Chiang Valerie, Mok Sabrina Wing Shan, Chan June King Chi, Leung Wai Yan, Ho Carmen Tze Kwan, Au Elaine Y L, Lau Chak Sing, Lee Tak Hong, Li Philip Hei
Division of Clinical Immunology, Department of Pathology, Queen Mary Hospital, Hong Kong, China.
Allergy Centre, Hong Kong Sanatorium and Hospital, Hong Kong, China.
World Allergy Organ J. 2022 Jan;15(1):100622. doi: 10.1016/j.waojou.2021.100622. Epub 2021 Dec 20.
Hong Kong has had a low incidence of COVID-19 vaccine related anaphylaxis, partly due to its Vaccine Allergy Safety (VAS) guidelines for screening those at higher risk of COVID-19 vaccine-associated allergic reactions. We characterize the initial experience of the VAS clinics, as well as the impact of unnecessary referrals to the vaccination program.
All patients attending the VAS Clinics of the public and private health services between February and June 2021 were reviewed.
Out of 1127 patients assessed at VAS clinics, 1102 (97.8%) patients were recommended for vaccination. Out of those contacted, more than 80% (450/558) received vaccination successfully; the remaining had not yet booked their vaccinations. The majority (87.5%) of patients not recommended was due to potential excipient allergies. Males were significantly more likely to be recommended (OR = 5.822, 95% CI = 1.361-24.903, p = 0.007), but no other features were associated with recommendation for vaccination. Almost half (45.1%) of public service referrals were rejected due to insufficient information or incorrect indications for referral. The majority of cases (56.2%) of patients referred for suspected "anaphylaxis" did not fulfil diagnostic criteria.
COVID-19 vaccination is very safe and 98% of high-risk patients were recommended for vaccination. Barriers to VAS include a high proportion of inappropriate referrals, inaccurate diagnoses of anaphylaxis and inability to diagnose excipient allergies. Our data validates that a prior history of COVID-vaccine unrelated anaphylaxis should be removed as a precaution for vaccination. Closer collaborations between primary care and allergy specialists and changes in pharmaceutical legislation should be made a priority to promote vaccination uptake.
香港与新冠疫苗相关的过敏反应发生率较低，部分原因是其疫苗过敏安全性（VAS）指南用于筛查新冠疫苗相关过敏反应风险较高的人群。我们描述了VAS诊所的初步经验，以及不必要转诊对接种计划的影响。
回顾了2021年2月至6月期间在公立和私立医疗服务机构的VAS诊所就诊的所有患者。
在VAS诊所评估的1127名患者中，1102名（97.8%）患者被建议接种疫苗。在被联系的患者中，超过80%（450/558）成功接种；其余患者尚未预约接种。未被建议接种的患者中，大多数（87.5%）是由于潜在的辅料过敏。男性被建议接种的可能性显著更高（OR = 5.822，95% CI = 1.361 - 24.903，p = 0.007），但没有其他特征与接种建议相关。近一半（45.1%）的公立服务转诊因信息不足或转诊指征错误而被拒绝。被转诊怀疑“过敏反应”的患者中，大多数病例（56.2%）不符合诊断标准。
新冠疫苗接种非常安全，98%的高危患者被建议接种。VAS的障碍包括不适当转诊比例高、过敏反应诊断不准确以及无法诊断辅料过敏。我们的数据证实，应取消将既往与新冠疫苗无关的过敏反应病史作为接种疫苗的预防措施。基层医疗与过敏专科医生之间更紧密的合作以及药品立法的变革应作为优先事项，以促进疫苗接种率的提高。
