As with all medication or biological products, people can be allergic to certain vaccines.
Immediate allergic reactions or anaphylaxis to vaccines are rare. These reactions usually start within minutes following the vaccination and are characterized by the same symptoms as immediate reactions to other allergens; skin manifestations (urticaria, swelling, itching), respiratory manifestations (cough, difficulty breathing, wheezing) and a reduction in blood pressure (weakness, loss of consciousness). If a significant immediate allergic reaction is suspected, it must be treated rapidly with epinephrine. It is important that the person suffering from the allergic reaction ultimately be referred to an allergist. Most of the time, allergy testing can confirm the allergy to the vaccine, and the resulting information can be very helpful for future vaccination. In general, most patients allergic to one vaccine in particular can receive other vaccinations without problems.
When symptoms might be due to an allergy (for example urticaria, redness, itching) but follow several hours or days after having received the vaccination, it is unlikely to be a true allergy to the vaccine.
Sometimes vaccines can cause important local reactions that begin in the hours following the vaccination or even the next day. The site of vaccination (usually the arm) can become inflamed, red, and painful. The reaction can last several days. Although these reactions can be quite alarming, they are not typically representative of an acute allergic reaction. There is generally no risk of an immediate allergic reaction with the next vaccination. Consultation with an allergist is not necessary. Vaccines containing the booster DT (diphtheria, tetanus) are more often associated with this kind of reaction.
Now that large scale vaccination against COVID has started, some people known to have allergies are wondering if it’s safe to get vaccinated. Although at the beginning of the vaccine campaign in the United Kingdom a recommendation was made to not vaccinate people having severe allergies, this contraindication was removed after analyzing the cases of people having had an allergic reaction to the vaccine. What’s more, even if it seems that vaccination against COVID-19 causes allergic reactions more frequently than other vaccines, the risk remains very low – 11.1 cases of anaphylaxis per million doses, in comparison with 1.3 per million doses for the flu vaccine.
At this moment, concerning allergies, the only contraindication to receiving COVID-19 vaccines is an allergy to their components. The vaccines approved at this moment (Pfizer-BioNTech, Moderna, AstraZeneca and Janssen) don’t contain food or animal proteins, antibiotics, preservatives or latex.
People suffering from food allergies, even serious ones, respiratory allergies (including asthma), insect allergy, antibiotic allergy or an allergy to anti-inflammatories such as aspirin or ibuprofen, an allergy to latex or to anesthetics can receive the vaccines against COVID-19. The same is true for people suffering from chronic urticaria or angioedema.
Only people with a history of allergy to polyethylene glycol (PEG) should be evaluated by an allergist before receiving a vaccine. PEG is found in many laxatives (eg, Lax-A-Day, RestoroLAX) and in several laxative preparations given prior to a colonoscopy (such as Colyte, golytely, Klean-Prep ou Peglyte ). People having had allergic reactions to these products should consult an allergist before receiving any of the currently approved COVID vaccines.
People with a history of immediate allergy (less than an hour after administration) to vaccines containing polysorbate (including flu vaccines) do not need to consult with an allergist and can be vaccinated at vaccination centres. They will receive the Pfizer-BioNTech or Moderna vaccines, since the Janssen and AstraZeneca vaccines contain polysorbate. The observation period after vaccination will be lengthened from 15 to 30 minutes.
People having had an immediate reaction (less than one hour) after receiving a COVID-19 vaccine, or those having a severe reaction in the 24 hours following vaccination must be directed to Public Health for further evaluation.
Note that people who have an autoimmune disease or an immunodeficiency can receive the vaccines approved in Canada against COVID-19. However, it’s possible the COVID-19 vaccines will be less effective in immunosuppressed people. This includes people who suffer from an immunodeficiency or in whom their immune system is weakened by certain medications or illnesses.
Here are links (in French and English) providing the complete list of components of different vaccines against COVID-19:
Recommendations of the National Advisory Committee on Immunization (NACI) concerning allergies:
Certain vaccines use egg embryos during the manufacturing process and so are administered with caution to individuals allergic to eggs. The seasonal flu vaccine contains a minimal quantity of egg protein. The majority of egg allergic individuals can receive this vaccine without an allergic reaction. Depending on the severity of the allergic reaction to eggs, the vaccine can be administered in one or several doses with a prolonged observation time. Previously this vaccine was administered by allergists or in a hospital setting, but due to accumulating evidence of only a very low risk when administered to egg-allergic patients, since 2011 these precautions are no longer obligatory. See also the most recent recommendations put forth by a consensus among university allergists in Québec (French version).
The vaccine against yellow fever, required when travelling to certain countries also contains egg protein. The risk of allergic reaction is higher with this vaccine than it is with the flu vaccine. A consultation with an allergist is necessary in order to evaluate the risk and to proceed with vaccination if possible.
The RRO (or MMR) vaccine (against measles/rougeole, mumps/oreillons and rubella/rubéole ) does not contain a significant quantity of egg protein. It has been known for many years now that this vaccine can be given without particular precautions to egg allergic individuals. An allergy consultation is not necessary and the vaccine can be given in the regular setting for recommended vaccinations.
Marie-Noel Primeau, MD
(translation by Andrew Moore, MD FRCPC)
NB : This article is not referring to desensitization or immunotherapy, which is typically prescribed to treat allergies to dust mites, pollens, or wasps, and which is sometimes referred to as "vaccines". This subject is treated in the Respitatory section (Immunotherapy).