Revaccination of people who had previous allergic reactions to COVID-19 vaccines is addressed in a guidance update of the 2021 GRADE (Grading of Recommendations Assessment, Development and Evaluation) recommendations. “While graded dosing (or stepwise desensitization) and premedication with either antihistamine or glucocorticosteroids are considered generally safe approaches, neither are required and have not been proven necessary compared to no premedication and/or administering a single vaccine dose in persons with a history of reaction to the vaccine or vaccine excipient,” authors write. “These management options are consistent with recommendations in past vaccine allergy practice parameters and may still be preferred steps by some patients and administering clinicians.”
The article describes the development of the guidance using a modified Delphi panel of experts in allergy, anaphylaxis, vaccinology, infectious diseases, emergency medicine, and primary care from Australia, Canada, Europe, Japan, South Africa, the United Kingdom, and the United States. “Recent meta-analyses assessed the incidence of severe allergic reactions to initial COVID-19 vaccination, risk of mRNA-COVID-19 revaccination after an initial reaction, and diagnostic accuracy of COVID-19 vaccine and vaccine excipient testing in predicting reactions,” the authors write. “We recommend vaccination for persons without COVID-19 vaccine excipient allergy and revaccination after a prior immediate allergic reaction. We suggest against >15-minute postvaccination observation. We recommend against mRNA vaccine or excipient skin testing to predict outcomes. We suggest revaccination of persons with an immediate allergic reaction to the mRNA vaccine or excipients be performed by a person with vaccine allergy expertise in a properly equipped setting. We suggest against premedication, split-dosing, or special precautions because of a comorbid allergic history.”