Outcomes of pediatric patients with suspected allergies to COVID-19 vaccines

• Published in: The journal of allergy and clinical immunology. Global 2025-02, Vol.4 (1), p.100387, Article 100387
• Main Authors: Lim, Qin Ying, Lau, Tsun Ming, Lai, Sophie H.Y., Chua, Gilbert T., Zhang, Kaiyue, Lam, Jennifer H.Y., Wong, Wilfred H.S., Lau, Yu Lung, Rosa Duque, Jaime S.
• Format: Article
• Language: English
• Subjects: Allergy; Brief Report; COVID-19; drug; pediatric; vaccine
• ISSN: 2772-8293; 2772-8293
• DOI: 10.1016/j.jacig.2024.100387

Adverse effects following immunizations (AEFIs) can contribute to vaccine hesitancy. We evaluated clinical outcomes of AEFIs subsequent to administration of the coronavirus disease 2019 (COVID-19) vaccine at 2 pediatric allergy centers. Data on pediatric patients referred for COVID-19 AEFI concerns between March 2021 and October 2022 were reviewed. The collected data included patient demographics, clinical characteristics, outcomes of prior COVID-19 vaccination, recommendations after consultation, and outcomes of revaccination. The 163 patients were separated into 2 groups based on the absence (n = 89 [54.6%]) or presence (n = 74 [45.4%]) of prior COVID-19–related AEFIs. The most common reason for referral without a prior AEFI was another suspected drug allergy (n = 58 [35.6%]). All patients in this group were recommended for COVID-19 vaccination. Of the 163 patients, 82 (92.1%) proceeded with vaccination, with 77 of them (93.9%) tolerating vaccination. Most of those with a prior COVID-19–related AEFI had a delayed cutaneous reaction (n = 60 [37.0%]); 1 patient (0.6%) had suspected anaphylaxis. In this group, 6 (8.1%) were advised to postpone COVID-19 vaccination until their debilitating skin conditions had improved in response to further treatment, whereas 45 (77.6%) tolerated subsequent vaccination to the same or an alternate COVID-19 vaccine type. The most common AEFI on revaccination was urticaria (in 8 of 11 patients [72.7%]). AEFI on revaccination was significantly associated with a history of spontaneous urticaria or angioedema (relative risk = 3.6 [95% CI = 1.30-9.99]; P = .020) and urticaria following COVID-19 vaccination previously (relative risk = 4.12 [95% CI = 1.22-13.87]; P = .017). Children with a history of urticaria or angioedema related or unrelated to prior COVID-19 vaccination were at higher risk of a COVID-19–related AEFI on revaccination, although most were able to complete the vaccination series under the management of our immunology/allergy service.