Table 3.
A suggested approach to the patients who reacted to the first dose of COVID-19 vaccine
| Mild side effects | |
| In case of mild side effects regardless of the interval after the first dose of COVID-19 vaccine such as headache, fever, tenderness in muscle, mild gastrointestinal symptoms etc. | Dose 2 of the same vaccine can be administered in any setting |
| Immediate reactions (within 4 h) | |
| Documentation of vital signs, blood pressure, saturation, chest auscultation, cutaneous symptoms, ear, nose and throat status is essential. Control tryptase | |
| Local reaction regardless of the size of the lesion | Dose 2 be administered in any setting |
| Verified anaphylaxis convincing clinical symptoms ± elevated serum tryptase | Dose 2 of the same vaccine is contraindicated. Should be referred for allergy evaluation. Dose 2 can be considered according to skin tests result and medical history in a setting with full resuscitation facilities; observation for at least 30 min is advised. Evaluate risk and benefit |
| Possible anaphylaxis or systemic symptoms such as urticaria, angioedema, severe gastrointestinal symptoms, rhinoconjunctivitis | Consider referral to allergologist/immunologist. Dose 2 can be considered according to skin tests result and medical history in a setting with full resuscitation facilities; observation for at least 30 min is advised. Evaluate risk and benefit |
| Delayed reactions (after 4 h) | |
| Documentation of vital signs, cutaneous and mucosal lesions, signs of organ failure, physical examination of the joints is advised. Skin biopsy can be considered in case of severe cutaneous/mucosal symptoms | |
| Delayed local reactions, even large exanthemas are described. Dose 2 can be administered in any setting, oral antihistamine or local steroid products can be used if itching and/or local tenderness occurs | |
| Mild systemic reactions such as urticaria, angiooedema or maculopapular exanthema can be treated with antihistamine once or twice a day (e.g. desloratadine 5–10 mg). If the symptoms resolve, dose 2 can be administered in any setting. Observation for at least 30 min is advised. Premedication with antihistamine before dose 2 (e.g. desloratadine 5–10 mg) can be considered | |
| Patients with severe delayed systemic reactions such as extensive urticaria, angiooedema, maculopapular exanthema, mucosal symptoms, arthralgia, suspected severe haematological differences, kidney or liver failure due to the vaccine should be referred to an allergologist/immunologist | |