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The COVID-19 Vaccine: The Latest Information for People With Asthma and Allergies

 
Updates as of Aug. 24, 2021:

  • Information on FDA approval of the Pfizer-Bio-NTech COVID-19 vaccine (Comirnaty)
  • Information on FDA approval of a third vaccine dose for people who are immunocompromised or pregnant
  • CDC recommendation of booster shots eight months after being fully vaccinated
  • Recommendation for fully vaccinated people to wear a mask in public indoor settings in areas of high transmission

As more information becomes available, we will continue to update our community.


On Aug. 23, 2021, the Food and Drug Administration (FDA) approved the first COVID-19 vaccine – the Pfizer-BioNTech COVID-19 vaccine. It will now be marketed under the name Comirnaty [koe-MIR-nah-tee] for the prevention of COVID-19 disease in people 16 years of age and older.

The Moderna and Johnson & Johnson (made by Janssen) have an emergency use authorization (EUA) from the FDA. The Pfizer-BioNTech still has an EUA for children 12 through 15 years of age and for the administration of a third dose in certain immunocompromised individuals. Other vaccines also are being tested and reviewed.

Information From the CDC on the COVID-19 Vaccines

The Centers for Disease Control and Prevention (CDC) released guidelines for the current COVID-19 vaccines. The Pfizer-BioNTech and Moderna COVID-19 vaccines were the first to be authorized by the FDA. The Pfizer-BioNTech is the first to be approved. They are mRNA-type vaccines. The mRNA vaccines teach your immune system to make a protein that starts an immune process. Your body then produces antibodies that can protect you from COVID-19.

The Pfizer-BioNTech vaccine is a shot given in two doses three weeks apart. The Moderna vaccine is also given in two doses about four weeks apart. Based on the clinical trials, you need both doses of these to be fully protected from COVID-19. If you are immunocompromised, it is recommended you get a third dose at least 28 days after your second shot.

The Johnson & Johnson (J&J) vaccine is only given in one shot. There is no recommendation for an additional or booster dose for the J&J COVID-19 vaccine at this time. It is a viral vector vaccine. It is different than mRNA vaccines. A viral vector vaccine uses a modified version of a different virus (that can’t spread) to deliver instructions (in the form of a gene) to cells in your body. This triggers your body to create antibodies to SARS-CoV2, the virus that causes COVID-19. You cannot get COVID-19 from this vaccine since it is a modified virus.

None of the vaccines will affect your DNA. These vaccines reduce the chance of getting COVID-19. They can also reduce the severity of your symptoms if you get the disease.

All three vaccines are very good at protecting you and your loved ones from having severe COVID-19 symptoms, staying in the hospital, or from dying from the virus.

You are fully vaccinated two weeks after getting your second Pfizer or Moderna shot or two weeks after getting one J&J shot.

What Are COVID-19 Vaccine Recommendations for People Who Are Immunocompromised?

On Aug. 12, 2021, the FDA authorized an additional vaccine shot, or third dose, of the Pfizer or Moderna COVID-19 vaccines. This is only for people who are moderately and severely immunocompromised. Other fully vaccinated people do not need an additional or booster dose right now. If you take a high dose of corticosteroids (like prednisone), have received an organ transplant, or have other serious health conditions, talk with your doctor about your vaccine options.

Currently, there are no recommendations for immunocompromised people who have gotten the J&J shot.

People who are immunocompromised may need a third dose of the vaccine because two doses are not enough to protect them from the start. This is different than a booster shot. A booster shot is given when the vaccine protection fades over time.

What Are the Recommendations for COVID-19 Vaccines for Pregnant People?

People who are pregnant or thinking of becoming pregnant should get the COVID-19 vaccine. Pregnant people are at a higher risk for severe COVID-19 when compared to non-pregnant people.1 Recent pregnancy (for at least 42 days following the end of pregnancy) may also raise a person’s risk for developing severe COVID-19. If you get COVID-19 while pregnant, you are at increased risk for preterm birth (delivering the baby earlier than 37 weeks) and other poor pregnancy outcomes.2

What Are the Recommendations for COVID-19 Vaccine Booster Shots?

On Aug. 18, 2021, the CDC has recommended that everyone 12 and older who received two shots of the mRNA Pfizer-BioNTech or Moderna vaccines get a booster shot. This recommendation is based on the data that show the COVID-19 vaccines begin to lose their effectiveness eight months after being fully vaccinated.

Even though the CDC recommends booster shots, the FDA needs to approve them before you can receive one. The FDA will conduct a thorough and independent evaluation. This evaluation will determine if booster shots of the mRNA vaccines are safe and effective. The CDC’s Advisory Committee on Immunization Practices (ACIP) will also review this safety evidence and make dosing recommendations.

People who received the J&J vaccine will probably need a booster shot as well. Administration of the J&J vaccine did not begin in the U.S. until March 2021. More data and a recommendation are expected on J&J booster shots in the next few weeks.

If approved by the FDA, the U.S. will be ready to provide the mRNA booster shots beginning Sept. 20, 2021, to people who received their vaccines first. This includes health care workers and people who live and work in nursing homes.

In the U.S., it is recommended that all doses must come from the same maker. For example, you should not get the Pfizer-BioNTech shot for the first dose and the Moderna shot for the second dose.

The below are considered immunocompromising health conditions:

  • Active treatment for solid tumor and hematologic malignancies
  • Receipt of solid-organ transplant and taking immunosuppressive therapy
  • Receipt of CAR-T-cell or hematopoietic stem cell transplant (within two years of transplantation or taking immunosuppression therapy)
  • Moderate or severe primary immunodeficiency (such as DiGeorge, Wiskott-Aldrich syndromes)
  • Advanced or untreated HIV infection
  • Active treatment with high-dose corticosteroids (for example, ≥20mg prednisone or equivalent per day), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, TNF blockers, and other biologic agents that are immunosuppressive or immunomodulatory

If you take daily oral steroids or injectable steroids like prednisone, talk with your doctor about getting a third mRNA shot. People taking inhaled corticosteroids or biologic medicines for asthma or allergies are not considered in this group.

Who Can Get the COVID-19 Vaccine?

People 12 and older can get the Pfizer-BioNTech COVID-19 vaccine. People 18 or older can get the Moderna or J&J COVID-19 vaccines. You can get your shot at a local pharmacy, clinic, or vaccination center. Go to vaccines.gov to find a location. The vaccine is free to everyone.

Do not take over-the-counter pain medicines like acetaminophen (Tylenol) or ibuprofen (Advil) before getting a COVID-19 vaccine to reduce side effects. Taking the over-the-counter pain medicines or anti-inflammatories may stop the vaccine from working as it should and reduce its ability to make antibodies. Talk with your doctor about taking pain medicines after you get the shot.

If you get another type of vaccine (like the flu or pneumococcal shots), make sure you wait 14 days before getting the COVID-19 vaccine.

If you get allergy shots (immunotherapy), talk with your allergist if your shot schedule overlaps with getting the COVID-19 shot. There are no data on allergy shots and the COVID-19 vaccine at this time. But to help reduce confusion if you have local reactions or side effects, it may help to spread these out by a couple days.

The following people can get a COVID-19 vaccine:

  • People age 12 and older
  • People with medical conditions
  • People who are immunocompromised or immunosuppressed
  • Pregnant and lactating (nursing) people
  • People with allergies to food, pets, insects, venom, pollen, dust, latex, and oral medicines
  • People with a non-serious allergy to other vaccines or injectable medicines
  • People with a family history of anaphylaxis or any other history of anaphylaxis to anything other than a vaccine or injectable medicine

Your doctor may need to give you more information about the vaccine depending on your condition.

If you have a history of severe allergic reactions (anaphylaxis), you may be monitored up to 30 minutes after the shot. For everyone else, you will be monitored for 15 minutes after the shot.

Some people should talk with their doctor about risks and benefits before getting a COVID-19 vaccine. If you do get the vaccine, get the shots in a clinic or doctor’s office:

  • People with a moderate or acute (short-term) illness (such as the flu)
  • People with a history of severe allergic reactions (anaphylaxis) to another vaccine or injectable medicines
  • Anyone who has had a severe or immediate allergic reaction to previous dose or any ingredient (also called “excipients” or “components”) of a COVID-19 vaccine
  • People who have a history of an allergic reaction to PEG or polysorbate

If you have a reaction to the first dose of an mRNA vaccine (Pfizer-BioNTech/Moderna), talk with your doctor about your options.

People who currently have or recently had COVID-19:

  • Should finish self-isolation and talk to their doctors about when to get the vaccine

If you received COVID-19 antibody treatment, you will need to wait 90 days after receiving the treatment to get a COVID-19 vaccine.



pfizer covid-19 vaccine chart-v2Click here for larger view

What Ingredients Are in the COVID-19 Vaccines?

The Pfizer-BioNTech and Moderna vaccines do not contain any food proteins, latex, or preservatives. Both contain mRNA (messenger ribonucleic acid).

The Pfizer-BioNTech COVID-19 vaccine contains:

COVID-19-vaccine-ingredients

The Moderna COVID-19 vaccine contains:

Moderna COVID-19 Vaccine Ingredients

The Johnson & Johnson (Janssen) COVID-19 vaccine contains:

Johnson & Johnson vaccine ingredients

What Are the Side Effects of the COVID-19 Vaccines?

Severe adverse reactions to vaccines are very rare. But some mild side effects are normal. This means your body is building your immune system to protect you against the coronavirus.

During clinical trials for the Pfizer-BioNTech COVID-19 vaccine, these were some of the common side effects:

  • Pain and swelling on the arm where the shot was given
  • Fever
  • Chills
  • Fatigue
  • Headache

During clinical trials for the Moderna COVID-19 vaccine, these were some of the common side effects:

  • Pain and swelling on the arm where the shot was given
  • Fever
  • Chills
  • Fatigue
  • Headache
  • Muscle pain
  • Joint pain
  • Swollen lymph nodes in the same arm where the injection was given
  • Nausea
  • Vomiting

During clinical trials for the J&J COVID-19 vaccine, these were some of the common side effects:

  • Pain, redness, and swelling on the arm where the shot was given
  • Fever
  • Nausea
  • Muscle aches
  • Fatigue
  • Headache

More people felt the side effects after the second dose for the mRNA vaccines.

What Do I Do If You Have Side Effects to the COVID-19 Vaccine?

If you have a history of severe allergic reactions (anaphylaxis), you may be monitored up to 30 minutes after the shot. That way, if you have an immediate reaction to the vaccine, you will receive medical help. After you go home, you may experience some of the side effects mentioned above.

For everyone else, you will be monitored for 15 minutes after the shot.

The CDC is asking people to help report any side effects to the COVID-19 vaccines. V-safe is a smartphone-based tool that uses text messaging and web surveys to provide personalized health check-ins after you receive a COVID-19 vaccination. Through v-safe, you can quickly tell the CDC if you have any side effects after getting the COVID-19 vaccine. Depending on your answers, someone from the CDC may call to check on you and get more information. And v-safe will remind you to get your second COVID-19 vaccine dose if you need one. The information on how to register for v-safe can be found on the vaccination record card you receive when you get the shot. If you cannot find your card, please contact your health care provider.

Should I Still Wear A Face Mask After I’ve Gotten the COVID-19 Vaccine?

In May 2021, the CDC updated their guidelines for wearing a mask. When fully vaccinated, the CDC stated you can safely resume activities without wearing a mask and staying 6 feet (2 meters) apart.

But in July 2021, the CDC provided new guidance due to the delta variant and rising COVID-19 cases. It is now recommended that everyone in areas of high transmission where a mask in public indoor places, even if they are fully vaccinated.

If you have a condition or are taking medicines that weaken your immune system, talk with your doctor about which activities are safe to do.

The CDC recommends universal indoor masking for all teachers, staff, students, and visitors to schools, regardless of vaccination status.

Continuing to wear a face mask may have benefits. If you have asthma or allergies, masks can help protect you from pollen and other allergens and irritants that trigger symptoms. Masks also can protect you from respiratory infections like the flu, COVID-19, and even the common cold. Masks provide increased protection for people who are immunocompromised.

What Should People With Allergies Know About Allergic Reactions to the COVID-19 Vaccines?

In December 2020, health officials in the United Kingdom issued a very broad warning on the Pfizer-BioNTech vaccine because two people had adverse reactions to the vaccine. Initially they stopped giving the vaccine to people with a history of any severe allergies. But the U.K. Medicines and Healthcare products Regulatory Agency (MHRA) – which is similar to the Food and Drug Administration – later updated their guidelines. The UK recommendations are now similar to the U.S. recommendations and only people with certain allergies should not get the vaccine.

According to Dr. June Raine, MHRA’s Chief Executive, “Anaphylaxis is a known, although very rare, side effect with any vaccine. Most people will not get anaphylaxis and the benefits in protecting people against COVID-19 outweigh the risks.”

In April 2021, the CDC’s Advisory Committee on Immunization Practices, the FDA and the CDC paused the use of the J&J vaccine. The pause was based on extreme caution. There were reports of a rare and severe type of blood clot in individuals after getting their COVID-19 vaccine. During the pause, medical teams from the CDC and FDA examined the data to assess the risks. The two agencies determined that the J&J vaccine was safe and effective in preventing COVID-19 and should resume in the United States.

“Safety is our top priority,” said Janet Woodcock, M.D., Acting FDA Commissioner. “This pause was an example of our extensive safety monitoring working as they were designed to work − identifying even these small number of cases. We’ve lifted the pause based on the FDA and CDC’s review of all available data and in consultation with medical experts and based on recommendations from the CDC’s Advisory Committee on Immunization Practices. We have concluded that the known and potential benefits of the Janssen COVID-19 Vaccine outweigh its known and potential risks in individuals 18 years of age and older. We are confident that this vaccine continues to meet our standards for safety, effectiveness, and quality. We recommend people with questions about which vaccine is right for them have those discussions with their health care provider.”

Only a very small number of allergic reactions – about two to five people per 1 million – to the vaccines have been reported. Most people have not had allergic reactions to the vaccines.

Q&A With AAFA's Medical Scientific Council

Now that the COVID-19 vaccine has reached the U.S., many people with asthma and allergies have questions about it. The Asthma and Allergy Foundation of America (AAFA) talked with three doctors on our Medical Scientific Council on Dec. 10, 2020, about the Pfizer-BioNTech COVID-19 vaccine. Please note this was recorded shortly before the FDA authorized the COVID-19 vaccines.

Here are a couple of the questions we asked the doctors and text excerpts from their answers. Please watch the videos below to hear their full answers.


AAFA: What do we know about the clinical trials for the COVID-19 vaccines?

Watch on YouTube

Dr. David Stukus: We don’t know specifically how many people had asthma or food allergies or allergic rhinitis. They didn’t break it down by that when they reported this. There are other categories that are more important in the grand scheme of things to try to figure out whether the vaccine is safe and effective. But they weren’t excluded. The only potential allergy that was excluded specifically were those participants who may have had a severe allergic reaction to prior vaccines or any of the specific ingredients contained in this Pfizer vaccine.

Of note, the Pfizer vaccine does not contain any food proteins, food allergens, or food derivatives. It wasn’t grown in embryos, so there’s no egg or anything like that. We have to assume there were people with some of the more common chronic conditions, especially asthma. We have to assume there were people with asthma, allergic rhinitis, atopic dermatitis, and food allergies enrolled in these trials. We’re not seeing any big scary signals from any group, let alone those.

Note: This is just an excerpt from the video. Watch the full video clip for the entire answer.

AAFA: What do people with allergies need to know about vaccine ingredients (which are called excipients or components) and allergic reactions?

Watch on YouTube

Dr. Matthew Greenhawt: The main ingredient I think people are suspicious of is something called polyethylene glycol or PEG. We eat this. It is in a decent amount of food. Orally this doesn’t really cause problems, but injecting it was the one thing that came up and people zeroed in on that.

We have absolutely no causative data. We have absolutely nothing that says this did or didn’t cause it. … I don’t see this as a risk for somebody with food allergy. This could be a general risk for reasons we don’t know and that will emerge. There’s no egg. There’s no peanut.

There are a lot of reasons why people can have a reaction to a vaccine. Some of it can be non-allergic. Just because you had an adverse reaction, that’s the larger umbrella, and allergy is a specific type of an adverse reaction. It happens through a very specific pathway.

Note: This is just an excerpt from the video. Watch the full video clip for the entire answer.


About our experts

  • Mitchell H. Grayson, MD, Director of the Division of Allergy and Immunology and Professor of Pediatrics at Nationwide Children’s Hospital and The Ohio State University, Chair of the Medical Scientific Council, and board member for AAFA
  • Matthew Greenhawt, MD, Director of the Food Challenge and Research Unit at Children’s Hospital Colorado
  • David R. Stukus, MD, Director of the Complex Asthma Clinic and Assistant Professor of Pediatrics in the Division of Allergy and Immunology at Nationwide Children’s Hospital, Ohio



As more information becomes available, we will continue to update our community.

Medical Review August 2021 by Mitchell Grayson, MD

References
1. Zambrano LD, Ellington S, Strid P, et al. Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–October 3, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1641–1647. DOI: http://dx.doi.org/10.15585/mmwr.mm6944e3  
2. Allotey J, Stallings E, Bonet M, Yap M, Chatterjee S, Kew T et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis BMJ 2020; 370 :m3320 doi:10.1136/bmj.m3320

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