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Updated: May 31, 2025
Basophil Activation Test for Allergy Diagnosis
Published on: May 31, 2021
Outcomes of pediatric patients with suspected allergies to COVID-19 vaccines
Qin Ying Lim1,2, Tsun Ming Lau2, Sophie H Y Lai1,2
1Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, Hong Kong, China.
Insights
Adverse effects following immunizations (AEFIs) for COVID-19 vaccines are uncommon in children. Most children with prior AEFIs tolerated revaccination, especially with allergy specialist management.
Area of Science:
- Pediatric Allergy and Immunology
- Vaccinology
- Immunology
Background:
- Adverse effects following immunizations (AEFIs) can influence vaccine hesitancy.
- Evaluating AEFIs is crucial for maintaining public trust in vaccination programs.
Purpose of the Study:
- To assess the clinical outcomes of AEFIs following COVID-19 vaccination in pediatric patients.
- To determine the safety and tolerability of revaccination in children with a history of AEFIs.
Main Methods:
- Retrospective review of pediatric patients referred for COVID-19 AEFI concerns (March 2021-October 2022).
- Data collected included demographics, clinical characteristics, vaccination history, and outcomes of consultation and revaccination.
- Patients were grouped based on the presence or absence of prior COVID-19-related AEFIs.
Main Results:
- 163 pediatric patients were analyzed; 74 had prior COVID-19 AEFIs.
- Most common prior AEFI was delayed cutaneous reaction (37.0%); anaphylaxis was rare (0.6%).
- 77.6% of patients with prior AEFIs tolerated revaccination, with urticaria being the most common AEFI upon revaccination (72.7%).
Conclusions:
- Children with a history of urticaria or angioedema are at higher risk for COVID-19 AEFIs upon revaccination.
- Most children can complete the COVID-19 vaccination series safely under allergy/immunology care.
- Management by specialists can mitigate risks and address concerns related to AEFIs.
Background:
Adverse effects following immunizations (AEFIs) can contribute to vaccine hesitancy.
Objective:
We evaluated clinical outcomes of AEFIs subsequent to administration of the coronavirus disease 2019 (COVID-19) vaccine at 2 pediatric allergy centers.
Methods:
Data on pediatric patients referred for COVID-19 AEFI concerns between March 2021 and October 2022 were reviewed. The collected data included patient demographics, clinical characteristics, outcomes of prior COVID-19 vaccination, recommendations after consultation, and outcomes of revaccination.
Results:
The 163 patients were separated into 2 groups based on the absence (n = 89 [54.6%]) or presence (n = 74 [45.4%]) of prior COVID-19-related AEFIs. The most common reason for referral without a prior AEFI was another suspected drug allergy (n = 58 [35.6%]). All patients in this group were recommended for COVID-19 vaccination. Of the 163 patients, 82 (92.1%) proceeded with vaccination, with 77 of them (93.9%) tolerating vaccination. Most of those with a prior COVID-19-related AEFI had a delayed cutaneous reaction (n = 60 [37.0%]); 1 patient (0.6%) had suspected anaphylaxis. In this group, 6 (8.1%) were advised to postpone COVID-19 vaccination until their debilitating skin conditions had improved in response to further treatment, whereas 45 (77.6%) tolerated subsequent vaccination to the same or an alternate COVID-19 vaccine type. The most common AEFI on revaccination was urticaria (in 8 of 11 patients [72.7%]). AEFI on revaccination was significantly associated with a history of spontaneous urticaria or angioedema (relative risk = 3.6 [95% CI = 1.30-9.99]; P = .020) and urticaria following COVID-19 vaccination previously (relative risk = 4.12 [95% CI = 1.22-13.87]; P = .017).
Conclusions:
Children with a history of urticaria or angioedema related or unrelated to prior COVID-19 vaccination were at higher risk of a COVID-19-related AEFI on revaccination, although most were able to complete the vaccination series under the management of our immunology/allergy service.
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