Association of self-reported high-risk allergy history with allergy symptoms after COVID-19 vaccination

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JAMA Netw Open. October 1, 2021; 4 (10): e2131034. doi: 10.1001 / jamanetworkopen.2021.31034.

ABSTRACT

IMPORTANCE: A history of allergies in people with confirmed anaphylaxis to a COVID-19 messenger RNA (mRNA) vaccine is common. However, the risk factors for allergy symptoms after receiving the vaccine are unknown.

OBJECTIVE: To assess the association between self-reported high-risk allergy history and self-reported allergic reactions following COVID-19 mRNA vaccination of healthcare workers.

DESIGN, BACKGROUND, AND PARTICIPANTS: This cohort study obtained demographic, medical, and vaccine administration data of Mass General Brigham employees from the facility’s electronic health record. Employees who received at least 1 dose of a COVID-19 mRNA vaccine between December 14, 2020 and February 1, 2021 and who completed at least 1 post-vaccination symptom survey within 3 days of vaccination have been included.

EXPOSURES: Self-reported history of high-risk allergy, defined as a previous severe allergic reaction to a vaccine, injectable drug, or other allergen.

MAIN RESULTS AND MEASURES: The primary outcome was 1 or more self-reported allergic reactions within the first 3 days after dose 1 or dose 2 of a COVID-19 mRNA vaccine. Multivariate logarithmic binomial regression was used to assess the association between allergic reactions and high-risk allergic status.

RESULTS: A total of 52,998 healthcare workers (average [SD] age, 42 [14] years; 38,167 women [72.0%]) were included in the cohort, of whom 51,706 (97.6%) received 2 doses of a COVID-19 mRNA vaccine and 474 (0.9%) reported a history of high-risk allergy . People with or without a history of high-risk allergy reported more allergic reactions after receiving dose 1 or 2 of the vaccine (11.6% [n = 55] against 4.7% [n = 2461]). In the fitted model, a history of high-risk allergy was associated with an increased risk of allergic reactions (adjusted relative risk [aRR], 2.46; 95% CI, 1.92-3.16), the risk being highest for urticaria (ARR, 3.81; 95% CI, 2.33 to 6.22) and angioedema (aRR, 4.36; 95% CI, 2.52 to 7.54).

CONCLUSIONS AND RELEVANCE: This cohort study found that a self-reported history of high-risk allergy was associated with an increased risk of self-reported allergic reactions within 3 days of COVID-19 mRNA vaccination. However, the reported allergy symptoms did not hinder the completion of the 2-dose vaccination protocol among a cohort of eligible healthcare workers, supporting the overall safety of the COVID-19 mRNA vaccine.

PMID: 34698847 | DOI: 10.1001 / jamanetworkopen.2021.31034


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