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Updated Guidance Regarding The Risk ofAllergic Reactions to COVID-19 Vaccines and Recommended Evaluation and Management: A GRADE Assessment, and International Consensus Approach

This guidance updates 2021 GRADE recomendations regarding immediate allergic reactions following COVID-19 vaccines and addresses re-vaccinating individuals with 1 st dose allergic reactions and allergy testing to determine re-vaccination outcomes. Recent meta-analyses assessed the incidence of sever...

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Published in:Journal of allergy and clinical immunology 2023-06
Main Authors: Greenhawt, Matthew, Dribin, Timothy E., Abrams, Elissa M., Shaker, Marcus, Chu, Derek K., Golden, David BK, Akin, Cem, Anagnostou, Akterini, ALMuhizi, Faisal, Alqurashi, Waleed, Arkwright, Peter, Baldwin, James L., Banerji, Aleena, Bégin, Philippe, Ben-Shoshan, Moshe, Bernstein, Jonathan, Bingeman, Theresa A., Bindslev-Jensen, Carsten, Blumenthal, Kim, Byrne, Aideen, Cahil, Julia, Cameron, Scott, Campbell, Dianne, Campbell, Ronna, Cavender, Michael, Chan, Edmond S., Chinthrajah, Sharon, Comberiatti, Pasquale, Eastman, Jacqueline J., Ellis, Anne K., Fleischer, David M., Fox, Adam, Frischmeyer-Guerrerio, Pamela A., Gagnon, Remi, Garvey, Lene H., Grayson, Mitchell H., Clarisse Isabwe, Ghislaine Annie, Hartog, Nicholas, Hendron, David, Horner, Caroline C., O'B Hourihane, Johnathan, Iglesia, Edward, Kan, Manstein, Kaplan, Blanca, Katelaris, Constance H., Kim, Harold, Kelso, John M., Kahn, David A., Lang, David, Ledford, Dennis, Levin, Michael, Lieberman, Jay A., Loh, Richard, Mack, Douglas P., Mazer, Bruce, Mody, Ketan, Mosnaim, Gissele, Munblit, Daniel, Mustafa, S. Shahzad, Nanda, Anil, Nathan, Richard, Oppenheimer, John, Otani, Iris M., Park, Miguel, Pawankar, Ruby, Perrett, Kirsten P., Peter, Jonny, Phillips, Elizabeth J., Picard, Matthieu, Pitlick, Mitchell, Ramsey, Allison, Rasmussen, Trine Holm, Rathkopf, Melinda M., Reddy, Hari, Robertson, Kara, Rodriguez del Rio, Pablo, Sample, Steven, Sheshradi, Ajay, Shiek, Javed, Sindher, Sayantani B., Spergel, Jonathan M., Stone, Cosby A., Stukus, David, Tang, Mimi LK, Tracy, James M., Turner, Paul J., Vander Leek, Timothy K., Wallace, Dana V., Wang, Julie, Wasserman, Susan, Weldon, David, Wolfson, Anna R., Worm, Margitta, Yacoub, Mona-Rita
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container_title Journal of allergy and clinical immunology
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creator Greenhawt, Matthew
Dribin, Timothy E.
Abrams, Elissa M.
Shaker, Marcus
Chu, Derek K.
Golden, David BK
Akin, Cem
Anagnostou, Akterini
ALMuhizi, Faisal
Alqurashi, Waleed
Arkwright, Peter
Baldwin, James L.
Banerji, Aleena
Bégin, Philippe
Ben-Shoshan, Moshe
Bernstein, Jonathan
Bingeman, Theresa A.
Bindslev-Jensen, Carsten
Blumenthal, Kim
Byrne, Aideen
Cahil, Julia
Cameron, Scott
Campbell, Dianne
Campbell, Ronna
Cavender, Michael
Chan, Edmond S.
Chinthrajah, Sharon
Comberiatti, Pasquale
Eastman, Jacqueline J.
Ellis, Anne K.
Fleischer, David M.
Fox, Adam
Frischmeyer-Guerrerio, Pamela A.
Gagnon, Remi
Garvey, Lene H.
Grayson, Mitchell H.
Clarisse Isabwe, Ghislaine Annie
Hartog, Nicholas
Hendron, David
Horner, Caroline C.
O'B Hourihane, Johnathan
Iglesia, Edward
Kan, Manstein
Kaplan, Blanca
Katelaris, Constance H.
Kim, Harold
Kelso, John M.
Kahn, David A.
Lang, David
Ledford, Dennis
Levin, Michael
Lieberman, Jay A.
Loh, Richard
Mack, Douglas P.
Mazer, Bruce
Mody, Ketan
Mosnaim, Gissele
Munblit, Daniel
Mustafa, S. Shahzad
Nanda, Anil
Nathan, Richard
Oppenheimer, John
Otani, Iris M.
Park, Miguel
Pawankar, Ruby
Perrett, Kirsten P.
Peter, Jonny
Phillips, Elizabeth J.
Picard, Matthieu
Pitlick, Mitchell
Ramsey, Allison
Rasmussen, Trine Holm
Rathkopf, Melinda M.
Reddy, Hari
Robertson, Kara
Rodriguez del Rio, Pablo
Sample, Steven
Sheshradi, Ajay
Shiek, Javed
Sindher, Sayantani B.
Spergel, Jonathan M.
Stone, Cosby A.
Stukus, David
Tang, Mimi LK
Tracy, James M.
Turner, Paul J.
Vander Leek, Timothy K.
Wallace, Dana V.
Wang, Julie
Wasserman, Susan
Weldon, David
Wolfson, Anna R.
Worm, Margitta
Yacoub, Mona-Rita
description This guidance updates 2021 GRADE recomendations regarding immediate allergic reactions following COVID-19 vaccines and addresses re-vaccinating individuals with 1 st dose allergic reactions and allergy testing to determine re-vaccination outcomes. Recent meta-analyses assessed the incidence of severe allergic reactions to initial COVID-19 vaccination, risk of mRNA-COVID-19 re-vaccination 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 recommenations. 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 UK, and the US formed the recommendations. We recommend vaccination for persons without COVID-19 vaccine excipient allergy, and re-vaccination after a prior immediate allergic reaction. We suggest against >15-minute post-vaccination observation. We recommend against mRNA vaccine or excipient skin testing to predict outcomes. We suggest re-vaccination 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 pre-medication, split-dosing, or special precautions because of a comorbid allergic history.
doi_str_mv 10.1016/j.jaci.2023.05.019
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Shahzad ; Nanda, Anil ; Nathan, Richard ; Oppenheimer, John ; Otani, Iris M. ; Park, Miguel ; Pawankar, Ruby ; Perrett, Kirsten P. ; Peter, Jonny ; Phillips, Elizabeth J. ; Picard, Matthieu ; Pitlick, Mitchell ; Ramsey, Allison ; Rasmussen, Trine Holm ; Rathkopf, Melinda M. ; Reddy, Hari ; Robertson, Kara ; Rodriguez del Rio, Pablo ; Sample, Steven ; Sheshradi, Ajay ; Shiek, Javed ; Sindher, Sayantani B. ; Spergel, Jonathan M. ; Stone, Cosby A. ; Stukus, David ; Tang, Mimi LK ; Tracy, James M. ; Turner, Paul J. ; Vander Leek, Timothy K. ; Wallace, Dana V. ; Wang, Julie ; Wasserman, Susan ; Weldon, David ; Wolfson, Anna R. ; Worm, Margitta ; Yacoub, Mona-Rita</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-pubmedcentral_primary_oai_pubmedcentral_nih_gov_102471433</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Greenhawt, Matthew</creatorcontrib><creatorcontrib>Dribin, Timothy E.</creatorcontrib><creatorcontrib>Abrams, Elissa M.</creatorcontrib><creatorcontrib>Shaker, Marcus</creatorcontrib><creatorcontrib>Chu, Derek K.</creatorcontrib><creatorcontrib>Golden, David BK</creatorcontrib><creatorcontrib>Akin, Cem</creatorcontrib><creatorcontrib>Anagnostou, Akterini</creatorcontrib><creatorcontrib>ALMuhizi, Faisal</creatorcontrib><creatorcontrib>Alqurashi, Waleed</creatorcontrib><creatorcontrib>Arkwright, Peter</creatorcontrib><creatorcontrib>Baldwin, James L.</creatorcontrib><creatorcontrib>Banerji, Aleena</creatorcontrib><creatorcontrib>Bégin, Philippe</creatorcontrib><creatorcontrib>Ben-Shoshan, Moshe</creatorcontrib><creatorcontrib>Bernstein, Jonathan</creatorcontrib><creatorcontrib>Bingeman, Theresa A.</creatorcontrib><creatorcontrib>Bindslev-Jensen, Carsten</creatorcontrib><creatorcontrib>Blumenthal, Kim</creatorcontrib><creatorcontrib>Byrne, Aideen</creatorcontrib><creatorcontrib>Cahil, Julia</creatorcontrib><creatorcontrib>Cameron, Scott</creatorcontrib><creatorcontrib>Campbell, Dianne</creatorcontrib><creatorcontrib>Campbell, Ronna</creatorcontrib><creatorcontrib>Cavender, Michael</creatorcontrib><creatorcontrib>Chan, Edmond S.</creatorcontrib><creatorcontrib>Chinthrajah, Sharon</creatorcontrib><creatorcontrib>Comberiatti, Pasquale</creatorcontrib><creatorcontrib>Eastman, Jacqueline J.</creatorcontrib><creatorcontrib>Ellis, Anne K.</creatorcontrib><creatorcontrib>Fleischer, David M.</creatorcontrib><creatorcontrib>Fox, Adam</creatorcontrib><creatorcontrib>Frischmeyer-Guerrerio, Pamela A.</creatorcontrib><creatorcontrib>Gagnon, Remi</creatorcontrib><creatorcontrib>Garvey, Lene H.</creatorcontrib><creatorcontrib>Grayson, Mitchell H.</creatorcontrib><creatorcontrib>Clarisse Isabwe, Ghislaine Annie</creatorcontrib><creatorcontrib>Hartog, Nicholas</creatorcontrib><creatorcontrib>Hendron, David</creatorcontrib><creatorcontrib>Horner, Caroline C.</creatorcontrib><creatorcontrib>O'B Hourihane, Johnathan</creatorcontrib><creatorcontrib>Iglesia, Edward</creatorcontrib><creatorcontrib>Kan, Manstein</creatorcontrib><creatorcontrib>Kaplan, Blanca</creatorcontrib><creatorcontrib>Katelaris, Constance H.</creatorcontrib><creatorcontrib>Kim, Harold</creatorcontrib><creatorcontrib>Kelso, John M.</creatorcontrib><creatorcontrib>Kahn, David A.</creatorcontrib><creatorcontrib>Lang, David</creatorcontrib><creatorcontrib>Ledford, Dennis</creatorcontrib><creatorcontrib>Levin, Michael</creatorcontrib><creatorcontrib>Lieberman, Jay A.</creatorcontrib><creatorcontrib>Loh, Richard</creatorcontrib><creatorcontrib>Mack, Douglas P.</creatorcontrib><creatorcontrib>Mazer, Bruce</creatorcontrib><creatorcontrib>Mody, Ketan</creatorcontrib><creatorcontrib>Mosnaim, Gissele</creatorcontrib><creatorcontrib>Munblit, Daniel</creatorcontrib><creatorcontrib>Mustafa, S. 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Shahzad</au><au>Nanda, Anil</au><au>Nathan, Richard</au><au>Oppenheimer, John</au><au>Otani, Iris M.</au><au>Park, Miguel</au><au>Pawankar, Ruby</au><au>Perrett, Kirsten P.</au><au>Peter, Jonny</au><au>Phillips, Elizabeth J.</au><au>Picard, Matthieu</au><au>Pitlick, Mitchell</au><au>Ramsey, Allison</au><au>Rasmussen, Trine Holm</au><au>Rathkopf, Melinda M.</au><au>Reddy, Hari</au><au>Robertson, Kara</au><au>Rodriguez del Rio, Pablo</au><au>Sample, Steven</au><au>Sheshradi, Ajay</au><au>Shiek, Javed</au><au>Sindher, Sayantani B.</au><au>Spergel, Jonathan M.</au><au>Stone, Cosby A.</au><au>Stukus, David</au><au>Tang, Mimi LK</au><au>Tracy, James M.</au><au>Turner, Paul J.</au><au>Vander Leek, Timothy K.</au><au>Wallace, Dana V.</au><au>Wang, Julie</au><au>Wasserman, Susan</au><au>Weldon, David</au><au>Wolfson, Anna R.</au><au>Worm, Margitta</au><au>Yacoub, Mona-Rita</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Updated Guidance Regarding The Risk ofAllergic Reactions to COVID-19 Vaccines and Recommended Evaluation and Management: A GRADE Assessment, and International Consensus Approach</atitle><jtitle>Journal of allergy and clinical immunology</jtitle><date>2023-06-07</date><risdate>2023</risdate><issn>0091-6749</issn><eissn>1097-6825</eissn><abstract>This guidance updates 2021 GRADE recomendations regarding immediate allergic reactions following COVID-19 vaccines and addresses re-vaccinating individuals with 1 st dose allergic reactions and allergy testing to determine re-vaccination outcomes. Recent meta-analyses assessed the incidence of severe allergic reactions to initial COVID-19 vaccination, risk of mRNA-COVID-19 re-vaccination 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 recommenations. 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 UK, and the US formed the recommendations. We recommend vaccination for persons without COVID-19 vaccine excipient allergy, and re-vaccination after a prior immediate allergic reaction. We suggest against &gt;15-minute post-vaccination observation. We recommend against mRNA vaccine or excipient skin testing to predict outcomes. We suggest re-vaccination 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 pre-medication, split-dosing, or special precautions because of a comorbid allergic history.</abstract><pub>Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma &amp; Immunology</pub><doi>10.1016/j.jaci.2023.05.019</doi><oa>free_for_read</oa></addata></record>
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title Updated Guidance Regarding The Risk ofAllergic Reactions to COVID-19 Vaccines and Recommended Evaluation and Management: A GRADE Assessment, and International Consensus Approach
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