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COMMENTARY | As we implement our national Covid-19 vaccination program, those of us who are healthcare professionals have numerous friends and acquaintances who ask us about the safety of Covid-19 vaccines. In particular, the risk of taking the vaccine if we have a history of allergies.
It is recognized that some people experience a rare and serious side effect, a severe allergic reaction called anaphylaxis. This can happen after taking a medicine, a bee sting, eating certain types of food, etc. and not only with vaccines; often we never know who will react this way.
This serious reaction can cause swelling of the face or body, shortness of breath, and a drop in blood pressure. It is recognized that some people have developed this after taking the Covid-19 vaccine. Therefore, we must be informed about this and be able to discuss our risk with our doctor if we suffer from allergies.
As always, it is important to look at data and evidence rather than relying on opinion or hearsay. I have attempted to summarize our understanding of the risk of anaphylaxis from the currently available data.
How common is anaphylaxis after a Covid-19 vaccine?
I have summarized data from three different countries in Table 1: The U.S. Centers for Disease Control and Prevention (CDC) Vaccine Adverse Event Reporting System, The Yellow Card Reporting System from the UK Department of Health and the Norwegian ADR Register of the Norwegian Medicines Agency.
These three countries report their experience of side effects. After more than 27 million doses, there were 276 confirmed anaphylaxis events giving a rate of 10.2 per million doses or one per 100,000 vaccinated people. There are different rates of anaphylaxis in different countries (different genetic backgrounds) and possibly different rates with different vaccines (more data needed here).
However, this means that anaphylaxis after Covid-19 is a very rare event. Keep in mind that all people who experienced anaphylaxis were well treated and discharged.
What more data do we need?
Ideally, we would like to see data showing the risk of anaphylaxis in people who had prior anaphylaxis and the risk of anaphylaxis in people with severe or severe allergies (by vaccine type). That is, of all the people vaccinated with severe allergies, how many actually developed anaphylaxis? The percentage (or rate) must be very small as many people suffer from allergies.
A little insight into this comes from a published CDC report describing 21 people who developed anaphylaxis after the Covid-19 vaccine. About 17 out of 21 (81 percent) had a documented history of allergies or allergic reactions to medications, medical products, foods, or insect bites. Seven of 21 (33 percent) had experienced an episode of anaphylaxis in the past (one after the rabies vaccine; one after the influenza A H1N1 vaccine).
Therefore, the risk of anaphylaxis is higher in those who have had a history of allergies and occurs less frequently in those without a history of allergies. But remember that a large number of people with allergies have been vaccinated safely and without reactions.
What constitutes a severe allergy?
Many people may have an allergy, often mild. It is estimated that between 20 and 30 percent of the population suffers from an allergic disease. Common mild allergic conditions would include eczema, allergic rhinitis, food allergy, hives, contact dermatitis, insect allergies, mild asthma, etc.
Examples of moderate allergic conditions would be drug allergies and severe asthma, especially when not controlled. Serious allergies would be previous anaphylaxis, or previous angioedema (skin edema without changes in blood pressure or respiration) or previous hypersensitivity reactions to vaccines or vaccine components (especially polyethylene glycol).
What do international organizations recommend?
International organizations or regulatory bodies have made statements about the use of the Covid-19 vaccine and allergies. Table 2 summarizes their opinions.
Note that most support vaccination in those with previous allergies and some even in those who have had prior anaphylaxis (with close observation). But not everyone supports vaccination in anyone who has had a previous reaction to Covid-19 vaccines or a reaction to other vaccines or medications that contained polyethylene glycol or polysorbate 80.
Some are more cautious and conservative and wait to get more data before eliminating some contraindications to vaccination.
What does our Ministry of Health advise?
The National Covid-19 Immunization Program brochure states that “the Covid-19 vaccine is safe for most people. However, some groups will need further consideration before receiving the vaccine. ” This includes “people with severe allergies.”
The National Agency for Pharmaceutical Regulation of the Ministry of Health has a section of frequently asked questions (FAQ) about the Pfizer (Comirnaty) vaccine. On allergies, they state: “Comirnaty should not be given to people who are known to have allergic reactions to any of the ingredients in the vaccine …
“The second dose of the vaccine should not be given to people who have had a severe allergic reaction after the first dose of this vaccine.”
They also advise people with allergies to talk to their doctor before deciding if they are eligible for vaccination, but they say you can get the vaccine even if you have an allergy.
It would be good if all doctors and health personnel had clearer guidelines so that they can advise those who come to be vaccinated. The Ministry of Health will monitor all side effects after vaccination and encourage us to report them.
What do I do if I have severe allergies?
After reading all of that, you may ask: What do I do if I am in the category of a person with a prior severe allergy (i.e. prior anaphylaxis or angioedema or a large number of severe drug allergies)?
Well, I am in the same situation as you. I have numerous drug allergies, some very serious (Steven Johnson reaction); I have had an episode of angioedema, an allergic airway obstruction and also have underlying asthma and eczema.
We want to support the Covid-19 vaccination program, we want to help protect others by getting vaccinated, and we certainly don’t want our lives to be restricted if we don’t get vaccinated (if the government or companies impose conditions on those who aren’t vaccinated).
I think there are three possible options for those of us with severe allergies:
- First, we can choose not to get vaccinated because we think the risk is too high. But we will have to accept a much stricter standard operating procedure for our lives and be prepared to have our lives restricted for some time.
- The second option is that we choose to vaccinate and, due to the high risk, we request that it be done with greater support from health professionals, that is, vaccinate in a hospital and have good medical support with adrenaline on hand.
- The third option is to delay vaccination and observe the data as more becomes available. The risk of anaphylaxis is small and is likely to be even lower as we get more vaccination data. We will also have a better idea of which vaccine has the lowest rate of serious allergic reaction. Once these data are available, we hope to be able to choose the least allergic vaccine and vaccinate in a hospital with good medical support.
Please note that this advice only applies to people with severe allergies. Those with milder allergies should consider getting vaccinated but inform their doctor about their allergies. Hundreds of thousands of allergy sufferers have already been safely vaccinated.
It would be nice if the MySejahtera app, when registering for vaccination, had a clear box to check for past allergies. Currently, we only have one “Other” box to check.
In this discussion, we must remember that the probability of dying from Covid-19, especially if you are over 60 like me, is much higher than any vaccine risk. Not to mention the 10-20 percent who can suffer from “prolonged Covid-19,” which is quite debilitating.
As always, we must appreciate that our vaccine will help protect those who cannot be vaccinated, especially children and those who are currently contraindicated due to health problems.
What we need is full data transparency, especially on adverse events. Quick and open sharing of granular data with the public kills rumors and helps our vaccination program.
DR AMAR-SINGH HSS is a senior consultant pediatrician.
The opinions expressed here are those of the author / contributor and do not necessarily represent the views of Malaysiakini.
