Covid-19 Vaccines and Allergies

Yes you can. Allergy to penicillins is not a contraindication to the Pfizer/BioNTech, AstraZeneca, Moderna or Janssen COVID-19 vaccine.

If you have a history of immediate onset anaphylaxis to multiple classes of drugs or unexplained anaphylaxis – please also refer to 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 2nd dose of vaccine, however some cases need advice from an Allergy Specialist.

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

No, according to the manufacturers, neither the Pfizer/BioNTech, AstraZeneca, Moderna or Janssen COVID-19 vaccine vial contains 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)

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:-

Following close national surveillance, the MHRA is no longer advising that individuals with a history of anaphylaxis to any vaccine, medicine or food do not get the vaccine. Anyone with a previous history of allergic reactions to the ingredients of the vaccine should not receive it, but those with any other allergies (such as a food allergy) can now have the vaccine.

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

Neither the Pfizer/BioNTech, AstraZeneca, Moderna or Janssen COVID-19 vaccine contain any egg proteins and none of the vaccines are contraindicated in 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 refer to 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 prior to having your vaccination. There is no gelatine in the Pfizer/BioNTech, AstraZeneca, Moderna or Janssen COVID-19 vaccines.

You are correct that squalene is used in some vaccines. It is 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.

Neither the Pfizer/BioNTech, AstraZeneca, Moderna or Janssen COVID-19 vaccination 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 the Pfizer/BioNTech, AstraZeneca, Moderna or Janssen COVID-19 vaccine.

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 the Pfizer/BioNTech, AstraZeneca, Moderna or Janssen COVID-19 vaccine.

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 which you can find here

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 for colonoscopy. Known allergy to PEG is rare but would contraindicate receipt of this vaccine. (Sellaturay P et al, 2020). It is unclear whether PEG is the only cause of allergic reactions in patients with systemic allergic symptoms after the first dose of Pfizer-BioNTech vaccine.

The rate of anaphylaxis reported to date to the AstraZeneca vaccine is in line with the expected rate of anaphylaxis to non-COVID vaccines. The AstraZeneca vaccine does not contain PEG but does contain a related compound called polysorbate 80. Some 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. Some injected influenza vaccines (including the main vaccine used in over 65 year olds) contain polysorbate 80. Individuals who have tolerated injections that contain polysorbate 80 (such as certain influenza vaccines) are likely to tolerate the AstraZeneca vaccine

Yes, there is no need to avoid the Pfizer/BioNTech, AstraZeneca, Moderna or Janssen COVID-19 vaccines 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 refer to the additional information at the end of these FAQs.

No, there is not. However good asthma control in the weeks before vaccination is important (just like with all other vaccines).

Yes, allergy to venom is not a contraindication to the Pfizer/BioNTech, AstraZeneca, Moderna or Janssen COVID-19 vaccines.

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, if your anaphylaxis occurred with a vaccine that did not contain Polysorbate 80 then there is no contraindication to receiving Covid vaccination.

• discuss with allergy specialist and consider possibility of PEG-allergy
• consider observation for 30 minutes if vaccination proceeds (see precautions)
• some patients may benefit from pre-treatment with antihistamine, however this may mask initial symptoms of a reaction

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

All people who carry 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 with several in the final stages of trials and 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 or otherwise 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:-

• 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 the specialist advice for you.  They will need to provide full details of your allergy history, and in some areas, this must be submitted on a dedicated form for COVID-19 vaccine and allergy requests. If you have any issues accessing these services, please call the Anaphylaxis Campaign helpline on 01252 542029.

The proposals put forward by the government do include exceptions for those individuals who have been advised by a medical professional not to be vaccinated. The consultation outcome states:-

‘There will be a small number of people where the clinical advice is that the COVID-19 vaccination is not suitable for them. We will ensure that the regulations allow for exemptions on medical grounds. 

The regulations will be drafted in line with the Green Book on Immunisation against infectious disease (COVID-19: the green book, chapter 14a) and The Joint Committee of Vaccination and Immunisation (JCVI) which reflect clinical advice. 

Individuals will be exempt from the requirement if they have an allergy or condition that the Green Book lists (Chapter 14a, page 16) as a reason not to administer a vaccine, for example prior allergic reaction to a component of the vaccine, including polyethylene glycol (PEG). 

Some individuals have an allergy or condition where the Green Book or the JCVI advises seeking medical advice, before proceeding with vaccination, where a professional medical opinion should be sought on whether the individual should be exempt. 

The government is considering the least burdensome way for people to demonstrate to their employers that they are medically exempt from vaccination.’