I have allergies – Can I take the Covid-19 vaccine? – Amar-Singh HSS | What you think

MARCH 1 – As we implement our national Covid-19 vaccination program, those of us who are healthcare professionals have many friends and acquaintances who ask us about the safety of Covid-19 vaccines . In particular, there is the issue of the risk of taking the vaccine if we have a history of allergies. It is recognized that some people have a rare and serious side effect, which is a serious allergic reaction called anaphylaxis. Anaphylaxis can occur after taking medication, a bee sting, food, etc. and not just vaccines; you often never know who will react in this way. This severe reaction can cause swelling of the face or body, difficulty breathing and low blood pressure. It is recognized that a few people developed it after taking the Covid-19 vaccine. We must therefore be informed about this and be able to discuss our risks with our doctor if we suffer from allergies.

As always, it’s important to examine data and evidence instead of relying on opinions or rumors. I have attempted to summarize our understanding of the risk of anaphylaxis from the data currently available.

How common is anaphylaxis after a Covid-19 vaccine?

I have summarized data from three different countries in Table 1 – the US CDC Vaccine Adverse Event Reporting System, the UK Department of Health’s Yellow Card Reporting System, and the Norwegian Adverse Reaction Registry. from the Norwegian Medicines Agency.

These three countries report their experience of side effects. After more than 27 million doses, 276 anaphylaxis events have been confirmed, giving a rate of 10.2 per million doses or ~ 1 per 100,000 people vaccinated. There are different rates of anaphylaxis in different countries (different genetic history) and possibly different rates with different vaccines (more data needed here).

This does mean, however, that anaphylaxis after Covid-19 is a very rare event. Note that all people with anaphylaxis have been treated and discharged well.

What other data do we need?

Ideally, we would like to see data that shows the risk of anaphylaxis in people with previous anaphylaxis and the risk of anaphylaxis in people with major or severe allergies (by vaccine type). This means that of all the people vaccinated against severe allergies, how many actually developed anaphylaxis? The percentage (or rate) should be very, very low because many people are allergic.

A small idea of ​​this comes from a report released by the US CDC that describes 21 people who developed anaphylaxis after the Covid-19 vaccine. 17 of 21 (81%) had a documented history of allergies or allergic reactions to drugs, medical products, foods, insect bites and

7 out of 21 (33%) had experienced an episode of anaphylaxis (1 after the rabies vaccine; 1 after the H1N1 influenza vaccine).

Therefore, the risk of anaphylaxis is higher in those who have had a history of allergies and occurs less often in those without a history of allergies. But remember that a very large number of people with allergies have received the vaccine safely without any reaction.

What constitutes a severe allergy?

Many people can have an allergy, often mild; estimated that 20 to 30 percent of the population suffered from an allergy. Common mild allergic conditions would include eczema, allergic rhinitis, food allergy, urticaria, contact dermatitis, insect allergies, mild asthma, etc. Examples of moderate allergic conditions would be drug allergies and severe asthma, especially when left unchecked. Severe allergies would be previous anaphylaxis, or previous angioedema (skin edema without blood pressure or respiratory changes) or previous hypersensitivity reactions to vaccines or vaccine components (especially polyethylene glycol).

What do international organizations recommend?

International organizations or regulatory bodies have made statements about the use of the Covid-19 vaccine and allergies. Table 2 summarizes their opinions.

Note that most support vaccination in people with previous allergies and some even those who have had anaphylaxis in the past (with close observation). But not all support vaccination in people who have had a reaction to Covid-19 vaccines or a reaction to other vaccines or drugs containing polyethylene glycol or polysorbate 80 in the past. Some are more cautious and conservative and hope to get more. data before eliminating certain contraindications to vaccination.

What does our Ministry of Health (MoH) advise?

The national Covid-19 vaccination program booklet indicates that “The Covid-19 vaccine is safe for the majority of people. However, some groups will need to be further investigated before receiving the vaccine.“. This includes “People with severe allergies“. The National Drug Regulatory Agency (NPRA) of the Department of Health has a Frequently Asked Questions (FAQ) section on the Pfizer vaccine (Comirnaty). On allergies, they say “Comirnaty should not be given to people known to have allergic reactions to any of the ingredients in the vaccine. The second dose of the vaccine should not be given to people who have had a severe allergic reaction after the first dose of this vaccine.“They also advise people with allergies to speak to their doctor before deciding on their suitability for vaccination, but say you can get the vaccine even if you have an allergy. It would be good if clearer guidelines were made available to all doctors and health workers so that they could advise those who come for vaccination. The Ministry of Health will monitor all side effects after vaccination and encourage us to report them.

What should I do if I have severe allergies?
After reading all of this, you may ask yourself: What should I do if I fall under the category of person who has had a severe allergy before (i.e. previous anaphylaxis or angioedema or severe number of bad drug allergies)? Well, I’m in the same situation as you. I have many drug allergies, some very serious (Steven Johnson reaction); I had an episode of angioedema, allergic airway obstruction and also underlying asthma and eczema.

We want to support the national Covid-19 vaccination program, we want to help protect others by getting vaccinated and we certainly don’t want our lives to be restricted if we don’t get vaccinated (whether the government or companies impose conditions for unvaccinated people).

I think there are three possible options for those of us with severe allergies:

1. First, we can choose not to get the vaccine because we believe the risk is too high. But we’ll have to come to terms with a much stricter SOP for our lives and be prepared to have our lives limited for a while.

2. The second option is that we choose to vaccinate and due to the high risk request that this be done with better professional healthcare support i.e. vaccinate in hospital and have good medical support with adrenaline at your fingertips.

3. The third option is to delay vaccination and monitor data as new information becomes available. The risk of anaphylaxis is low and probably even lower as we get more immunization data. We will also have a clearer idea of ​​which vaccine has the lowest severe allergic reaction rate. Once these data are available, we hope to be able to choose the least allergic vaccine and vaccinate in a hospital with good medical support.

Note that this advice only applies to people with severe allergies. People with milder allergies should consider getting vaccinated but inform their doctor about their allergies. Hundreds of thousands of people with allergies have already received the vaccine safely.

It would be nice if the MySejahtera app, when registering for vaccination, had a clear box to check for past allergies. Currently we only have one “Others” box to check.

In this discussion, we need to remember that the risk of dying from Covid-19, especially if you’re over 60, like me, is much, much higher than any vaccine risk. Not to mention the 10 to 20% who can suffer from “long Covid”, which is quite debilitating. As always, we need to understand that our vaccination will help protect those who cannot get vaccinated, especially children and those who are currently contraindicated due to poor health. What we need is full data transparency, especially on adverse events. Quick and open sharing of granular data with the public kills rumors and makes our immunization program easier.

* This is the personal opinion of the writer or publication and does not necessarily represent the views of Malaysian courier.