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This referral pathway is for patients with a history of allergic disease that raises concerns about receiving COVID vaccination.
All referrals will be reviewed by the allergy department and advice and guidance will be provided as soon as possible to avoid unnecessary delays in receiving vaccination.
A very small number of individuals have experienced anaphylaxis when vaccinated with the Pfizer BioNTech vaccine. Following close national surveillance, the MHRA is no longer advising that individuals with a history of anaphylaxis to any vaccine, medicine or food do not get the vaccine. Anyone with a previous history of allergic reactions to the ingredients of the vaccine should not receive it, but those with any other allergies (such as a food allergy) can now have the vaccine.
All recipients of the Pfizer BioNTech and Moderna mRNA COVID-19 vaccines should be kept for observation and monitored for a minimum of 15 minutes. Facilities for management of anaphylaxis should be available at all vaccination sites.
Most recent advice in the Green Book is that:
Devon COVID Vaccine Allergy Referral form – please ensure the form is completed as fully as possible. Failure to do so may result in the referral being returned and a delay in patient assessment.
All referrals without a Devon COVID Vaccine Allergy Referral form attached will be returned.
Please note these need to be sent by the referring clinician and not directly from the patient.
Patients that experience red flag symptoms should receive emergency management and be admitted to hospital via ambulance (even if symptoms have settled):
Amended criteria for the diagnosis of anaphylaxis, proposed by the WAO Anaphylaxis Committee, 2019.
Anaphylaxis is highly likely when any one of the following 2 criteria are fulfilled:
1. Acute onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (e.g., generalized hives, pruritus or flushing, swollen lips-tongue-uvula)
AND AT LEAST ONE OF THE FOLLOWING:
a. Respiratory compromise (e.g., dyspnoea, wheeze-bronchospasm, stridor, reduced PEF, hypoxemia)
b. Reduced BP or associated symptoms of end-organ dysfunction (e.g., hypotonia [collapse], syncope, incontinence)
c. Severe gastrointestinal symptoms (e.g., severe crampy abdominal pain, repetitive vomiting), especially after exposure to non-food allergens
2. Acute onset of hypotension* or bronchospasm or laryngeal involvementa after exposure to a known or highly probable allergenb for that patient (minutes to several hoursc), even in the absence of typical skin involvement.
PEF, Peak expiratory flow; BP, blood pressure.
*Hypotension defined as a decrease in systolic BP greater than 30% from that person's baseline, OR.
i. Infants and children under 10 years: systolic BP less than (70 mmHg + [2 x age in years])
ii. Adults: systolic BP less than 90 mmHg.
aLaryngeal symptoms include: stridor, vocal changes, odynophagia.
ballergen is a substance (usually a protein) capable of triggering an immune response that can result in an allergic reaction. Most allergens act through an IgE-mediated pathway, but some non-allergen triggers can act independent of IgE (for example, via direct activation of mast cells).
cThe majority of allergic reactions occur within 1–2 hours of exposure, and usually much quicker. Reactions may be delayed for some food allergens (e.g., alpha-gal) or in the context of immunotherapy, occurring up to 10 hours after ingestion.”
Patients with suspected anaphylaxis reactions should have:
The following groups of people can receive any of the available vaccines without prior allergy assessment:
Details of the excipients of the vaccines can be found at the following links:
e-Referral Service Selection
Specialty: Allergy
Clinic Type: Allergy
Service: Covid-19 Vaccine Allergy Service-Devon CCG-15N
Devon COVID Vaccine Allergy Referral form
Please ensure the form is completed as fully as possible. Failure to do so may result in the referral being returned and a delay in patient assessment.
All referrals without a Devon COVID Vaccine Allergy Referral form attached will be returned.
Please note these need to be sent by the referring clinician and not directly from the patient.
Allergy UK - (Allergy and the coronavirus (COVID-19) Vaccine)
Publication date: March 2021
Publication date: March 2021
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