Suitability for COVID-19 vaccination based on prior allergy or current dietary practices

Ashley Marsden, Senior Medicines Optimisation Pharmacist, Pharmacy Practice Unit, Royal Liverpool HospitalPublished Last updated See all updates

Prior allergy and religious or other dietary requirements could occasionally affect suitability for vaccination, and patients will often have questions.

Key points

Allergic reactions to vaccines are possible based on previous allergy.

In addition, patients may ask about their suitability for vaccination based on religious or other dietary requirements or beliefs.

We’ve created a series of articles to help you advise patients when they need advice on individual vaccine suitability.

Prior allergy to COVID-19 Vaccine

Where patients have had an allergic reaction to the first dose of any COVID-19 vaccine, options for the second dose will vary dependent on the nature of the initial reaction.

Our decision tool below guides you through these options.

COVID-19 Vaccine Prior Allergy Decision Tool

Advice end-points

Given the nature of the previous reaction, you should seek advice from a specialist before proceeding.

The patient can have the second dose using the same vaccination in any vaccination setting.

Observe the patient for 30 minutes after they’ve received the vaccine.

The patient can have the second dose using the same vaccination in any vaccination setting.

Consider pre-treatment with a non-sedating oral antihistamine 30 minutes beforehand.

Background to decision tool

Advice from BSACI

The decision tool is derived from British Society for Allergy and Clinical Immunology (BSACI) advice represented in Public Health England’s Immunisation Against Infectious Disease (The Green Book): Flowchart for managing patients who have allergic reactions to the first dose of COVID-19 vaccine.

The flowchart and tool suggest that individuals who have had a possible reaction to the first dose of a COVID-19 vaccine may be able to receive a second dose as per the management advice below:

Where symptoms began within 2 hours of the first vaccination, this could indicate an immediate-type allergic reaction:

  • If the patient had systemic symptoms (including anaphylaxis), advice from an allergy specialist should be sought prior to second vaccination.
  • If the reaction involved swelling or rash local to injection site only, the individual can have the second dose using the same vaccine in any vaccination setting; observe for 30 minutes.

Where symptoms began 2 or more hours after the first vaccination, this could indicate delayed urticaria/angioedema:

  • If the reaction involved swelling or rash local to injection site only, the individual can have the second dose using the same vaccine in any vaccination setting; observe for 30 minutes.
  • If the reaction was self-limiting or resolved with oral antihistamine, the individual can have the second dose using the same vaccine in any vaccination setting; consider pre-treatment with a non-sedating antihistamine, 30 minutes prior to second vaccination.
  • If the reaction required medical attention, advice from an allergy specialist should be sought prior to second vaccination.

Individuals with non-allergic reactions (vasovagal episodes, non-urticarial skin reaction or non-specific symptoms) to the first dose of a COVID-19 vaccine can receive the second dose of vaccine in any vaccination setting.

Flowchart in Green Book

The flowchart from which the decision tool and advice above has been generated is also reproduced below with kind permission from the authors of the Green Book.

 

 

Change history

  1. Context and background to decision tool added to page including flowchart from which generated
  1. COVID-19 Vaccine Prior Allergy Decision Tool added.
  1. Published