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I have “allergies”, do I need to worry about Pfizer’s COVID-19?

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The short answer, for almost everyone with allergies, is — you should still get the vaccine, but there are some precautions to take if you’ve ever had anaphylaxis before.

December 8th was the first day patients in the UK began to receive the Pfizer COVID-19 vaccine.  Six days later, on the 14th, the first patients in the US received the vaccine.  

On December 11th, just days into vaccine administration in Britain and before the US began administering vaccines, British regulators issued a warning after two health care workers, both with a history of food allergy with anaphylaxis, had anaphylaxis after receiving the vaccine.  Both workers were treated and recovered.

Unfortunately, as the New York Times article on the topic states, “The initial report on the British cases touched off alarm and confusion by advising that people who had ever had a “severe allergic reaction” to a food, drug or vaccine should not receive the vaccine. The nature of the reaction was not explained at first, leaving many people with allergies to food or bee stings wondering if the new vaccine would be safe for them. But the regulators’ subsequent clarification specified that their advice applied to people who had ever gone into anaphylaxis.”

On January 6, 2021, the Centers for Disease Control and Prevention released a report of allergic reactions, including anaphylaxis, after receipt of the first dose of Pfizer vaccine in the US.  According to the report, “During December 14–23, 2020, monitoring by the Vaccine Adverse Event Reporting System detected 21 cases of anaphylaxis after administration of a reported 1,893,360 first doses of the Pfizer-BioNTech COVID-19 vaccine (11.1 cases per million doses); 71% of these occurred within 15 minutes of vaccination.”  

The CDC lists the following implications for public health practice: “Locations administering COVID-19 vaccines should adhere to CDC guidance for use of COVID-19 vaccines, including screening recipients for contraindications and precautions, having the necessary supplies available to manage anaphylaxis, implementing the recommended post vaccination observation periods, and immediately treating suspected cases of anaphylaxis with intramuscular injection of epinephrine.”  

The observations of Dr. Anthony Fauci, the nation’s leading expert on infectious diseases, as reported in the New York Times article linked above, provide helpful insight into how concerned patients should be if they have a history of allergies.  “…the allergic reactions were concerning but most likely rare, the kind of effects that show up when a vaccine moves out of testing and into broader distribution.“If I were a person that had an underlying allergic tendency, I might want to be prepared that I might get a reaction, and therefore be ready to treat it.”  

Dr. Paul Offit, a vaccine expert at Children’s Hospital of Philadelphia, added “millions of people in the United States are allergic to foods like eggs or peanuts, as well as medicines or bee stings, and have had reactions that were serious enough to lead doctors to advise them to carry epinephrine injectors. But that does not necessarily mean the vaccine is risky for them. About five percent of children and four percent of adults in the United States have food allergies, according to the National Institute of Allergy and Infectious Diseases. Fewer than one in a million recipients of other vaccines a year in the United States have an anaphylactic reaction, Dr. Offit said. Those reactions are treatable, and much easier to control than a severe case of COVID-19, he said. Many people with allergies to foods, bee stings or medicines have received multiple vaccines without problems.”

While it is important that those who have had anaphylactic reactions in the past take care in receiving their vaccine only at a center which complies by the CDC recommendations above (e.g. mandatory 15-30min post-vaccination observation period, having supplies available to manage anaphylaxis), having had a prior anaphylactic reaction is NOT a contraindication to the Pfizer COVID-19 vaccine unless this reaction was in response to a previous mRNA vaccine or to polysorbate (due to potential cross-reactive hypersensitivity with the vaccine ingredient PEG).  More CDC information on COVID-19 vaccine contraindications can be found here.  

Jennifer Abrams, MD, January 6, 2021