Kimberly G. Blumenthal, Esther E. Freeman, Rebecca R. Saff, Lacey B. Robinson, Anna R. Wolfson, Ruth K. Foreman, Dean Hashimoto, Aleena Banerji, Lily Li, Sara Anvari, Erica S. Shenoy
In this editorial letter, published by the New England Journal of Medicine, Blumenthal et al. report on 12 cases of large local reactions to the COVID-19 mRNA-1273 vaccine from Moderna. The found that these delayed skin reactions occurred at the point of injection up to 11 days after the first dose of vaccine. Ultimately, all 12 patients were encouraged to receive the second dose and completed their vaccination regimen safely. Half of the patients had no reaction to the second dose, while the others experienced a reaction milder than or comparable to their reaction to the first dose, though with an earlier onset time.
After over 60,000 Mass General Brigham employees received the first dose of an mRNA COVID-19 vaccine, Blumenthal et al. analyze the symptom-surveys completed by more than 50,000 employees. This research letter in JAMA uncovered that vaccine-related anaphylaxis occurred in just 2.47 vaccinations out of every 10,000, and none of the cases of anaphylaxis required medication to maintain normal blood pressure or a breathing tube be placed. However, that result is nearly 100 times greater than the incidence rate reported by the US Centers for Disease Control and Prevention (CDC), at 0.025 vaccinations per 10,000. Despite this significant difference, even the larger rate of anaphylaxis is relatively low and comparable to other common healthcare exposures.
A simplified version of Table 1. Anaphylaxis was confirmed using two separate sets of criteria, the Brighton criteria (7 Pfizer-BioNTech cases, 7 Moderna cases) and the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network criteria (4 Pfizer-BioNTech cases, 5 Moderna cases). “Confirmed anaphylaxis” cases presented symptoms consistent with anaphylaxis according to either set of criteria, and some instances were consistent with both (4 Pfizer-BioNTech cases, 3 Moderna cases).
A team of UK researchers, along with MGH allergy specialist Dr. Kimberly Blumenthal, addressed concerns about allergic reactions to the Pfizer-BioNTech and Moderna COVID-19 vaccines in The BMJ. These vaccines have been reported to cause allergic reactions, but severe reactions were very rare (between 2.5 and 11 cases per one million Americans). The authors conclude that the only individuals who cannot get this vaccine are those with a history of a severe allergic reaction to the vaccines’ ingredients (i.e. polyethylene glycol [PEG]); thus people with allergies to other foods or medications should feel assured that they are not at greater risk of allergic reaction to the vaccines.
Banerji et al. authored this special article for the Journal of Allergy and Clinical Immunology: In Practice to guide practicing allergists on the identification and treatment of allergic reactions to authorized COVID-19 vaccines. Building a framework from the current data and information about the vaccines from Pfizer and Moderna, the authors provide a background on the potential allergic ingredients in the vaccines (Polyethylene glycol [PEG] and polysorbate 80), the best clinical approach to vaccine reactions, and advice on directing patients concerned about reactions to vaccination.