Outcomes of pediatric patients with suspected allergies to COVID-19 vaccines

• Published in: Journal of Allergy and Clinical Immunology: Global
• Main Authors: Qin Ying Lim, MBBS, Tsun Ming Lau, BSc, Sophie H.Y. Lai, MBBS, Gilbert T. Chua, MBBS, Kaiyue Zhang, MPH, Jennifer H.Y. Lam, BSc (Hon), Wilfred H.S. Wong, PhD, Yu Lung Lau, MD (Hon), Jaime S. Rosa Duque, MD
• Format: Article
• Language: English
• Published: Elsevier 2025-02-01
• Subjects: Allergy; COVID-19; drug; pediatric; vaccine
• Online Access: http://www.sciencedirect.com/science/article/pii/S2772829324001838
• ISSN: 2772-8293

Background: Adverse effects following immunizations (AEFIs) can contribute to vaccine hesitancy. Objective: We evaluated clinical outcomes of AEFIs subsequent to administration of the coronavirus disease 2019 (COVID-19) vaccine at 2 pediatric allergy centers. Methods: Data on pediatric patients referred for COVID-19 AEFI concerns between March 2021 and October 2022 were reviewed. The collected data included patient demographics, clinical characteristics, outcomes of prior COVID-19 vaccination, recommendations after consultation, and outcomes of revaccination. Results: The 163 patients were separated into 2 groups based on the absence (n = 89 [54.6%]) or presence (n = 74 [45.4%]) of prior COVID-19–related AEFIs. The most common reason for referral without a prior AEFI was another suspected drug allergy (n = 58 [35.6%]). All patients in this group were recommended for COVID-19 vaccination. Of the 163 patients, 82 (92.1%) proceeded with vaccination, with 77 of them (93.9%) tolerating vaccination. Most of those with a prior COVID-19–related AEFI had a delayed cutaneous reaction (n = 60 [37.0%]); 1 patient (0.6%) had suspected anaphylaxis. In this group, 6 (8.1%) were advised to postpone COVID-19 vaccination until their debilitating skin conditions had improved in response to further treatment, whereas 45 (77.6%) tolerated subsequent vaccination to the same or an alternate COVID-19 vaccine type. The most common AEFI on revaccination was urticaria (in 8 of 11 patients [72.7%]). AEFI on revaccination was significantly associated with a history of spontaneous urticaria or angioedema (relative risk = 3.6 [95% CI = 1.30-9.99]; P = .020) and urticaria following COVID-19 vaccination previously (relative risk = 4.12 [95% CI = 1.22-13.87]; P = .017). Conclusions: Children with a history of urticaria or angioedema related or unrelated to prior COVID-19 vaccination were at higher risk of a COVID-19–related AEFI on revaccination, although most were able to complete the vaccination series under the management of our immunology/allergy service.