Second COVID-19 mRNA vaccine dose safe even after allergic reaction to first dose: JAMA

Among 189 patients, 32 (17%) experienced anaphylaxis after their first dose of mRNA COVID-19 vaccine. A total of 159 patients (84%) went on to receive a second dose. All 159 patients, including 19 individuals who had experienced anaphylaxis following the first dose, tolerated the second dose. Thirty-two patients (20%) reported immediate and potentially allergic symptoms associated with the second dose that were self-limited, mild, and/or resolved with antihistamines alone.

"One important point from this study is that these immediate onset mRNA vaccine reactions may not be mechanistically caused by classic allergy, called immediate hypersensitivity or Ig-E-mediated hypersensitivity. For classic allergy, re-exposure to the allergen causes the same or even worse symptoms," says co-senior author Kimberly G. Blumenthal, MD, MSc, co-director of the Clinical Epidemiology Program within MGH's Division of Rheumatology, Allergy and Immunology.

The study's findings suggest that it's safe for most individuals to receive a second dose of the mRNA COVID-19 vaccine, notes co-senior author Aleena Banerji, MD, clinical director of the Allergy and Clinical Immunology Unit at MGH. "After first dose reactions, allergy specialists may be useful to help guide risk/benefit assessments and assist with completion of safe vaccination," she says.

This study was funded by the National Institutes of Health and MGH.