Current guidelines from the American Academy of Allergy Asthma and Immunology regarding patients that experience allergic reactions to several medications:

Patients with allergies to oral medications (including oral equivalent of injectable medications), foods, insect, latex and environmental allergens have no restrictions and are recommended to receive the vaccine, followed by a 15-minute observation period.

Patients with non-serious reactions to vaccines or other injectables also have no restrictions, and are recommended to receive the vaccine, followed by a 15-minute observation period.

Patients with a history of severe allergic reactions (eg anaphylaxis) to vaccines (other than Pfizer-BioNTech COVID-19) or history of severe allergic reaction to any injectable medication, should be assessed for risk. The CDC ACIP suggests considering potential deferral of vaccination, and to observe for 30 minutes, if vaccination is given.

Patients with a history of severe allergic reactions (eg anaphylaxis) to any component of the Pfizer-BioNTech or Moderna vaccines should not receive the vaccine.

In all cases, equipment and medications should be available to treat any potential anaphylactic event.

Submitted by Jeffrey G Demain, MD, FAAAAI

Information regarding where to receive the vaccination:

The current available COVID-19 vaccines (both Pfizer and Moderna) will be distributed by the government and cannot be prescribed by individual medical providers. For vaccination priorities as per government and CDC guidelines, please refer to this website:

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations.html

COVID-19 as it relates to individuals with a history of immunodeficiency Q&A:

Q - Are patients with CVID amore prone to being infected with COVID-19 and experiencing severe symptoms?

 

A - Regarding patients with CVID, those on regular immunoglobulin replacement appear to have a milder clinical course. In April 2020, Quinti et al, postulated complete B cell depletion (such as in XLA) may actually be a protective factor. This hypothesis was further strengthened by another report of two XLA patients with mild COVID-19 courses. There are reports of COVID -19 related fatalities in patients with CVID, but a review of literature suggests that this is likely the exception rather than the rule. The majority of patients with CVID who have therapeutic IgG levels will likely have a benign clinical course.
Quinti I, Lougaris V, Milito C, et al. A possible role for B cells in COVID-19? Lesson from patients with agammaglobulinemia. J Allergy Clin Immunol. 2020;146(1):211-213.e4. doi:10.1016/j.jaci.2020.04.013

 Soresina A, Moratto D, Chiarini M, Paolillo C, Baresi G, Focà E, Bezzi M, Baronio B, Giacomelli M, Badolato R. Two X-linked agammaglobulinemia patients develop pneumonia as COVID-19 manifestation but recover. Pediatr Allergy Immunol. 2020 Jul;31(5):565-569. doi: 10.1111/pai.13263. Epub 2020 May 19. PMID: 32319118; PMCID: PMC7264678.

Q - Is antibody testing reliable for patients with CVID?

A - Antibody testing will not be reliable in patients with CVID. Some reports indicate patients with CVID did not have detectable SARS-COV2 IgG antibody responses despite having PCR positivity. Further, a positive SARS-COV2 IgG could be reflective of the IVIG donor rather than the patient herself (as infection rates climb precipitously in the United States). A recent study published that the seroprevalence in the general population in the US is <10%, so at best there would be limited IVIG donors that have anti-SARS-COV2 antibodies

Bajema KL, Wiegand RE, Cuffe K, et al. Estimated SARS-CoV-2 Seroprevalence in the US as of September 2020. JAMA Intern Med. Published online November 24, 2020. doi:10.1001/jamainternmed.2020.7976

Q - Are mRNA vaccines safe for patients with CVID?

 

- It appears that both RNA and adenovirus vaccines are safe for patients with CVID, although their efficacy in this population is unknown.

Q - How do the mRNA vaccines work (Pfizer and Moderna)?

 

A - This is a new type of vaccine where RNA is injected so that the body can produce a bit of the spike protein that an immune system will respond to. RNA is like a computer code and it tells your own cells to make the spike protein rather than directly injecting the spike protein. mRNA doesn't enter the cell nucleus; it goes directly to the ribosomes and starts protein synthesis producing antibodies. 

Q - What are other vaccine options that are not currently available but are being tested?

A - Astra Zeneca Oxford vaccine is another variation of a COVID-19 vaccine which is currently being developed. It uses an attenuated form of the virus that is not able to replicate and therefor will not cause infection. Rather, it produces a spike protein that will fight off infection.