People with medication allergies or a history of allergic reactions are often wary of trying new medications or vaccines. When initial reports of reaction to COVID-19 vaccines came out, experts gathered to determine how to best counsel patients with a history of allergies regarding weighing the risk versus benefits of the vaccine. Current Center for Disease Control (CDC) guidelines for people with a history of allergic reaction to vaccines or injectable medications is to consider a consultation with an Allergist/Immunologist prior to vaccination. Making the decision about whether to get the vaccine can be difficult. Following these five tips can make the decision easier.

1. Understand your allergies. People with prior severe allergic reactions to foods, environmental allergens, venoms (insect stings), or oral medications are recommended to receive the COVID-19 vaccine. They are at a lower risk of reaction to the vaccine than someone with a history of allergic reaction to a vaccine or injectable medication. A longer observation period after the vaccine, such as 30 minutes instead of 15 minutes, is reasonable for people with allergies and recommended if the previous allergic reaction was anaphylaxis.

2. Consult an expert. If you have considered your own allergies, history of reactions, and family history and you are still concerned about your ability to tolerate the vaccine, talk to your doctor. Sometimes a reaction is not straightforward, or something happened so long ago that details are missing. If questions remain, ask your doctor about consulting with an Allergist/Immunologist to help sort out the details.

3. Get tested. When a previous reaction is related to a component of the COVID-19 vaccine, like polyethylene glycol, an Allergist/Immunologist can perform a simple skin test to vaccine components. The test can determine if your reaction is a true, IgE-mediated (life-threatening) allergy. If concern for IgE-mediated allergy remains, they can also do bloodwork to check antibody titers to COVID-19. Protective titers could support deferring the vaccine.

4. Premedicate. If your Allergist/Immunologist concludes that you are at low risk for a life-threatening allergic reaction to the vaccine, they may suggest taking medication prior to receiving the vaccine. Some patients with a history of consistently getting a rash or swelling after injectable medications may be more comfortable pretreating with antihistamines to reduce the severity of those symptoms. Your doctor can help determine if and which pre-medications are right for you.
 

5. Have a plan for treating a reaction. Side effects to injectable medications and vaccines are common, and the COVID-19 vaccine is no exception. Make a plan with your doctor prior to getting the vaccine for how to treat common reactions like headache, fatigue, local swelling or pain. If your previous reactions have occurred after the recommended post-vaccine observation time, for example, at 1 or 2 hours after immunization rather than 15 or 30 minutes, plan for a longer observation time. If you verify ahead of time that there is staff and space available, most vaccine clinics do not mind you sitting in the waiting area for as long as you need to feel comfortable before leaving. This allows you to remain in a medical setting where there is medically trained staff and medication for treating more severe reactions.
 

In conclusion, understanding your personal history of allergic reactions and working with your doctor to make a plan can help you make a confident decision about the COVID-19 vaccine with your safety in mind. 

Amber Patterson, MD

Allergy & Immunology

Allergy & Immunology Specialists of Northwest Ohio

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Blanchard Valley Health System provides a total continuum of care to more than 100,000 households in an eight-county area.