If you’ve had a history of allergic reactions to vaccines or tend to be skeptical of vaccination side effects, you may have quite a few questions regarding the newly available COVID-19 vaccinations.
While our team of board-certified allergists advises the majority of our patients to move forward with scheduling their vaccination appointments as they are able, there are some who have experienced allergic reactions to vaccines in the past and will need to proceed with caution. In order to best serve these patients along with other Lowcountry residents concerned about vaccine reactions, our team is excited to announce we are offering allergy testing specifically for the COVID-19 vaccine!
We took a moment to get all of the details from Dr. Meredith Moore, a board-certified allergist at Charleston Allergy & Asthma, to learn more about the vaccine and to find out who might want to consider an allergy test before moving forward with their vaccination appointment:
Why would someone want to get tested to see if they might have an allergic reaction to the COVID-19 vaccine?
Individuals should be evaluated by a board-certified allergist/immunologist if they have a history of severe allergic reaction to any vaccine in the past, any reaction within 4 hours of receiving the first COVID shot, or an allergic reaction to any of the components of the COVID-19 vaccine. At this time, it is not known which COVID-19 vaccine component(s) is/are causing allergic reactions. Polyethylene glycol is an ingredient in the mRNA vaccines and has been associated with anaphylaxis. Polysorbate 80 is used in the Johnson & Johnson vaccine and can cross-react with polyethylene glycol.
How will Charleston Allergy & Asthma test for COVID-19 vaccine allergic reactions?
We use a protocol that was developed by a team of allergists/immunologists specifically for COVID-19 vaccination. The protocol tests for immediate skin test reactivity to the vaccine components polyethylene glycol, polysorbate 20 and polysorbate 80. We use both skin prick testing and intradermal testing. With skin prick testing, we introduce the testing material to the immune system just under the skin. There is no bleeding and only minimal discomfort from the testing device that lasts for a few seconds. Intradermal testing uses a very small needle to inject the antigen under the skin.
The tests can be administered at any Charleston Allergy & Asthma location. The test results are available immediately when the test is completed. The test can take up to three hours to complete.
If someone tests positive for an allergic reaction to the COVID-19 vaccine, what should their next steps be? Will they be allergic to all three that are currently available (Pfizer, Modern, J&J)?
Patients will be tested for different ingredients of the vaccines. If you test positive for one component, but negative for a different component then that may suggest that one of the vaccines may be better tolerated than the others. In that case, you and your board-certified allergist may decide to proceed with vaccination to a certain brand of COVID-19 vaccine.
To note, there have been fewer reports of severe allergic reactions to the Moderna and Johnson & Johnson vaccines. However, most of this data is provided through reporting which may not be fully accurate. Additionally, only a fraction of the final doses have been administered so these numbers may change over time. It is recommended that individuals receive whichever vaccine is available unless they are at risk for a severe allergic reaction in which case it is recommended they seek evaluation by a board-certified allergist.
Are there any risks associated with getting tested to see if an individual is allergic to the COVID-19 vaccine?
As with any allergy testing, there is a rare risk of an allergic reaction. Our experienced staff monitor patients for any sign of allergic reaction throughout the procedure.
If someone does not test positive for allergies to the COVID-19 vaccine, should they move forward with receiving the vaccine?
This will be a decision made between the patient and their board-certified allergist. It involves weighing multiple factors such as the severity of any prior allergic reactions, any medical condition that may increase the risk of an allergic reaction, their exposure risk to COVID-19 infection, availability of the vaccine in locations experienced in treating allergic reactions and the patient’s personal preferences.
How effective are the COVID-19 vaccines that are currently available (Pfizer, Moderna and Johnson & Johnson)?
The vaccines currently available in the U.S. have been shown to reduce COVID-19 infection by 72 – 95% and prevent 86 – 100% of severe infections.
What are some of the most common side effects experienced after receiving the COVID-19 vaccine?
Most people experience mild side effects from the COVID-19 vaccine that are similar to common side effects from other vaccines. Most people, if they have an allergic reaction, will experience the following:
- Headache (22% of recipients)
- Tiredness (17% of recipients)
- Dizziness (17% of recipients)
- Muscle aches
These side effects are a sign that your immune system is recognizing the vaccine and developing protective antibodies. These symptoms generally go away on their own in 1-2 days. For some people, these common side effects are more intense after the second dose of a 2-shot series.
What are the most common allergic reactions that individuals are having to the COVID-19 vaccine?
According to a paper published in the Journal of American Medical Association which tracked reactions in Mass General Brigham employees, the most common allergic reactions were rash, itching, hives, swelling that was not at the injection site and respiratory symptoms (Blumenthal). This occurred in a total of 2% of vaccinated individuals. Anaphylaxis, a more severe allergic reaction, occurred in 0.025% of vaccine recipients (16 people out of 64,900).
How serious is anaphylactic shock?
When someone experiences anaphylaxis they have allergic symptoms in multiple organs. These patients have difficulty breathing, low blood pressure or severe gastrointestinal symptoms in addition to hives or itchy rashes. Anaphylaxis can be life-threatening if the heart or lungs are severely involved. Fortunately, for those who experience anaphylaxis, injectable epinephrine is very effective at reversing anaphylaxis if used early. Among the Mass General Brigham employees, 16 developed anaphylaxis but only 1 required hospitalization. The Vaccine Adverse Event Reporting System has received reports of 3.8 anaphylaxis reactions per 1,000,000 doses of mRNA vaccines.
How are reactions treated at COVID-19 vaccination sites? Is every site equipped to handle reactions?
The CDC has created a Checklist of Best Practices for Vaccination Clinics Held at Satellite, Temporary or Off-Site Locations. This checklist includes expectations that vaccine providers are CPR certified and that an emergency medical kit is on-site. Most vaccine sites are advising patients to wait 15 minutes after receiving the vaccine to ensure they are in a location where medical assistance can be provided.
What signs should an individual look for or consider as they gauge their risk of an allergic reaction to the COVID-19 vaccine?
Most severe allergic reactions start within 15 minutes of the vaccine being administered. Common symptoms are hives, cough, shortness of breath, fast heart rate or nausea. Let a vaccine provider know if you experience these symptoms.
Are there any additional details to note on allergy testing for the COVID-19 vaccine?
The COVID-19 skin testing protocol was developed by experts in the allergy and immunology field using our current understanding of the ingredients of the COVID-19 vaccines. The protocol has not been extensively evaluated so we do not know how reliable the test protocol is. The testing results will provide you and your allergist information that can be incorporated in decision-making regarding COVID-19 vaccine administration.
If you have a history of allergic reactions to vaccines or components of the COVID-19 vaccine, our team of board-certified allergists recommends you consult with your healthcare provider before receiving the COVID-19 vaccine. To find out if it’s recommended that you receive allergy testing for the COVID-19 vaccine, request an appointment with one of our board-certified allergists today.