Recent mRNA vaccine approval in the fight against COVID-19 has provided hope to millions around the world. However, for those individuals with a history of severe allergic reactions, the potential for vaccination is less certain. Current guidelines warn against mRNA vaccine administration to this patient group. Therefore, there is a clear need for risk stratification in regard to these individuals when assessing their likelihood of developing anaphylaxis.

To help guide clinicians and reassure those at risk, Banjeri et al. reviewed the current evidence surrounding anaphylaxis in response to the Pfizer−BioNTech and Moderna COVID-19 mRNA vaccines. The work summarised the rate of allergic reactions, which occurred at 1.3 per 100,000 doses, with severe events of fatigue and headache occurring at 3.8% and 2.0% respectively. Encouragingly, hypersensitivity events occurred at a rate consistent with the placebo groups, suggesting that no component of the vaccines poses a risk. However, the authors do suggest the use of four screening questions to help evaluate risk level, and disclosure of a comprehensive list of vaccine constituents. It is also important to consider that vaccine administration is unlikely to always be performed by staff who regularly diagnose and treat anaphylaxis.

As rollout of the mRNA vaccines begins, administrators will have to remain watchful and ensure all groups have sufficient information and support to make an informed decision.

Read the full article in Journal of Allergy & Clinical Practice doi:10.1016/j.jaip.2020.12.047