Should I take COVID-19 vaccines if I have a significant history of allergic reactions?
This section addresses contraindications and precautions to mRNA COVID-19 vaccines. Individuals with allergy questions or concerns should consult a health care provider. Disclose any allergies to medical staff prior to vaccination.
While rare, anaphylactic reactions have been reported following vaccination with mRNA COVID-19 vaccines. Although investigations are ongoing, persons with a history of an immediate allergic reaction (of any severity) to an mRNA COVID-19 vaccine or any of its components might be at greater risk for severe reaction upon taking additional doses. For the purposes of this guidance, an immediate allergic reaction to a vaccine or medication is defined as any hypersensitivity-related signs or symptoms such as hives (urticaria); swelling around the face, lips, and tongue (angioedema); wheezing or other respiratory distress; or anaphylaxis that occur within four hours following getting the vaccine.
Recommendations for contraindications and precautions are described below and summarized in the figure from CDC at the end of this question section. The following recommendations may change as further information becomes available.
Contraindication to vaccination:
Contraindications are conditions or factors that would be a reason to not get vaccination due to harm. (Individuals with a contraindication should not get the COVID-19 vaccine.)
CDC considers a history of the following to be a contraindication to vaccination with both the Pfizer-BioNTech and Moderna COVID-19 vaccines:
- Severe allergic reaction (e.g., anaphylaxis) after a previous dose of an mRNA COVID-19 vaccine or any of its components
- 2. Immediate allergic reaction* (within 4 hours) of any severity to a previous dose of an mRNA COVID-19 vaccine or any of its components (including polyethylene glycol [PEG])
- Immediate allergic reaction* (within 4 hours) of any severity to polysorbate (due to potential cross-reactive hypersensitivity with the vaccine ingredient PEG)*
*As noted above: For the purposes of this guidance, an immediate allergic reaction to a vaccine or medication is defined as any hypersensitivity-related signs or symptoms such as hives (urticaria); swelling around the face, lips, and tongue (angioedema); wheezing or other respiratory distress; or anaphylaxis that occur within four hours following getting the vaccine.
Persons with an immediate allergic reaction to the first dose of an mRNA COVID-19 vaccine should NOT receive additional doses of either of the mRNA COVID-19 vaccines. Providers should attempt to determine whether reactions reported following vaccination are consistent with immediate allergic reactions versus other types of reactions commonly observed following vaccination, such as passing out (a vasovagal reaction) or post-vaccination side effects—which are not contraindications to receiving the second vaccine dose (see the figure at the bottom of this question section).
The following fact sheets contain additional information about who should not receive the vaccine.
Pfizer-BioNTech Fact Sheet for Vaccine Recipients and Caregivers: https://www.fda.gov/media/144414/download
Moderna Fact Sheet for Vaccine Recipients and Caregivers: https://www.fda.gov/media/144638/download
The following ingredients list is available from: https://www.cdc.gov/vaccines/acip/meetings/downloads/slides-2020-12/slides-12-19/06-COVID-Mbaeyi.pdf
Precaution to vaccination:
Precautions are conditions or factors that would be a reason to consult with a health care provider before proceeding with vaccination. Vaccine providers should observe these patients for 30 minutes after vaccination to monitor for the development of immediate adverse reactions.
The CDC considers a history of immediate allergic reaction to any other vaccine or injectable therapy (e.g., intramuscular, intravenous, or subcutaneous) as a precaution but not a contraindication to vaccination. These persons may still receive vaccination but should be counseled about unknown risks of developing a severe allergic reaction and balance these risks against the benefits of vaccination. All vaccination sites will have the medication they need, and the trained medical professionals, to respond to an allergic reaction if one occurs. The CDC advises that individuals who are concerned about their history of allergies may prefer to be vaccinated in a setting where more comprehensive medical care is immediately available for anaphylaxis.
No contraindication or precaution:
There are allergies that do not constitute a contraindication or precaution to vaccination, including:
- History of food, pet, insect, venom, environmental/seasonal, latex, or other allergies not related to vaccines or injectable therapies
- History of allergy to oral medications (including the oral equivalent of an injectable medication)
- Family history of anaphylaxis
- Any other history of anaphylaxis that is not related to a vaccine or injectable therapy
For rare instances when individuals experience immediate allergic reactions, appropriate medical treatments are available (and are mandatory on site) to manage the symptoms. Clinical considerations are available here: https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/anaphylaxis-management.html
Triage of Individuals Presenting for COVID-19 Vaccination:
The above figure is available at: https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html
Are children and adolescents recommended to receive COVID-19 mRNA (Pfizer and Moderna) vaccines?
Children/adolescents under age 16.
COVID-19 vaccines are not recommended for children/teens under age 16 (Pfizer) or under age 18 (Moderna) at this time. In early clinical trials for various COVID-19 vaccines, only adults who were not pregnant participated. Older children (12 and up) were added in later trials. However, clinical trials continue to expand and include other groups, so these recommendations may change in the future.
Adolescents age 16 and older.
Individuals aged 16-17 years are eligible to receive the Pfizer-BioNTech COVID-19 vaccines (but not the Moderna COVID-19 vaccine at this time). No safety concerns were identified in this group during Pfizer-BioNTech COVID-19 clinical trials. Although vaccine safety and efficacy data in this age group are somewhat limited, there is no medical reason to believe that responses from this group would be different from those who are 18 years of age and older. Adolescents aged 16-17 years who are part of a group recommended to receive a COVID-19 vaccine may be vaccinated with the Pfizer-BioNTech vaccine.
Should I take the vaccine if I am pregnant?
Currently, there are no data on the safety and efficacy of COVID-19 vaccines in pregnant women. However, people who are pregnant and become infected with COVID-19 can have an increased risk of severe illness or negative pregnancy outcomes, such as preterm birth. Based on current knowledge, experts believe that mRNA vaccines are unlikely to pose a risk for people who are pregnant. Reputable sources, such as the American College of Obstetricians and Gynecologists, have advised that the benefit of vaccination may outweigh the risk of severe COVID-19 disease. For this reason, if a person who is pregnant is part of a group who is recommended to receive a COVID-19 vaccine, they may choose to be vaccinated. A discussion with a health care provider can help make an informed decision. Although a conversation with a healthcare provider may be helpful, it is not required prior to vaccination.
Should I take the vaccine if I am breastfeeding?
If someone who is breastfeeding is part of a group who is recommended to receive a COVID-19 vaccine, they may choose to be vaccinated. Currently, there is no data on the safety and efficacy of COVID-19 vaccines in breastfeeding women as they were excluded from clinical trials. However, the CDC has stated that since the mRNA vaccine does not contain live virus, it is not thought to be a risk to breastfeeding infants. A discussion with a health care provider can help to make an informed decision. Although a conversation with a healthcare provider may be helpful, it is not required prior to vaccination.
Are the mRNA vaccines safe for people who want to become pregnant?
There is no evidence the COVID-19 vaccine affects fertility. People who are trying to become pregnant or who are pregnant and for whom the vaccine is recommended may choose to be vaccinated. A discussion with a health care provider can help to make an informed decision.
More information from the American Society for Reproductive Medicine is available here: https://www.asrm.org/news-and-publications/news-and-research/press-releases-and-bulletins/asrm-issues-statement-on-covid-19-vaccines-joins-other-obgyn-groups-on-community-wide-statement/
Should I take the vaccine if I am immunocompromised?
Currently, there is no data on the safety and efficacy of COVID-19 vaccines in immunocompromised people. However, persons with immunocompromising conditions or who take immunosuppressive medications or therapies might be at increased risk for severe disease if they get COVID-19. Therefore, the CDC recommends these individuals receive the COVID-19 vaccine. Immunocompromised individuals should discuss this with a healthcare provider. It is important to note that the mRNA vaccines do not contain live virus; so, it is not possible to develop COVID-19 from vaccination.
Are COVID-19 vaccines safe for people with autoimmune disease?
Experts say there is no reason to believe that the currently approved mRNA COVID-19 vaccines will be unsafe for people with autoimmune disease. Additionally, authorized mRNA vaccines are expected to be safe for immunocompromised patients and those on immunosuppressant drugs. However, it is yet unconfirmed whether immunosuppressant medications or unchecked disease activity may reduce vaccine effectiveness. Persons with autoimmune conditions who have no contraindications to vaccination may receive an mRNA COVID-19 vaccine. A discussion with a health care provider can help to make an informed decision.
Should I take the vaccine if I have Guillain-Barré syndrome?
To date, no cases of Guillain-Barré syndrome (GBS) have been reported following vaccination among participants in the mRNA COVID-19 vaccines clinical trials. With few exceptions, Advisory Committee on Immunization Practices (ACIP) general best practice guidelines for immunization does not include history of GBS as a contraindication or precaution to vaccination. Persons with a history of GBS may receive an mRNA COVID-19 vaccine unless they have a contraindication to vaccination. Any occurrence of GBS following mRNA COVID-19 vaccination should be reported to VAERS.
Should I take the vaccine if I have a history of Bell’s palsy?
Cases of Bell’s palsy were reported following vaccination in participants in both the Pfizer-BioNTech and Moderna COVID-19 vaccines’ clinical trials. However, the FDA does not consider these to be above the frequency expected in the general population and has not concluded that these cases were causally related to vaccination. The FDA and CDC will continue to monitor the vaccines’ safety. In the absence of such evidence, persons with a history of Bell’s palsy may receive an mRNA COVID-19 vaccine unless they have a contraindication to vaccination. Any occurrence of Bell’s palsy following mRNA COVID-19 vaccination should be reported to VAERS.
Should I take the vaccine if I have had convalescent plasma or monoclonal antibody?
The Advisory Committee on Immunization Practices (ACIP) recommends that vaccination should be deferred until 90 days after receiving convalescent plasma or monoclonal antibodies. Currently, there are no data on the safety and efficacy of COVID-19 vaccines in people who received convalescent plasma or monoclonal antibody therapy. This is to avoid interference of these treatments with vaccine-induced immune responses. The risks and benefits of vaccination based upon the underlying risk factors, including living in a nursing home, could be considered. A discussion with a health care provider can help make an informed decision.
Should I take the vaccine if I already had COVID-19 and recovered?
Data from clinical trials indicate that mRNA COVID-19 vaccines are safe in persons with evidence of a prior SARS-CoV-2 infection. Vaccination should be offered to individuals regardless of history of COVID-19 (symptomatic or asymptomatic). The length of immunity after recovering from COVID-19 is unknown; early studies show that it is not long lasting and rare cases of reinfection have been reported.
Testing specifically to determine whether a person has active or prior COVID-19 infection is not recommended solely for the purpose of vaccine decision-making.
How long after recovering from COVID-19 should I take the vaccine?
The CDC states current evidence suggests reinfection is uncommon within 90 days after initial infection, so vaccination could be deferred until the end of this period; however, given initially limited supply of vaccines, it is not certain when another opportunity for vaccination will be available.
Should I take the vaccine if I currently am infected with COVID-19?
No. Those infected should wait until they have recovered from the acute illness (if the person had symptoms) and criteria have been met for them to end their isolation. This waiting period is essential to avoid exposing healthcare personnel (HCP) or other persons during the vaccination visit. Getting the vaccine while infected is not expected to harm you, but leaving isolation will put others in danger of getting COVID-19. This recommendation applies to persons who get COVID-19 before receiving any vaccine doses as well as those who get COVID-19 after the first dose but before taking the second dose.
Should I get the vaccine if I am in quarantine?
Individuals in a community or outpatient setting should defer vaccination until quarantine period has ended to avoid exposing healthcare personnel (HCP) or other persons during the vaccination visit.
Residents of congregate healthcare settings (e.g., long-term care facilities) may be vaccinated, as this likely would not result in any additional exposures. HCP are already in close contact with residents and should employ appropriate infection prevention and control procedures.
Residents of other congregate settings (e.g., correctional facilities, homeless shelters, residential settings) may be vaccinated, in order to avoid delays and missed opportunities for vaccination. Where possible, precautions should be taken to limit mixing of these individuals with other residents or non-essential staff.
How long after the flu shot or other vaccines do I have to wait to take the COVID-19 vaccine?
Given the lack of data on the safety and efficacy of mRNA COVID-19 vaccines administered simultaneously with other vaccines, the vaccine series should routinely be administered alone, with a minimum interval of 14 days before or after administration with any other vaccine. However, mRNA COVID-19 and other vaccines may be administered within a shorter period in situations where the benefits of vaccination are deemed to outweigh the potential unknown risks of vaccine co-administration (e.g., tetanus toxoid-containing vaccination as part of wound management, measles or hepatitis A vaccination during an outbreak) or to avoid barriers or delays to mRNA COVID-19 vaccination (e.g., in long-term care facility residents or healthcare personnel who received influenza or other vaccinations prior to/upon admission or onboarding). If mRNA COVID-19 vaccines are administered within 14 days of another vaccine, doses do not need to be repeated for either vaccine.
Should premedication be given prior to vaccination?
Taking medications such as acetaminophen or ibuprofen before receiving the vaccine to try to prevent symptoms like fever or pain is not recommended at this time. This is because there is not enough information on how pain-relieving medications will impact immune responses. These medications may be taken after receiving the vaccine for the treatment of symptoms.