Consensus Statements on the Approach to COVID-19 Vaccine Allergy Safety in Hong Kong

Abstract

Background: Mass coronavirus disease 2019 (COVID-19) vaccination to achieve herd immunity is an effective means to mitigate the current COVID-19 pandemic. Reports of COVID-19 vaccine-associated allergic reactions and lack of clear local guidance are contributing factors leading to a low vaccine acceptance rate in the community. A task force of experts from the Hong Kong Institute of Allergy (HKIA) has been formed to address current needs.Objective: To formulate a set of consensus statements (CS) on COVID-19 vaccine allergy safety (VAS) in Hong Kong.Methods: A nominated task force of experts managing patients with drug and vaccine allergies in Hong Kong formulated the CS by the Delphi method. An agreement was a priori defined as ≥80% consensus.Results: A total of 11 statements met the criteria for consensus with good overall agreement among task force members, including seven statements on pre-vaccination recommendations and four statements on vaccination and post-vaccination guidance. Individuals with a history of suspected allergic reaction to prior COVID-19 vaccination should not receive further COVID-19 vaccination, and other groups at risk of COVID-19 vaccine-associated allergic reactions have been identified. The importance of pre-vaccination and post-vaccination assessment by frontline healthcare workers and evaluation by allergists are highlighted.Conclusion: The CS provides pragmatic and timely guidance for local frontline healthcare providers on decisions regarding COVID-19 VAS.

The Role of the Allergist in Coronavirus Disease 2019 Vaccine Allergy Safety

“…Individuals at higher risk of potential COVID-19 vaccine-related allergies were defined as those with history of anaphylaxis or severe, immediate-type allergic reactions to multiple classes of drugs or foods were cautioned and may require allergist assessment before COVID-19 vaccination. 5 Inappropriate referrals were defined as insufficient information or absence of such criteria.…”

“…Owing to the initial fear of potential excipientassociated allergies, patients with history of anaphylaxis or severe, immediate-type allergic reactions to multiple classes of drugs or foods were cautioned and may require allergist assessment before COVID-19 vaccination. 5 A territory-wide VAS Clinic was set up for prevaccination evaluation of these at-risk individuals. However, this VAS Clinic had limited capacity as there was only 1 specialist in Immunology and Allergy working in Hong Kong's public health care system.…”

Caution against injudicious vaccine allergy skin tests: Adverse reactions after intradermal COVID‐19 vaccine testing

“…All individuals with suspected allergic reaction to the first dose vaccine should be referred to an allergist for a workup, which may include vaccine skin testing. 1 However, selecting individuals for testing should be based on clinical suspicion as to avoid false-positive/false-negative results or adverse reactions. To demonstrate, we report a case of severe delayed "positive" reaction following an intradermal test (IDT) for workup of a suspected immediate-type allergy to SV.…”

Chronic Spontaneous Urticaria in Hong Kong: Clinical Characteristics, Real-World Practice and Implications for COVID-19 Vaccination

“… 22 Although several authorities have advocated the safety of COVID-19 vaccines for CSU patients, vaccine hesitancy and misdiagnosis of vaccine-related ‘allergy’ remain, especially among CSU patients with vaccine-triggered CSU attacks. 22 23 24 25 The impact of CSU on COVID-19 vaccine uptake, albeit likely significant, remains unknown.…”