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COVID-19 Vaccine-Related eConsults: Case 13

eConsult Clinical Question

A 61-year-old woman works for the county and has been told not a candidate due to her anaphylaxis to tetanus and other vaccines. She is wondering if she should still consider the vaccine or is it truly out of the question. She shares after past vaccines (pneumonia, flu, Shingles, tetanus), she will have either instant or in hours difficulty breathing, swelling, facial redness and flushing, then later will always get 7 to 10 days of the illness related, arm swelling and pain. Is it safe for this patient to get the COVID-19 vaccine?

eConsult Response

  1. Given her reactions to prior vaccines containing polysorbate, I would recommend avoidance of the Janssen (J&J) COVID-19 vaccine. However, unless she has a polyethylene glycol (PEG) allergy or another contraindication to receiving the mRNA vaccine (that wasn't mentioned in the eConsult), she should be okay from my allergy perspective to get the Moderna or Pfizer (mRNA) COVID 19 vaccines with 30 minutes of observation in a healthcare setting that can treat for anaphylaxis. No vaccines prior to this vaccine contain PEG.
  2. If primary recommendations do not address the clinical question, I recommend a formal referral to allergy/immunology for discussion directly with the patient.

These real-life examples have some limitations. Given the evolving recommendations and guidance on COVID-19 care, these cases should not be considered complete or definitive and may not reflect the most up-to-date guidance.