Photo by Kelly Sikkema on Unsplash

Life with food allergies (FAs), as with any chronic condition, adds layers of complexity to decisions. As nurses with experience caring for children with FA in our families or in our practices, we understand that choosing COVID vaccination can be a tough decision for some, but are heartened by the overall safety and effectiveness of the vaccines to date.

Rapid access to information (and misinformation) on social media can complicate the vaccine decision-making process. The United States Surgeon General recently called on health care professionals, including nurses, to “take the time to understand each patient’s knowledge, beliefs, and values. Listen with empathy, and when possible, correct misinformation in personalized ways.” As nurses caring for patients who are among the estimated 30 million people with food allergies in the US, you can help patients to make an informed and timely decision.

Concerning data about COVID in children and young adults.

About half of the US population is fully vaccinated, though statistics vary by age group, leaving those who cannot receive a vaccine at great risk. Infection with the Delta variant suggests increased transmissibility and more infections in the unvaccinated, including children and young adults.

To underscore the ongoing need for vaccination (and other public health measures), the CDC recently shared concerning data about hospitalizations and severe disease in adolescents, and the American Academy of Pediatrics highlighted a growing proportion of COVID-19 cases among children. While most children do not experience severe illness, the long-term impact of the disease is unknown.

Scientists and medical experts continue to scrutinize reported complications, examine emerging data, and translate that information for health care providers and the public. For example, guidance has been updated for one vaccine after review of some hematologic complications in women ages 18 to 49. Similarly, after a CDC Advisory Committee on Immunization Practices, the FDA added a new warning to vaccination fact sheets explaining an increased risk for myocarditis and pericarditis after a scientific review.

Despite the rare heart complication in young adults, and a warning of a rare but potential link between one of the vaccines and Guillain-Barre syndrome, the CDC reassures the public that the vaccine remains safe and effective for most people and the benefits continue to outweigh the risks.

Alarming headlines about potential complications grab our attention, send us on an emotional roller-coaster, and threaten to undermine our confidence. For individuals and families with a history of FA, the feeling is a familiar one. Making the decision to be vaccinated involves the usual thought process followed when allergies must be taken into account:

Being protected from COVID infection is critical, but how will the vaccine affect the person with FA? What are the ingredients? Does a history of allergic reactions increase the risk? What precautions should be taken?

All of these questions must be considered, and decisions based on accurate information.

Guidance about the vaccine for individuals with food allergies.

Nothing in life is without risk, but current evidence provides a measure of comfort that the vaccines are not only effective but safe for those with FA. Except in very specific circumstances, the COVID vaccine can be safely administered. According to the CDC Vaccine Adverse Event Reporting System (VAERS), the risk of anaphylaxis in the general population from the COVID vaccines ranges from two to five cases per million vaccinated.

While the incidence of confirmed anaphylaxis to mRNA vaccines in one study was greater than that reported by the CDC, the overall risk of anaphylaxis to Pfizer-BioNTech COVID-19 and Moderna vaccines remains extremely low. A follow-up report of second mRNA vaccine dose safety in individuals who were deemed to have an allergic reaction to the first vaccination provides early evidence that they can be safely administered.

Careful study of the vaccines continues, including an ongoing vaccine clinical trial following healthy children under age 12 for vaccine safety. Studies are also underway through NIH/NIAID for people with a history of allergic reaction or mast cell disease and are available at multiple locations throughout the US*.

The American College of Allergy, Asthma, and Immunology detailed key guidance recommending screening for any previous reaction to vaccines, with referral to a board-certified allergist/immunologist to assess risk. COVID-19 vaccines in use in the US to date do not contain antibiotics, metals, animal protein from eggs, or other vaccine components that may cause allergic reactions. People with polyethylene glycol (PEG) allergies should not receive an mRNA COVID vaccine and should consult with their provider, and those allergic to polysorbate should also discuss their concerns. In fact, we strongly encourage anyone with questions to consult their health care provider for the best advice for their situation.

CDC recommendations for vaccination centers for managing potential anaphylaxis include a longer precautionary observation period of 30 minutes, since most such reactions have occurred within 15 minutes, and immediate access to emergency medications and appropriate emergency care capability. Anyone who experiences an allergic reaction after the first injection should seek advice from their allergist before receiving the second dose.

In addition, the CDC provides helpful information about contraindications and other precautions for COVID-19 vaccination, and offers a consultation for health care professionals and health departments for “complex COVID-19 vaccine safety questions” via their Clinical Immunization Safety Assessment Project.

Nurses play a crucial role in educating patients and families.

For most of us, getting vaccinated has been both a blessing and an act of courage. For those with FA, considering personal circumstances, critically analyzing the available data, and seeking out guidance and information from reliable sources such as trusted health care professionals, nationally recognized organizations, and trustworthy experts is essential.

The science on vaccine safety continues to evolve—that’s the nature of scientific investigation. Nurses play an important role in dispelling myths and educating patients and families, including those with food allergies, about COVID-19 vaccine safety and the evolving science.

Authors: 

Josie Howard-Ruben, PhD, APRN-CNS, AOCN, assistant professor, Adult Health and Gerontological Nursing, Rush University College of Nursing, Chicago, IL

Julianne Doucette DNP, APRN, CPNP-PC, program director and assistant professor in the Primary Care Pediatric Nurse Practitioner program, Rush University College of Nursing

Olga Kagan, PhD, RN, nurse consultant, adjunct faculty at City University of New York School of Professional Studies and Molloy College.

Susan Kelly, BSN, RN, MPH candidate, Hofstra University; food allergy support group leader

Alena Bolten, BSN, RN, allergy and asthma nurse in private practice for 5 years, Allied Physicians Group, and nurse practitioner student, Molloy College.

All of the authors of this article are members of the Food Allergy Nursing Interest Group.

Additional sources and resources:

Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine. JAMA Insights.

Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Moderna COVID-19 Vaccine — United States, MMWR, December 21, 2020–January 10, 2021.

Safety Evaluation of the Second Dose of Messenger RNA COVID-19 Vaccines in Patients With Immediate Reactions to the First Dose. JAMA Internal Medicine; research letter.

ACAAI Updates to Guidance on Risk of Allergic Reactions to COVID-19 Vaccines

More detail on the vaccine ingredients is available in a statement from the World Allergy Organization Anaphylaxis Committee.

Allergic reactions can be reported to Vaccine Adverse Event Reporting System (VAERS) in the United States, World Allergy Organization global surveillance for anaphylaxis reactions to COVID-19 vaccines portal, and directly to Pfizer, Moderna and J&J vaccine manufacturers.

*The COVID Vaccine Allergy Study will investigate immune reactions to the mRNA COVID vaccines in people with and without allergies and is looking for participants.