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Get Clarity on COVID-19

Allergic Reactions to COVID-19 Vaccine Explained

Dr. Reena Mehta is a board-certified immunologist in New Orleans, LA that can help you navigate COVID-19 vaccination and any other COVID related health concerns that you have.

“The staff at Uptown Allergy & Asthma is wonderful, very caring and patient. Dr. Reena Mehta took her time with me going over all my symptoms and past treatments. She was very assuring when she talked about getting to the bottom of my symptoms. She is great.“

– Savina B, October 2021

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COVID-19 Vaccination Allergy Specialist Dr. Reena Mehta in New Orleans, LA

Navigating COVID-19 Vaccine Allergies

In the United States, there are currently two commercially available COVID-19 mRNA vaccines which are manufactured by Moderna and Pfizer-BioNTech. Neither the Pfizer-BioNTech nor the Moderna COVID-19 vaccine contain preservatives, eggs, or gelatin. If you have a personal or family history of allergic reaction to food, you are okay to get COVID-19 vaccinated. The mRNA vaccines are packaged in vials with stoppers that are not made of natural rubber latex, so there is no contraindication to vaccination or extra precaution for individuals with a history of latex allergy. In addition, people with a personal or family history of allergic reaction to pets, insect venom, other environmental allergens, or oral medications can also get COVID-19 vaccinated.

Allergic Reactions to COVID-19 Vaccine Ingredients

Both commercially available COVID-19 mRNA vaccines contain ingredients that may cause allergic reactions in some individuals. If you’ve had an immediate allergic reaction to a component found in the COVID-19 mRNA vaccine (i.e. hives or swelling within 4 hours of exposure), even if it was not severe, you should see your allergist to help you navigate COVID-19 vaccination. Dr. Mehta can test you for COVID vaccine allergies, and if needed, prescribe premedications to prevent an allergic reaction to the vaccine, allowing you to safely receive both doses. For reference, the ingredients of both the Pfizer-BioNTech and the Moderna vaccines are provided below.

Pfizer-BioNTech mRNA COVID-19 vaccine ingredients list:

• Nucleoside-modified mRNA encoding the viral spike (S) glycoprotein of SARS-CoV-2
• 2[(polyethylene glycol)-2000]-N,N-ditetradecylacetamide
• 1,2-distearoyl-sn-glycero-3-phosphocholine
• Cholesterol
• (4-hydroxybutyl)azanediyl)bis(hexane-6,1-diyl)bis(2-hexyldecanoate)
• Potassium chloride
• Monobasic potassium phosphate
• Sodium chloride
• Dibasic sodium phosphate dihydrate
• Sucrose

Moderna vaccine ingredients list:

• Nucleoside-modified mRNA encoding the viral spike (S) glycoprotein of SARS-CoV-2
• PEG2000-DMG: 1,2-dimyristoyl-rac-glycerol, methoxypolyethylene glycol
• 1,2-distearoyl-sn-glycero-3-phosphocholine
• Cholesterol
• SM-102: heptadecan-9-yl 8-((2-hydroxyethyl) (6-oxo-6-(undecyloxy) hexyl) amino) octanoate
• Tromethamine
• Tromethamine hydrochloride
• Acetic Acid
• Sodium Acetate
• Sucrose

Allergic Reactions to the First Dose

It is normal to experience some unpleasant side effects after receiving a dose of a COVID-19 mRNA vaccine. These side effects are not necessarily indicative of an allergic reaction and should go away in a few days. Common side effects include:

• Pain at the site of injection
• Swelling at the site of injection
• Fever
• Chills
• Fatigue
• Headache

If you do have an allergic reaction to the vaccine, it will usually occur within the first few minutes of being injected. Any reaction requiring epinephrine treatment or hospitalization is considered a severe allergic reaction. Early vaccine guidance stated that individuals who experienced a severe reaction to the first dose of a COVID-19 vaccine should not pursue a second dose. However, more recent studies have demonstrated that patients can safely get a second dose with proper premedication and oversight from an allergist, even if they’ve had a severe (or mild) allergic reaction to the first dose. If you had a reaction to your first dose (either mild or severe) and are concerned about your second dose, we recommend scheduling a consultation with Dr. Mehta to learn how you can get vaccinated while minimizing allergic reactions.

How Common are Allergic Reactions to the COVID-19 Vaccines?

Based on reports from the CDC, only a few cases of anaphylaxis have been reported through the Vaccine Adverse Event Report System. From December 21, 2020 to January 10, 2021, 10 cases of anaphylaxis out of a reported 4,041,396 first doses of Moderna COVID-19 vaccine were detected. This equates to 2.5 cases of anaphylaxis per million doses administered.

During the rollout of Pfizer-BioNTech’s COVID-19 vaccine from December 14, 2020 to December 23, 2020, 21 cases of anaphylaxis occurred after administration of a reported 1,893,360 first doses of the Pfizer-BioNTech COVID-19 vaccine. This equates to 11 cases of anaphylaxis per million doses.

No anaphylaxis-related deaths were reported for either vaccine rollout, and most cases of anaphylaxis occurred within 15 minutes of vaccination.

More recent data from a study of 52,805 healthcare employees of the Mass General Brigham health care system reported a higher rate of anaphylaxis, stating that anaphylaxis occurred in 247 cases per million individuals vaccinated. This study also looked closer at individuals with history of severe allergic reactions, and found that about 1 in 10 (11.6%) had an allergic reaction to a vaccine dose compared to about 1 in 20 (4.7%) of those without a history of severe allergic reactions. Importantly, the study concluded that allergy symptoms did not impede the completion of the 2-dose vaccine protocol among a cohort of eligible health care employees, supporting the overall safety of mRNA COVID-19 vaccine even in individuals with allergies.

Talking to Your Allergist About COVID-19 Vaccination

You should speak to your allergist prior to getting vaccinated if you:

• Have a history of severe anaphylaxis
• Have had a non-severe but immediate allergic reaction to another vaccine or injectable therapy
• Are on prescription medications, such as daily oral steroids, that may interfere with the antibody response to the COVID-19 vaccine
• Suspect that you’re allergic to an ingredient in the COVID-19 vaccines
• Had an allergic reaction to your first dose of the vaccine

COVID-19 Vaccine Allergy Testing

COVID-19 Vaccine Allergy Skin Testing

If you’ve had a reaction to a prior vaccine dose, skin testing can be done at Uptown Allergy & Asthma to rule out (or rule in) allergies to Polyethylene Glycol (PEG) and polysorbate, two ingredients that have been proposed as the cause of anaphylaxis cases following the COVID-19 vaccine.

COVID-19 Vaccine Allergy Blood Testing

Uptown Allergy & Asthma is not offering COVID-19 vaccine allergy blood testing at this time. However, blood testing protocols do exist. In the US, Tryptase is one commercially available blood test that healthcare professionals can order to help assess a severe allergic reaction following COVID-19 vaccination. However, these lab tests cannot definitively diagnose the cause of a severe allergic reaction.

Blood samples for these lab tests should only be collected once a patient is medically stabilized. Ideally, blood samples should be collected between 30 and 90 minutes after the start of the allergic reaction, when certain markers are still elevated. Blood samples may still be helpful even if collected up to 6 hours after a reaction.

Get Clarity on COVID-19 in New Orleans

Dr. Mehta is providing telemedicine visits to answer your questions about COVID-19, allergies, and asthma and help you through any health concerns that you might have about the virus and the vaccine. Dr. Mehta has a reputation for developing strong relationships with her patients and being exceptionally attentive to their needs and concerns.