The following is a summary of “Identifying and Managing Those at Risk for Vaccine-Related Allergy and Anaphylaxis,” published in the July 2023 issue of Allergy and Clinical Immunology by Stone et al.
Immediate hypersensitivity reactions to vaccines, the most severe of which is anaphylaxis, are rare, occurring in less than 1 in a million administered doses. Rarely are these reactions immunoglobulin E–mediated. A response to a single dose of a vaccine is rarely a contraindication to redosing because it is unlikely to recur.
This narrative review article contextualizes the current knowledge 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 context of what is known about immediate reactions to other routine and globally essential vaccinations. Researchers concentrate on what is known about evidence-based approaches to diagnosis and treatment and what is new in their understanding of the mechanisms underlying acute vaccine reactions.
Specifically, they examine the epidemiology of immediate hypersensitivity vaccine reactions, the differential diagnosis for immune-mediated and nonimmune reaction clinical phenotypes, and how to identify immunization stress–related responses. In addition, they emphasize what is known about the mechanisms and review the rare but significant contribution of excipient allergies, including when testing for them should be considered, as well as other factors that contribute to safety evaluation and management.