CDC Issues New Contraindication Guidelines For COVID-19 Vaccines

As COVID-19 vaccinations continue throughout the U.S., federal health officials have issued updated recommendations based on data from the first round of shots, indicating individuals should not be given a second vaccine dose if they developed an allergic reaction to the first COVID-19 shot.

The new contraindication guidelines issued by the U.S. Centers for Disease Control and Prevention (CDC) offer updated interim guidance for COVID-19 vaccines. The agency also wants to provide more guidance since many people who received a first dose will now be receiving their second dose.

The guidelines allow for people over the age of 16 to receive the Pfizer/BioNTech vaccine and those over 18 years old to receive the Moderna vaccine. It also reduces the grace period between the first dose and second dose by four days. The CDC indicated immunocompromised persons may receive the COVID-19 vaccine, including those with the HIV infection, as they face increased risk for severe COVID-19.

Allergic Reactions

The updated guidelines were broadened to include considerations for people with a history of immediate allergic reaction to a previous dose of, or any component of, mRNA COVID-19 vaccines, including polyethylene glycol.

Those with a history of “immediate allergic reaction of any severity” to any components of mRNA COVID-19 vaccines or to polysorbate, an emulsifier often used in food and medicines, should not be vaccinated, the CDC warns.

The guidelines also indicate those who develop severe allergic reactions, like anaphylaxis, after receiving the first dose of the COVID-19 vaccine should not receive the second dose.

People with histories of allergies to ingredients in the Pfizer/BioNTech and Moderna vaccines listed by the CDC in the interim clinical considerations document should be considered for allergist/immunologist referral to determine if they can receive the vaccine.

Symptoms of allergic reaction can include urticaria, angioedema, respiratory distress like wheezing, and anaphylaxis. Symptoms can occur within four hours after receiving the dose. Roughly 90% of people who experience anaphylaxis will also have skin symptoms.

Those allergic reaction symptoms are different from vaccine side effects, which include fever, chills, and fatigue These symptoms do not require medical attention and are not life threatening, according to CDC officials.

The agency reports that most immediate allergic reactions occur within 15-30 minutes of vaccination, while vaccine side effects occur 1-3 days later.

Contraindications do not include those with allergic reactions to other vaccines or injectable therapies not related to COVID-19 vaccines. The CDC recommends those people consult with their allergist-immunologist to weigh the benefits and the risks of receiving the COVID-19 vaccine.

Patient histories of allergic reactions to food, pet dander or latex are not contraindications for vaccination. Those people should still receive the vaccine, according to the CDC.

The guidelines indicate anyone with a history of anaphylaxis due to any cause should be observed for 30 minutes after vaccination. Everyone else should be observed for 15 minutes afterwards.

To date, only 29 people in the United States developed anaphylaxis after being vaccinated with the COVID-19 vaccine. This is roughly 5.5 cases of anaphylaxis per 1 million vaccine doses. While that figure may change as more people receive the vaccine, anaphylaxis is still considered rare compared to the more than 2,000 deaths occurring each day from COVID-19.