Risk of Second Allergic Reaction to SARS-CoV-2 VaccinesA Systematic Review and Meta-analysis

Accepted for Publication: December 26, 2021.

Published Online: February 21, 2022. doi:10.1001/jamainternmed.2021.8515

Corresponding Author: Matthew Greenhawt, MD, MBA, MSc, Food Challenge and Research Unit, Section of Allergy and Clinical Immunology, Children’s Hospital Colorado, University of Colorado School of Medicine, 13123 E 16th Ave, Aurora, CO 80045 (matthew.greenhawt@childrenscolorado.org).

Author Contributions: Drs Chu and Greenhawt had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Chu, Abrams, Stone, Krantz, Shaker, Greenhawt.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Chu, Abrams, Golden, Stone, Krantz, Shaker, Greenhawt.

Critical revision of the manuscript for important intellectual content: Chu, Abrams, Golden, Blumenthal, Wolfson, Krantz, Shaker, Greenhawt.

Statistical analysis: Chu, Abrams, Greenhawt.

Administrative, technical, or material support: Chu, Wolfson, Stone, Krantz, Shaker, Greenhawt.

Supervision: Stone, Greenhawt.

Conflict of Interest Disclosures: Dr Golden reported receiving grants from Pfizer, GSK, Novartis, Genentech, and Regeneron outside the submitted work. Dr Blumenthal reported receiving grants from the National Institutes of Health/National Institute of Allergy and Infectious Diseases, Agency for Healthcare Research and Quality (AHRQ), Massachusetts General Hospital Executive Committe on Research, Department of Medicine (DOM) Transformative Scholar Award, and DOM COVID-19 Junior Investigator Initiative; personal fees from Weekley, Schulte, Valdes, Murman, Tonelli, Piedmont Liability Trust, and Vasios, Kelly & Strollo PA; and royalties from UpToDate Inc outside the submitted work. Dr Stone reported receiving grants from the AHRQ and American Academy of Allergy, Asthma & Immunology Foundation Career Development Award during the conduct of the study. Dr Shaker reported being a member of the Joint Taskforce on Allergy Practice Parameters; having a family member who is CEO of Altrix Medical; being an associate editor for the Annals of Allergy, Asthma & Immunology; and serving on the editorial boards of the Journal of Allergy and Clinical Immunology In Practice and the Journal of Food Allergy. Dr Greenhawt reported serving as a consultant for Aquestive; being a member of physician/medical advisory boards for DBV Technologies, Sanofi/Regeneron, Genentech, Nutricia, Novartis, Acquestive, Allergy Therapeutics, AstraZeneca, ALK-Abello, Pfizer, US World Meds, Allergenis, Aravax, and Prota, all unrelated to vaccines/vaccine development or COVID-19 treatment; being an unpaid member of the scientific advisory council for the National Peanut Board and medical advisory board of the International Food Protein Induced Enterocolitis Syndrome Association; being a member of the Brighton Collaboration Criteria Vaccine Anaphylaxis 2.0 working group; being the senior associate editor for the Annals of Allergy, Asthma & Immunology; being a member of the Joint Taskforce on Allergy Practice Parameters; receiving honoraria for lectures from ImSci, MedLearningGroup, and multiple state/local allergy societies; and receiving past research support ending in 2020 from the AHRQ (K08-HS024599). No other disclosures were reported.

Disclaimer: Dr Abrams reported she is an employee of the Public Health Agency of Canada (PHAC). The views expressed are her own and not that of the PHAC.

Additional Contributions: We would like to thank and acknowledge Shazahd Mustafa, MD, and Allison Ramsey, MD, Rochester Regional Health and University of Rochester, Rochester, New York; Nicholas Hartog, MD, and Kimberly Eastman, MD, Spectrum Health Helen DeVos Children’s Hospital, Grand Rapids, Michigan; Miguel Park, MD, and Mitchell Pitlick, MD, Division of Allergic Diseases, Mayo Clinic, Rochester, Minnesota; Carsten Bindslev-Jensen, MD, PhD, DMSci, and Trine Rasmussen, MD, Odense Research Center for Anaphylaxis, Odense University Hospital, Odense, Denmark; Arnon Elizur, MD, PhD, Institute of Allergy, Immunology and Pediatric Pulmonology, Yitzhak Shamir Medical Center, Zerifin, Israel, and Sackler School of Medicine, Tel Aviv University, Tel-Aviv, Israel; John Kelso, MD, Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, California; Kari Nadeau, MD, PhD, Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, California; Christopher Warren, PhD, Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford, California, and Center for Food Allergy and Asthma Research, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Anita Kohli-Pamnani, MD, and Pamela L. Kwittken, MD, Allergy, Asthma & Immunology Center LLC, Milford, Connecticut; Sumito Inoue, MD, Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan; Blanka Kaplan, MD, Division of Allergy and Immunology, Northwell Health, Great Neck, New York, and Departments of Pediatrics and Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York; Lacey Robinson, MD, MPH, and Aleena Banerji, MD, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston; Lene Garvey, MD, PhD, Copenhagen University Hospital–Herlev and Gentofte, Copenhagen, Denmark; Elizabeth Phillips, MD, PhD, Vanderbilt University Medical Center, Nashville, Tennessee; Mona-Rita Yacoub, MD, Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy, and Vita-Salute San Raffaele University, Milan, Italy; and Merin Kuruvilla, MD, Emory University School of Medicine, Atlanta, Georgia, for their assistance with verifying data and study design questions pertaining to their included works. They were not compensated for their contributions.