COVID-19 and vaccines

The guidance relating to allergies has been updated since the initial covid-19 vaccination roll out.

The latest guidance in the Green Book says you can have any vaccine, including Pfizer, if you have a history of previous allergic reaction, including anaphylaxis, to the following:
– food
– insect sting
– most medicines (where trigger has been identified)
– family history of allergies
– previous non-systemic reaction to a vaccine
– hypersensitivity to non-steroidal anti-inflammatory drugs e.g. aspirin, ibuprofen
– mastocytosis

If you have a history of immediate-onset anaphylaxis to multiple classes of drugs or unexplained anaphylaxis, please also see the additional information at the end of these FAQs.

Yes, you can. Allergy to penicillins is not a contraindication to any of the COVID-19 vaccines currently available. If you have a history of immediate-onset anaphylaxis to multiple classes of drugs or unexplained anaphylaxis – please also see the additional information at the end of these FAQs.

The British Society for Allergy and Clinical Immunology (BSACI) has advised that individuals who have a reaction to the first dose of a COVID-19 vaccine may be able to receive a second dose of vaccine, as in the flowchart below. Many individuals have tolerated subsequent doses of the same vaccine, and this is preferred as it avoids an individual being wrongly labelled as allergic for life.

In the Green Book there is a table (table 5) and flow chart for managing patients who have had an allergic reaction to the first dose of COVID-19 vaccine.

No, according to the manufacturers, none of the COVID-19 vaccines currently available are supplied in vials with stoppers containing latex.

The Pfizer/BioNtech vaccination is supplied in vials that have a stopper made from bromobutyl. This is a synthetic form of rubber which does not contain any dry natural rubber (latex). Pfizer have confirmed that latex is not used at all in the raw materials used to produce the vaccine.

The AstraZeneca vaccination is supplied in vials that have a stopper made from halobutyl which is also a synthetic form of rubber which does not contain any dry natural rubber (latex)

The Moderna vaccination is supplied in vials that do not contain any dry natural rubber (latex)

The Janssen vaccine is supplied in vials that have a stopper made from a synthetic form of rubber called chorobutyl with fluoropolymer coated surface which does not contain dry natural rubber (latex).

The Novovax vaccination is supplied in vials that have a stopper made from bromobutyl. This is a synthetic form of rubber which does not contain any dry natural rubber (latex).

The Valneva vaccination is supplied in vials that have a stopper made from bromobutyl. This is a synthetic form of rubber which does not contain any dry natural rubber (latex).

It is important to let your healthcare provider know about your latex allergy so they can ensure they do not use any latex-containing products whilst treating you.

The latest information in the Green Book states:

A very small number of individuals have experienced anaphylaxis when receiving a COVID-19 vaccine. Anyone with a history of allergic reaction to an excipient in the COVID-19 vaccine should not receive that vaccine except with expert advice, but those with any other allergies such as a food allergy, including those with prior anaphylaxis, can have the vaccine.

If you have a history of immediate-onset anaphylaxis to multiple classes of drugs or unexplained anaphylaxis – please also see the additional information at the end of these FAQs.

None of the COVID-19 vaccines currently available contain any egg proteins, and none of them are contraindicated if you have an egg allergy.

The latest information in the Green Book states vaccination can proceed as normal in individuals who have had:

– previous allergic reaction (including anaphylaxis) to a food, insect sting and most medicines (where the trigger has been identified)
– family history of allergies
– previous non-systemic reaction to a vaccine
– hypersensitivity to nonsteroidal anti-inflammatory drugs e.g. aspirin, ibuprofen
– mastocytosis.

If you have a history of immediate-onset anaphylaxis to multiple classes of drugs or unexplained anaphylaxis, please also see the additional information at the end of these FAQs.

No. The ingredients for each vaccine are listed in the patient information sheet which you should be given to read before having your vaccination. There is no gelatine in any of the COVID-19 vaccines currently available .

Squalene is used in some vaccines, but it is a highly-purified fat that does not contain the proteins which cause the allergic reaction. It is not considered to pose any risk for patients with fish allergy.

None of the COVID-19 vaccines currently available contain any squalene, and there is no reason to suspect that they would cause any problems for someone allergic to fish.

Yes, you can. Allergy to aeroallergens such as house dust mites, pollen or animal allergens is not a contraindication to any of the COVID-19 vaccines currently available.

Many common side effects of vaccination, such as localised pain and swelling at the site of injection or flu-like symptoms, can be mistaken for allergy. They are not a reason to avoid any of the COVID-19 vaccines currently available.

Severe allergic reactions to COVID-19 vaccines are very rare. The MHRA constantly monitors reports of adverse reactions to vaccines through the yellow card scheme and publishes a regularly-updated report on COVID-19 vaccine reactions.

The Pfizer BioNTech and Moderna mRNA vaccines contain polyethylene glycol (PEG). PEGs (also known as macrogols) are a group of known allergens commonly found in medicines, many household products and cosmetics. Medicines containing PEG include some tablets, laxatives, depot steroid injections, and some bowel preparations used before colonoscopy. Known allergy to PEG is rare and has been implicated in only a small minority of allergic reactions reported after COVID-19 vaccines.

The AstraZeneca, Janssen, Novovax and Valneva vaccines do not contain PEG but do contain a related compound called polysorbate 80. Rarely, people with PEG allergy may also be allergic to polysorbate 80. However, polysorbate 80 is widely used in medicines and foods, and is present in many medicines including monoclonal antibody preparations. Recent research shows that even individuals with severe allergy to PEG tolerate the polysorbate 80-containing vaccines such as the AstraZeneca, Janssen, Novovax or Valneva vaccine.

Yes, there is no need to avoid any of the COVID-19 vaccines currently available if you have had a mild to moderate reaction to a food or an identified drug.

If you have a history of immediate-onset anaphylaxis to multiple classes of drugs or unexplained anaphylaxis, please also see the additional information at the end of these FAQs.

No, there is not. However, it’s important to have good asthma control in the weeks before vaccination, as with other vaccines.

Yes, they can. Allergy to venom is not a contraindication to any of the COVID-19 vaccines currently available.

The latest information in the Green Book recommends special precautions be taken in individuals who have a history of anaphylaxis to a vaccine, injected antibody preparation or a medicine likely to contain PEG (e.g. depot steroid injection, laxative). However, before the COVID-19 vaccines, there were none that contained PEG.

Patients with undiagnosed PEG allergy often have a history of immediate onset-unexplained anaphylaxis or anaphylaxis to multiple classes of drugs. Such individuals should not be vaccinated with the Pfizer BioNTech or Moderna vaccine, except on the expert advice of an allergy specialist. The AstraZeneca, Janssen, Novovax or Valneva vaccine can be used as an alternative (unless otherwise contraindicated). The vaccine should be administered in a setting with full resuscitation facilities (e.g. a hospital), and a 30-minute observation period is recommended.

Everyone who carries adrenaline should take their two auto injectors with them everywhere they go. Anaphylaxis to a vaccine is extremely rare. Public Health guidelines require anyone responsible for giving a vaccine to receive training on the management of anaphylaxis.

A protocol for the management of anaphylaxis and an anaphylaxis pack which includes adrenaline must always be available whenever vaccines are given.

There are many COVID-19 vaccines in development. Several are in the final stages of trials and are likely to become available over the coming months. Each vaccine is different, and they use a variety of different technologies. Until a vaccine is approved, we will not know exactly what the ingredients are, so it is impossible to comment on their safety for people with particular allergies.

Before having any vaccination, it is important that you are given the patient information leaflet to read. This contains vital information about who should receive the vaccine along with a complete list of ingredients.

The Green Book states that if you have:

– prior non-anaphylaxis allergic reaction to COVID-19 vaccine
– history of immediate anaphylaxis to multiple different drug classes with the trigger unidentified (this may indicate PEG allergy)
– history of anaphylaxis to a vaccine, injected antibody preparation or a medicine likely to contain PEG (e.g. depot steroid injection, laxative)
– history of idiopathic anaphylaxis.

You may need special precautions for your vaccination which should be discussed with an allergy specialist.

The local pathway to access advice from an allergy specialist can vary depending on your area of the country, but it most areas your GP can put in what is known as an ‘advice and guidance’ request via their online e-referral system to receive specialist advice for you. Your GP will need to provide full details of which flu vaccine you received and your allergy history, and in some areas, this must be submitted on a dedicated form for COVID-19 vaccine and allergy requests.

The Department of Health and Social care have announced that the process for applying for official proof that you’re unable to be vaccinated is now live.

One of the possible reasons for medical exemption listed is if you are ‘a person with severe allergies to all currently available vaccines’.

There are very few people who cannot be vaccinated against COVID-19 due to a previous allergic reaction. In the vast majority of cases, people with a history of severe allergies can safely receive a COVID-19 vaccination.

Applications can only be made by requesting an NHS COVID Pass medical exemptions application form by phoning 119. If you are eligible, the form will be sent in the post and must then be given to your GP or specialist clinician to complete.