Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
JAMA Netw Open. 2021 Oct 1;4(10):e2131034. doi: 10.1001/jamanetworkopen.2021.31034.
IMPORTANCE: Allergic history in individuals with confirmed anaphylaxis to a messenger RNA (mRNA) COVID-19 vaccine is common. However, the risk factors for allergy symptoms after receiving the vaccine are unknown. OBJECTIVE: To assess the association between self-reported history of high-risk allergy and self-reported allergic reactions after mRNA COVID-19 vaccination of health care employees. DESIGN, SETTING, AND PARTICIPANTS: This cohort study obtained demographic, medical, and vaccine administration data of employees of Mass General Brigham from the institutional electronic health record. Employees who received at least 1 dose of an mRNA COVID-19 vaccine between December 14, 2020, and February 1, 2021, and who completed at least 1 postvaccination symptom survey in the 3 days after vaccination were included. EXPOSURES: Self-reported history of high-risk allergy, defined as a previous severe allergic reaction to a vaccine, an injectable medication, or other allergen. MAIN OUTCOMES AND MEASURES: The primary outcome was 1 or more self-reported allergic reactions in the first 3 days after dose 1 or dose 2 of an mRNA COVID-19 vaccine. Multivariable log binomial regression was used to assess the association between allergic reactions and high-risk allergy status. RESULTS: A total of 52 998 health care employees (mean [SD] age, 42 [14] years; 38 167 women [72.0%]) were included in the cohort, of whom 51 706 (97.6%) received 2 doses of an mRNA COVID-19 vaccine and 474 (0.9%) reported a history of high-risk allergy. Individuals with vs without a history of high-risk allergy reported more allergic reactions after receiving dose 1 or 2 of the vaccine (11.6% [n = 55] vs 4.7% [n = 2461]). In the adjusted model, a history of high-risk allergy was associated with an increased risk of allergic reactions (adjusted relative risk [aRR], 2.46; 95% CI, 1.92-3.16), with risk being highest for hives (aRR, 3.81; 95% CI, 2.33-6.22) and angioedema (aRR, 4.36; 95% CI, 2.52-7.54). CONCLUSIONS AND RELEVANCE: This cohort study found that self-reported history of high-risk allergy was associated with an increased risk of self-reported allergic reactions within 3 days of mRNA COVID-19 vaccination. However, reported allergy symptoms did not impede the completion of the 2-dose vaccine protocol among a cohort of eligible health care employees, supporting the overall safety of mRNA COVID-19 vaccine.
重要性：在确诊对信使 RNA（mRNA）COVID-19 疫苗发生过敏反应的个体中，过敏史很常见。然而，疫苗接种后出现过敏症状的危险因素尚不清楚。 目的：评估报告的高风险过敏史与医疗保健工作者接种 mRNA COVID-19 疫苗后报告的过敏反应之间的关联。 设计、地点和参与者：本队列研究从机构电子健康记录中获取了麻省总医院员工的人口统计学、医疗和疫苗接种管理数据。该研究纳入了 2020 年 12 月 14 日至 2021 年 2 月 1 日期间至少接种过 1 剂 mRNA COVID-19 疫苗且在接种后 3 天内至少完成过 1 次疫苗接种后症状调查的员工。 暴露：报告的高风险过敏史，定义为以前对疫苗、注射药物或其他过敏原的严重过敏反应。 主要结局和措施：主要结局为在接受 mRNA COVID-19 疫苗第 1 剂或第 2 剂后 3 天内出现 1 次或多次报告的过敏反应。采用多变量对数二项式回归评估过敏反应与高风险过敏状态之间的关联。 结果：共有 52998 名医疗保健员工（平均[SD]年龄，42[14]岁；38167 名女性[72.0%]）被纳入该队列，其中 51706 名（97.6%）接种了 2 剂 mRNA COVID-19 疫苗，474 名（0.9%）报告有高风险过敏史。与未报告高风险过敏史的人相比，报告高风险过敏史的人在接种第 1 剂或第 2 剂疫苗后更易发生过敏反应（11.6%[n=55] vs 4.7%[n=2461]）。在调整模型中，高风险过敏史与过敏反应风险增加相关（调整后的相对风险[aRR]，2.46；95%CI，1.92-3.16），其中荨麻疹（aRR，3.81；95%CI，2.33-6.22）和血管性水肿（aRR，4.36；95%CI，2.52-7.54）的风险最高。 结论和相关性：本队列研究发现，报告的高风险过敏史与 mRNA COVID-19 疫苗接种后 3 天内报告的过敏反应风险增加相关。然而，在合格的医疗保健员工队列中，报告的过敏症状并未妨碍完成 2 剂疫苗接种方案，这支持了 mRNA COVID-19 疫苗的总体安全性。
JAMA Intern Med. 2022-4-1
Allergy Asthma Proc. 2021-11-1
Ann Fam Med. 2022-4-1
Med Sci (Basel). 2025-4-1
Glob Health Action. 2024-12-31
Vaccines (Basel). 2024-9-17
Rev Esp Salud Publica. 2023-10-2
Cureus. 2023-9-20
J Allergy Clin Immunol Pract. 2021-6
JAMA. 2021-4-20
N Engl J Med. 2021-4-1
MMWR Morb Mortal Wkly Rep. 2021-2-26
Zotero 插件