavirus Disease 2019 Vaccine.

Ethical Considerations Surrounding Employment Mandated Coronavirus Disease 2019 Vaccination and Allergy Skin Testing for the Coronavirus Disease 2019 Vaccine.

A guide for the management of post vaccination allergy and anaphylaxis in a pharmacy clinic.

Vaccination falls within the scope of practice of a pharmacist and the coronavirus disease 2019 pandemic has seen an increase in pharmacies providing vaccination services. These vaccines are not without risk of allergic reactions and anaphylaxis. The available guidelines for the management of anaphylaxis include the administration of intravenous (IV) fluids. However, IV administration does not fall within the scope of practice of a pharmacist. A gap was identified in the availability of guidelines for the management of anaphylaxis without the use of IV fluid administration. This review aimed to address this gap by describing the mechanisms of allergic reactions and anaphylaxis and developing an algorithm to assist pharmacy personnel to manage these within the scope of practice. The authors used the recommendations for developing guidelines. The availability of anaphylaxis guidelines and clinical studies catering for anaphylaxis and allergy management by pharmacists was deficient, thus the review modified the available management guidelines to align the management of allergy and anaphylaxis within the scope of a pharmacist. The items required for the management were also identified and listed as items that form part of the emergency tray in the pharmacy. The review designed algorithms based on the available literature to assist pharmacy personnel to manage allergy and anaphylaxis within the relevant scope of practice. The review also lists the equipment needed for an emergency tray. This review serves to offer guidance for the management of allergy and anaphylaxis in a pharmacy setting.

Vaccination practices, knowledge and attitudes regarding COVID-19 vaccines among Chinese university students: a cross-sectional study from a comprehensive university in Wuhan

ObjectiveIn China, a free national COVID-19 vaccination programme has been launched in spring 2021 and is ongoing across the country. This study aimed to preliminarily understand the current COVID-19 vaccination...

USING COVID VACCINE SKIN TESTING IN SHARED DECISION MAKING TO ADDRESS VACCINE HESITANCY

<h3>Introduction</h3> COVID-19 vaccine hesitancy among healthcare workers (HCW) remains due to misconceptions. Our study attempts to improve vaccination rates among vaccine-hesitant healthcare workers as part of COVID-19 Vaccine Allergy Program. <h3>Methods</h3> We enrolled 38 vaccine-hesitant HCWs in the COVID-19 Vaccine Allergy program. A questionnaire assessed their risk and concerns. They were then offered COVID-19 vaccine evaluation and skin prick testing(SPT). <h3>Results</h3> Among 38 participants, reasons for vaccine refusal included: side effects(47%), fear of an allergic reaction(26%), underlying medical conditions(18%), and previous COVID-19 infection(18%). If there were no mandatory orders for COVID-19 vaccination towards HCW, 71% of participants definitely would not get the COVID-19 vaccine, 21% were not likely to get the vaccine, and 8% would likely get the vaccine. 89% of the participant expressed interest in getting the COVID-19 SPT, and 11% showed no interest. Out of 31 participants who had SPT, 97% were negative and 3%(n=1) were positive. Upon follow-up, 71% received COVID-19 vaccine, 23% rejected COVID-19 vaccine, and 6% were lost to follow-up. Regarding those who declined COVID-19 vaccine, 86% refused due to religious exemptions, while 14% had medical exemptions. Of individuals that were either not likely or definitely not likely to receive the COVID-19 vaccine, 69% ultimately received the vaccine. <h3>Conclusions</h3> : Our study showed a preponderance of HCW who were unlikely to get the vaccine, and subsequently agreed to receive it after negative SPT. Thus COVID-19 Vaccine Allergy Program can be used to dispel misinformation and help HCW in the shared decision-making process to improve vaccination rates.

PEG allergy — A COVID-19 pandemic-made problem? A German perspective

BackgroundPolyethylene glycol (PEG) has been used for decades, but only caused allergic reactions exceptionally. Introduction of PEG-containing COVID-19 vaccines might have fostered public interest beyond medical reasoning. ObjectivesTo investigate the impact of the SARS-CoV-2 pandemic on the public interest in PEG allergy in Germany and the published PEG allergy cases worldwide. MethodsA retrospective longitudinal study was conducted to measure public interest in PEG allergy analyzing Google search volume in Germany from February 2018 to January 2022. Medically confirmed “PEG allergy” cases were analyzed by looking at the numbers of PubMed case reports and case series from 1977 until January 2022. ResultsWeb results in Germany before COVID-19 show search volumes related to “PEG allergy/testing” was negligible, with 10 search queries per month. The pandemic led to a >200-fold increase from 250 queries 2 years before to 55 720 queries 2 years thereafter, reflecting tremendous public interest. Additionally, the maximum monthly search volume from before to during the pandemic increased immensely for “vaccination” (57-fold), “vaccination and adverse effects” (85-fold), “vaccination and allergy” (71-fold). In contrast, the increase of publication numbers for the search term “PEG allergy” was small from 2019 to 2021 (2.5-fold). Only a very low number of 211 cases with “PEG allergy” worldwide since 1977 could be identified. ConclusionPEG allergy became a topic of major public interest because of COVID-19 vaccination. Scientific publications have increased to a lesser extent, probably promoted by public awareness. Conversely, the overall number of cases published with PEG allergy remain very low. The current high demand for COVID-19 vaccination allergy testing is triggered by public interest instead of medical reasoning.

Efficacy and safety of an e-consult program for COVID-19 vaccine allergy concerns.

Background: Although severe allergic reactions to coronavirus disease 2019 (COVID-19) vaccines are rare, fear of allergic reactions remains a major source of vaccine hesitancy. For concerned patients and providers alike, allergist consultation is recommended for further guidance on the risk of vaccination. The electronic consultation (e-consult) medium has the potential to make this guidance more widely accessible, thereby supporting vaccination efforts. Objective: To determine the safety and efficacy of an e-consult program for COVID-19 vaccine allergy concerns. Methods: We performed a retrospective analysis of a single-center COVID-19 vaccine allergy e-consult program. Data on demographics, allergy history, and outcomes after recommendations were gathered via review of the electronic medical record (EMR). Patients without EMR data available following the e-consult were called to inquire about vaccination status. Results: Our study included 64 patients, most of whom (51.6% [33/64]) had e-consults placed for second-dose concerns. E-consults were completed within 2 days for all patients. The most common recommendation was that patients receive any COVID-19 vaccination available (62.5%, [40/64]). Forty-one patients (64.1%) were vaccinated after receiving recommendations from an allergist, 11 of whom (26.8%) reported a vaccine reaction. Most of these reactions were nonallergic (9/11 [81.2%]). No anaphylactic events were reported. Conclusion: Results of our study suggest that e-consults were a safe and effective method of providing guidance with regard to COVID-19 vaccine risk in patients with concerns about allergic reactions. The efficiency of this medium, highlighted by the 2-day turnaround time in our study, has the potential to expand access to vaccine risk evaluations by board-certified allergist/immunologists.

Anaphylaxis after COVID-19 vaccination: A registry-based study

Anaphylaxis after COVID-19 vaccination: A registry-based study