Study supports safety of mRNA COVID-19 vaccines in patients with allergy history
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Researchers identified an association between a self-reported history of high-risk allergy and an increased risk for allergic reactions after receipt of an mRNA COVID-19 vaccine.
However, most people with a history of severe allergic reactions were able to complete the two-dose regimen, according to findings published in JAMA Network Open.
“Our study contributes to the growing body of evidence regarding safety of mRNA vaccination in individuals despite high-risk allergy history,” Kimberly G. Blumenthal, MD, MSc, co-director of the clinical epidemiology program in the division of rheumatology, allergy and immunology at Massachusetts General Hospital, told Healio Primary Care. “We hope that this work will help inform conversations with patients, and particularly those who are hesitant to receive COVID-19 vaccine due to allergic concerns.”
Blumenthal and colleagues assessed the association between a self-reported history of high-risk allergy and allergic reactions following mRNA COVID-19 vaccination in 52,998 health care workers at Massachusetts General Brigham. The study cohort included those who received at least one dose of an mRNA COVID-19 vaccine between Dec. 14, 2020, and Feb. 1, 2021, and who completed at least one symptom survey within 3 days following vaccination.
A history of high-risk allergy, reported by 0.9% of participants, involved having a previous severe allergic reaction to a vaccine, injectable medication or other allergen. The mean age of the health care workers was 42 years; 72% were women and 97.6% received both doses of the vaccine.
Overall, 4.7% of the study cohort reported one or more allergy symptoms during the 3 days following vaccination, including rash or itching, respiratory symptoms, hives and angioedema. Individuals with a history of high-risk allergy reported more allergic reactions after receiving one or both doses of the vaccine (11.6%) compared with workers without an allergy history (4.7%), according to Blumenthal and colleagues. Moreover, after adjusting for potential confounders, the researchers reported that a history of high-risk allergy was associated with a 2.5-fold (95% CI, 1.92-3.16) increased risk for allergic reactions. The risk was highest for hives (adjusted RR [aRR] = 3.81; 95% CI, 2.33-6.22) and angioedema (aRR = 4.36; 95% CI, 2.52-7.54).
The high-risk allergy group had higher percentages of women (80.8% vs. 71.9%) and Black individuals (9.5% vs. 4.8%), according to the researchers. In addition, individuals with a high-risk allergy history were significantly more likely to be older (46 years vs. 42 years), have more atopic disease (16.7% vs. 8.7%) and a higher prevalence of anxiety (28.9% vs. 23.9%), hypertension (14.6% vs. 10.9%) and malignant neoplasm (4% vs. 2.4%). Administration of the Moderna vaccine compared with the Pfizer vaccine was also associated with an increased risk for allergic reactions (RR = 1.49; 95% CI, 1.37-1.63). Severe allergic reactions following vaccination were uncommon, occurring in 0.3% of the study cohort, among whom 4.3% had a history of high-risk allergy, according to the researchers.
“Our study supports the overall safety of mRNA COVID-19 vaccination in all eligible individuals despite high-risk allergy histories such as previous anaphylaxis episodes attributed to vaccines or medications. Symptoms such as hives and swelling may occur, but most reported allergic-type symptoms were mild and did not hinder completion of the vaccine series,” Lily Li, MD, the lead author of the study and an allergy faculty member in the division of allergy and clinical immunology at Brigham and Women’s Hospital, said.
References:
Study supports safety of COVID-19 vaccines in people with a history of severe allergic reactions. https://www.massgeneral.org/news/press-release/Study-supports-safety-of-covid-19-vaccines-in-people-with-a-history-of-severe-allergic-reactions. Published Oct. 26, 2021. Accessed Oct. 26, 2021.