TY - JOUR

T1 - Identifying and Managing Those at Risk for Vaccine-Related Allergy and Anaphylaxis

AU - Stone, Cosby A.

AU - Garvey, Lene H.

AU - Nasser, Shuaib

AU - Lever, Charley

AU - Triggiani, Massimo

AU - Parente, Roberta

AU - Phillips, Elizabeth J.

N1 - Publisher Copyright: © 2023 American Academy of Allergy, Asthma & Immunology

PY - 2023

Y1 - 2023

N2 - Immediate hypersensitivity reactions to vaccines, the most severe of which is anaphylaxis, are uncommon events occurring in fewer than 1 in a million doses administered. These reactions are infrequently immunoglobulin E–mediated. Because they are unlikely to recur, a reaction to a single dose of a vaccine is rarely a contraindication to redosing. This narrative review article contextualizes the recent knowledge we have gained from the coronavirus 2019 (COVID-19) pandemic rollout of the new mRNA platform with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines within the much broader context of what is known about immediate reactions to other vaccinations of routine and global importance. We focus on what is known about evidence-based approaches to diagnosis and management and what is new in our understanding of mechanisms of immediate vaccine reactions. Specifically, we review the epidemiology of immediate hypersensitivity vaccine reactions, differential diagnosis for immune-mediated and nonimmune reaction clinical phenotypes, including how to recognize immunization stress–related responses. In addition, we highlight what is known about mechanisms and review the rare but important contribution of excipient allergies and specifically when to consider testing for them as well as other key features that contribute to safe evaluation and management.

AB - Immediate hypersensitivity reactions to vaccines, the most severe of which is anaphylaxis, are uncommon events occurring in fewer than 1 in a million doses administered. These reactions are infrequently immunoglobulin E–mediated. Because they are unlikely to recur, a reaction to a single dose of a vaccine is rarely a contraindication to redosing. This narrative review article contextualizes the recent knowledge we have gained from the coronavirus 2019 (COVID-19) pandemic rollout of the new mRNA platform with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines within the much broader context of what is known about immediate reactions to other vaccinations of routine and global importance. We focus on what is known about evidence-based approaches to diagnosis and management and what is new in our understanding of mechanisms of immediate vaccine reactions. Specifically, we review the epidemiology of immediate hypersensitivity vaccine reactions, differential diagnosis for immune-mediated and nonimmune reaction clinical phenotypes, including how to recognize immunization stress–related responses. In addition, we highlight what is known about mechanisms and review the rare but important contribution of excipient allergies and specifically when to consider testing for them as well as other key features that contribute to safe evaluation and management.

KW - Anaphylaxis

KW - Complement

KW - Excipient

KW - Hypersensitivity

KW - Immediate

KW - ISRR

KW - Vaccine

UR - http://www.scopus.com/inward/record.url?scp=85163887829&partnerID=8YFLogxK

U2 - 10.1016/j.jaip.2023.05.004

DO - 10.1016/j.jaip.2023.05.004

M3 - Journal article

C2 - 37182566

AN - SCOPUS:85163887829

VL - 11

SP - 2008

EP - 2022

JO - The Journal of Allergy and Clinical Immunology: In Practice

JF - The Journal of Allergy and Clinical Immunology: In Practice

SN - 2213-2198

IS - 7

ER -