Most people with allergies can safely get vaccinated for COVID-19. However, there is a very small subgroup of people with a history of allergic reactions to previous vaccinations or allergies to two vaccine ingredients -- called polyethylene glycol and polysorbate -- who should consult an allergist before receiving a COVID shot.
When to Consult an Allergist
The Centers for Disease Control and Prevention recommends that people get vaccinated for COVID-19 even if they have a history of severe allergic reactions not related to vaccines or injectable medications -- such as food, pet, venom, environmental or latex allergies. People with a history of allergies to oral medications or a family history of severe allergic reactions may also get vaccinated.
If you know you're allergic to polyethylene glycol (PEG) or polysorbate, you should consult your allergist before deciding which vaccine to get. An allergy specialist can evaluate you to determine which vaccine you'll be able to tolerate.
If you're allergic to PEG, you should not get an mRNA COVID-19 vaccine (Pfizer or Moderna). PEG is an ingredient in these vaccines. It's also found in colonoscopy preparations (GoLYTELY) or constipation treatment (MiraLAX). Consult with an allergy specialist to determine if you can get the Johnson & Johnson vaccine.
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If you are allergic to the synthetic ingredient polysorbate, you should not get the J&J COVID-19 vaccine. Consult with an allergy specialist to determine if you can get an mRNA vaccine.
If you have had an immediate allergic reaction -- even if it wasn't severe -- to a vaccine or injectable therapy for another disease, talk to an allergy specialist to find out if you can get a COVID-19 vaccine.
If you had an immediate allergic reaction such as hives, swelling, itching, nausea, vomiting, dizziness, wheezing or shortness of breath within four hours after getting a shot of a COVID-19 vaccine, you should not get a second shot of that vaccine, even if your allergic reaction was not severe enough to require emergency care. Ask an allergy specialist if you can get the second vaccine dose .
Signs of a severe allergic reaction happen within four hours of getting vaccinated. They include symptoms such as hives, swelling, wheezing, nausea, vomiting, dizziness or fainting. Common reactions to the vaccine such as fatigue, muscle aches, headache and fever are not signs of an allergic reaction. The incidence of severe allergic reaction has been very low so far in people vaccinated for COVID-19.
Monitoring for Allergic Reaction
All people who get a COVID-19 vaccine should be monitored on site. People who have had severe allergic reactions or who have had any type of immediate allergic reaction to food or medication or an unknown cause should be monitored for at least 30 minutes after getting the vaccine. All other people should be monitored for at least 15 minutes after getting the vaccine.
If you get a COVID-19 vaccine and think you might be having a severe allergic reaction after leaving the vaccination provider site, seek immediate medical care by calling 911.
' COVID' Arm Rashes
Some people develop a red, itchy, swollen or painful rash where they got the shot. These rashes can start a few days to more than a week after the first shot and are sometimes quite large. These rashes are known as "COVID arm." If you develop a rash after getting the first shot, you should still get the second shot if you're getting a two-dose vaccine. Tell your vaccination provider that you experienced a rash or "COVID arm" after the first shot. Your vaccination provider may recommend that you get the second shot in the opposite arm and be monitored for 30 minutes .
If the rash is itchy, you can take an antihistamine. If it's painful, you can take a pain medication like acetaminophen or a non-steroidal anti-inflammatory drug. It is not advisable to pre-medicate with Benadryl or another antihistamine immediately before getting the vaccine, since it may mask symptoms of a severe allergic reaction. However, if someone routinely takes antihistamines daily for their environmental allergies, they may take their usual medications.
MaLourdes de Asis, MD, MPH, FAAAAI, Section Chief, Allergy and Immunology at Montefiore Nyack Hospital in Nyack, NY, is a board certified, Fellowship-trained Allergy and Immunology specialist. With a special interest in sinus disease and drug allergy, Dr. de Asis has provided comprehensive allergy, asthma, and immunology care for more than 20 years and has extensive experience in chemotherapy, aspirin and other drug evaluation and desensitization procedures.