Table 3. Summary of evaluation and management of patients with allergic reactions (not anaphylaxis) to the first dose of COVID-19 vaccine according to allergy organizations.
| Organization | Skin testing | Premedication with antihistamines | Graded challenge |
|---|---|---|---|
| WAO1 | Consider skin test | May mask initial symptoms of a reaction | No description |
| ARIA-EAACI60 | Consider skin test | No description | No description: desensitization protocols with individual vaccine components can be envisaged (4) |
| APAAACI61 | Consider skin test | No description | No description |
| AAAAI9 | Consider skin test | May mask initial symptoms, however, fexofenadine or cetirizine can be considered in individuals with mild symptoms (pruritis or urticaria only) | No description in the positional paper (5); allergist supervised graded vaccine challenge can be considered, however, the safety and efficacy of this approach is unknown (6) |
| BASCI59 | No description (refer to allergy specialists) | May benefit from pretreatment with antihistamine, however, this may mask initial symptoms of a reaction | No description |
| CSACI62 | Allergy test is not required for patients with a suspected or confirmed severe allergic reaction to a COVID-19 vaccine or any of its components | No description | Graded administration of these vaccines in someone with a suspected or confirmed allergy to the vaccine or one of its components can be considered if further doses are required |
| KAAACI* | Refer to allergy specialists | May benefit from pretreatment with antihistamine; however, this may mask initial symptoms of a reaction | No description |
| Consider skin testing |
COVID-19, coronavirus disease 2019; WAO, the World Allergy Organization; ARIA-EAACI, Allergic Rhinitis and its Impact on Asthma - European Academy of Allergy and Clinical Immunology; APAAACI, Asia-Pacific Association of Allergy, Asthma, and Clinical Immunology; AAAAI, American Academy of Allergy, Asthma & Immunology; BASCI, British Society for Allergy and Clinical Immunology; CSACI, Canadian Society of Allergy and Clinical Immunology; KAAACI, the Korean Academy of Asthma, Allergy and Clinical Immunology.
*This is the consensus statements of the Urticaria/Angioedema/Anaphylaxis Working Group of KAAACI.