Updated guidance regarding the risk of allergic reactions to COVID-19 vaccines and recommended evaluation and management: A GRADE assessment and international consensus approach

Matthew Greenhawt; Timothy E. Dribin; Elissa M. Abrams; Marcus Shaker; Derek K. Chu; David B.K. Golden; Cem Akin; Akterini Anagnostou; Faisal ALMuhizi; Waleed Alqurashi; Peter Arkwright; James L. Baldwin; Aleena Banerji; Philippe Bégin; Moshe Ben-Shoshan; Jonathan Bernstein; Theresa A. Bingemann; Carsten Bindslev-Jensen; Kim Blumenthal; Aideen Byrne; Julia Cahill; Scott Cameron; Dianne Campbell; Ronna Campbell; Michael Cavender; Edmond S. Chan; Sharon Chinthrajah; Pasquale Comberiati; Jacqueline J. Eastman; Anne K. Ellis; David M. Fleischer; Adam Fox; Pamela A. Frischmeyer-Guerrerio; Remi Gagnon; Lene H. Garvey; Mitchell H. Grayson; Ghislaine Annie Clarisse Isabwe; Nicholas Hartog; David Hendron; Caroline C. Horner; Johnathan O'B Hourihane; Edward Iglesia; Manstein Kan; Blanka Kaplan; Constance H. Katelaris; Harold Kim; John M. Kelso; David A. Khan; David Lang; Dennis Ledford; Michael Levin; Jay A. Lieberman; Richard Loh; Douglas P. Mack; Bruce Mazer; Ketan Mody; Gisele Mosnaim; Daniel Munblit; S. Shahzad Mustafa; Anil Nanda; Richard Nathan; John Oppenheimer; Iris M. Otani; Miguel Park; Ruby Pawankar; Kirsten P. Perrett; Jonny Peter; Elizabeth J. Phillips; Matthieu Picard; Mitchell Pitlick; Allison Ramsey; Trine Holm Rasmussen; Melinda M. Rathkopf; Hari Reddy; Kara Robertson; Pablo Rodriguez del Rio; Stephen Sample; Ajay Sheshadri; Javed Sheik; Sayantani B. Sindher; Jonathan M. Spergel; Cosby A. Stone; David Stukus; Mimi L.K. Tang; James M. Tracy; Paul J. Turner; Timothy K. Vander Leek; Dana V. Wallace; Julie Wang; Susan Wasserman; David Weldon; Anna R. Wolfson; Margitta Worm; Mona-Rita Yacoub

doi:10.1016/j.jaci.2023.05.019

Back

Updated guidance regarding the risk of allergic reactions to COVID-19 vaccines and recommended evaluation and management: A GRADE assessment and international consensus approach

Journal article

Peer reviewed

Updated guidance regarding the risk of allergic reactions to COVID-19 vaccines and recommended evaluation and management: A GRADE assessment and international consensus approach

Matthew Greenhawt, Timothy E. Dribin, Elissa M. Abrams, Marcus Shaker, Derek K. Chu, David B.K. Golden, Cem Akin, Akterini Anagnostou, Faisal ALMuhizi, Waleed Alqurashi, …

Journal of allergy and clinical immunology, Vol.152(2), pp.309-325

2023

DOI: https://doi.org/10.1016/j.jaci.2023.05.019

PMID: 37295474

Abstract

allergic reactions

anaphylaxis

COVID-19

mRNA COVID-19 vaccine

polyethylene glycol

polysorbate 80

repeat allergic reactions

SARS-CoV-2

skin testing

vaccination

This guidance updates 2021 GRADE (Grading of Recommendations Assessment, Development and Evaluation) recommendations regarding immediate allergic reactions following coronavirus disease 2019 (COVID-19) vaccines and addresses revaccinating individuals with first-dose allergic reactions and allergy testing to determine revaccination outcomes. Recent meta-analyses assessed the incidence of severe allergic reactions to initial COVID-19 vaccination, risk of mRNA-COVID-19 revaccination after an initial reaction, and diagnostic accuracy of COVID-19 vaccine and vaccine excipient testing in predicting reactions. GRADE methods informed rating the certainty of evidence and strength of recommendations. A modified Delphi panel consisting of experts in allergy, anaphylaxis, vaccinology, infectious diseases, emergency medicine, and primary care from Australia, Canada, Europe, Japan, South Africa, the United Kingdom, and the United States formed the recommendations. We recommend vaccination for persons without COVID-19 vaccine excipient allergy and revaccination after a prior immediate allergic reaction. We suggest against >15-minute postvaccination observation. We recommend against mRNA vaccine or excipient skin testing to predict outcomes. We suggest revaccination of persons with an immediate allergic reaction to the mRNA vaccine or excipients be performed by a person with vaccine allergy expertise in a properly equipped setting. We suggest against premedication, split-dosing, or special precautions because of a comorbid allergic history.

Details

Title: Updated guidance regarding the risk of allergic reactions to COVID-19 vaccines and recommended evaluation and management: A GRADE assessment and international consensus approach
Authors/Creators: Matthew Greenhawt - Children's Hospital Colorado
Timothy E. Dribin - Cincinnati Children's Hospital Medical Center
Elissa M. Abrams - University of Manitoba
Marcus Shaker - Dartmouth College
Derek K. Chu - McMaster University Medical Centre
David B.K. Golden - Johns Hopkins University
Cem Akin - University of Michigan
Akterini Anagnostou - Baylor College of Medicine
Faisal ALMuhizi - Security Forces Hospital
Waleed Alqurashi - University of Ottawa
Peter Arkwright - University of Manchester
James L. Baldwin - University of Michigan
Aleena Banerji - Harvard University
Philippe Bégin - Centre Hospitalier Universitaire Sainte-Justine
Moshe Ben-Shoshan - Montreal Children's Hospital
Jonathan Bernstein - University of Cincinnati
Theresa A. Bingemann - University of Rochester
Carsten Bindslev-Jensen - Odense University Hospital
Kim Blumenthal - Harvard University
Aideen Byrne - Trinity College Dublin
Julia Cahill - University of Alberta
Scott Cameron - Allergy Victoria, Victoria, British Columbia, Canada
Dianne Campbell - Children's Hospital at Westmead
Ronna Campbell - Mayo Clinic
Michael Cavender - Carilion Clinic
Edmond S. Chan - University of British Columbia
Sharon Chinthrajah - Stanford University School of Medicine
Pasquale Comberiati - University of Pisa
Jacqueline J. Eastman - Grand Rapids Community College
Anne K. Ellis - Queen's University
David M. Fleischer - Children's Hospital Colorado
Adam Fox - National Health Service
Pamela A. Frischmeyer-Guerrerio - National Institutes of Health
Remi Gagnon - Clinique Spécialisée en Allergie de la Capitale, Québec, Canada
Lene H. Garvey - University of Copenhagen
Mitchell H. Grayson - Nationwide Children's Hospital
Ghislaine Annie Clarisse Isabwe - Montreal Children's Hospital
Nicholas Hartog - Grand Rapids Community College
David Hendron - University Physicians
Caroline C. Horner - Washington University in St. Louis
Johnathan O'B Hourihane - Royal College of Surgeons in Ireland
Edward Iglesia - Vanderbilt University Medical Center
Manstein Kan - Fraser Health
Blanka Kaplan - Northwell Health
Constance H. Katelaris - Camden and Campbelltown Hospitals
Harold Kim - Western University
John M. Kelso - Scripps Health
David A. Khan - The University of Texas Southwestern Medical Center
David Lang - Cleveland Clinic
Dennis Ledford - University of South Florida
Michael Levin - University of Cape Town
Jay A. Lieberman - University of Tennessee at Knoxville
Richard Loh - Princess Margaret Hospital for Children
Douglas P. Mack - McMaster University
Bruce Mazer - Montreal Children's Hospital
Ketan Mody - Institute for Sports Medicine
Gisele Mosnaim - Endeavor Health
Daniel Munblit - Imperial College London
S. Shahzad Mustafa - Unity Health System
Anil Nanda - The University of Texas Southwestern Medical Center
Richard Nathan - Idaho Falls Infectious Diseases, Idaho Falls, Idaho
John Oppenheimer - Rutgers, The State University of New Jersey
Iris M. Otani - University of California, San Francisco
Miguel Park - Mayo Clinic
Ruby Pawankar - Nippon Medical School
Kirsten P. Perrett - Royal Children's Hospital
Jonny Peter - University of Cape Town
Elizabeth J. Phillips - Vanderbilt University Medical Center
Matthieu Picard - Hôpital Maisonneuve-Rosemont
Mitchell Pitlick - Mayo Clinic
Allison Ramsey - Unity Health System
Trine Holm Rasmussen - Odense University Hospital
Melinda M. Rathkopf - Allergy and Asthma Associates of Allen, Allen, Tex
Hari Reddy - University of Alaska Anchorage
Kara Robertson - Western University
Pablo Rodriguez del Rio - Allergy Department, University Hospital Niño Jesus, Madrid, Spain
Stephen Sample - Memorial Hospital and Health Care Center, Jasper, Ind
Ajay Sheshadri - The University of Texas MD Anderson Cancer Center
Javed Sheik - Kaiser Permanente
Sayantani B. Sindher - Palo Alto University
Jonathan M. Spergel - Children's Hospital of Philadelphia
Cosby A. Stone - Vanderbilt University Medical Center
David Stukus - Nationwide Children's Hospital
Mimi L.K. Tang - Royal Children's Hospital
James M. Tracy - University of Nebraska at Omaha
Paul J. Turner - National Health Service
Timothy K. Vander Leek - University of Alberta
Dana V. Wallace - Nova Southeastern University
Julie Wang - Icahn School of Medicine at Mount Sinai
Susan Wasserman - McMaster University
David Weldon - White Clinic
Anna R. Wolfson - Massachusetts General Hospital
Margitta Worm - Humboldt-Universität zu Berlin
Mona-Rita Yacoub - Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele
Publication Details: Journal of allergy and clinical immunology, Vol.152(2), pp.309-325
Publisher: Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology
Number of pages: 17
Identifiers: 991005884844707891
Murdoch Affiliation: Research and Innovation Office; Institute for Immunology and Infectious Diseases
Language: English
Resource Type: Journal article

Metrics

1 Record Views