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
Department
Allergy and Immunology
Document Type
Article
Publication Title
The Journal of Allergy and Clinical Immunology
Abstract
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.
First Page
309
Last Page
325
DOI
10.1016/j.jaci.2023.05.019
Volume
152
Issue
2
Publication Date
8-1-2023
Medical Subject Headings
Humans; COVID-19 Vaccines; GRADE Approach; Consensus; Vaccine Excipients; COVID-19; Hypersensitivity, Immediate; Anaphylaxis; Excipients
PubMed ID
37295474
Recommended Citation
Greenhawt, M., Dribin, T., Abrams, E., Shaker, M., Chu, D., Golden, D., Akin, C., Anagnostou, A., ALMuhizi, F., Alqurashi, W., Arkwright, P., Baldwin, J., Banerji, A., Bégin, P., Ben-Shoshan, M., Bernstein, J., Bingemann, T., Bindslev-Jensen, C., Blumenthal, K., Byrne, A., Cahill, J., Cameron, S., Campbell, D., Campbell, R., Cavender, M., Chan, E., Chinthrajah, S., Comberiati, P., Eastman, J., Ellis, A., Fleischer, D., Fox, A., Frischmeyer-Guerrerio, P., Gagnon, R., Garvey, L., Grayson, M., Isabwe, G., Hartog, N., Hendron, D., Horner, C., Hourihane, J., Iglesia, E., Kan, M., Kaplan, B., Katelaris, C., Kim, H., Kelso, J., Khan, D., Lang, D., Ledford, D., Levin, M., Lieberman, J., Loh, R., Mack, D., Mazer, B., Mody, K., Mosnaim, G., Munblit, D., Mustafa, S., Nanda, A., Nathan, R., Oppenheimer, J., Otani, I., Park, M., Pawankar, R., Perrett, K., Peter, J., Phillips, E., Picard, M., Pitlick, M., Ramsey, A., Rasmussen, T., Rathkopf, M., Reddy, H., Robertson, K., Rodriguez Del Rio, P., Sample, S., Sheshadri, A., Sheik, J., Sindher, S., Spergel, J., Stone, C., Stukus, D., Tang, M., Tracy, J., Turner, P., Vander Leek, T., Wallace, D., Wang, J., Wasserman, S., Weldon, D., Wolfson, A., Worm, M., & Yacoub, M. (2023). Updated guidance regarding the risk of allergic reactions to COVID-19 vaccines and recommended evaluation and management: A GRADE assessment and international consensus approach. The Journal of Allergy and Clinical Immunology, 152 (2), 309-325. https://doi.org/10.1016/j.jaci.2023.05.019
