Management of patients with immediate reactions to COVID vaccines

Immediate reactions suggestive of an allergic reaction to either a first or subsequent mRNA coronavirus disease 2019 (COVID-19) vaccine dose are very rare. Reactive patients have tended to be overrepresentated by females and persons self-reporting multiple drug allergies or intolerances, past adverse reactions to vaccines, and anxiety.1,2 Few such reactions meet the level 1 Brighton Collaboration Criteria (BCC), and of those meeting the level 1 to level 3 BCC, many would not meet the stringent anaphylaxis criteria established by either the National Institutes of Allergy and Infectious Diseases or the World Allergy Organization.