Review and Feature Article
The Importance of a Timely Second Dose of the 2021 COVID-19 mRNA Vaccine Depends on the Protection Afforded by a First Dose and Subsequent Risk of Anaphylaxis

https://doi.org/10.1016/j.jaip.2021.04.015Get rights and content

Vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents our greatest hope to combat the devastating coronavirus disease 2019 (COVID-19) pandemic. Amid ongoing global vaccination efforts, rare cases of severe allergic reactions to COVID-19 mRNA vaccines have received significant attention. Although the exact nature of these reactions may be heterogeneous, various approaches exist to engage with patients, communities, public health departments, primary care providers, and other clinicians in a multidisciplinary approach to advance population health. Whereas it is optimal for patients to receive COVID-19 vaccination as outlined in emergency use authorizations, second-dose deferral of mRNA vaccines may be a consideration within a shared decision-making paradigm of care in select circumstances characterized by high durable first-vaccine–dose protection and significant elevations of vaccine anaphylaxis risk. Still, the durability of protection afforded by a single dose of a COVID-19 mRNA vaccine is uncertain, and alternative approaches to complete vaccination, including precautionary use of a COVID-19 viral vector vaccine, also remain patient-preference–sensitive options. There is an urgent need to define correlates of COVID-19 immunity and the level of longer-term protection afforded by COVID-19 vaccination.

Key words

COVID-19
Vaccine
Adverse effects
Anaphylaxis
Guideline
Shared decision making

Abbreviations used

CDC
U.S. Centers for Disease Control and Prevention
COVID-19
Coronavirus disease 2019
EUA
Emergency use authorization
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2

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No funding has been received for this study.

Conflicts of interest: M. Shaker is a member of the Joint Taskforce on Allergy Practice Parameters; has a family member who is CEO of Altrix Medical; serves on the Editorial Board of the Journal of Food Allergy and the Annals of Allergy, Asthma, and Immunology. E. Phillips reports grants from the National Institutes of Health (grant nos. P50GM115305, R01HG010863, R01AI152183, R21AI139021, and U01AI154659) and from the National Health and Medical Research Council of Australia; receives royalties from Uptodate and consulting fees from Janssen Vertex, Regeneron, and Biocryst; is codirector of IIID Pty Ltd, which holds a patent for HLA-B∗57:01 testing for abacavir hypersensitivity; and has a patent pending for Detection of Human Leukocyte Antigen-A∗32:01 in connection with Diagnosing Drug Reaction with Eosinophilia and Systemic Symptoms without any financial remuneration and not directly related to the submitted work. E. M. Abrams is on the Steering Committee of Food Allergy Canada's National Food Allergy Action Plan; is a collaborator with the Institute for Health metrics and Evaluation; and has received moderator/speaker fees from AstraZeneca, GSK, and Sanofi. J. Oppenheimer performs research/adjudication for AZ, GSK, Sanofi, Novartis; is a consultant for GSK, AZ, Sanofi; is an associate editor for Annals of Allergy Asthma Immunology and AllergyWatch; is a section editor for Current Opinion of Allergy; receives royalties from Up to Date; is a board liaison for ABIM for ABAI. T. K. V. Leek has served on advisory boards and received honoraria from Aralez, Bausch Health, and Pfizer. D. P. Mack is a member of the Board of Directors for the Canadian Society of Allergy and Clinical Immunology; serves on the Editorial Board of the Journal of Food Allergy; has provided consultation and speaker services for Pfizer, Aimmune, Merck, Covis, and Pediapharm; and has been part of an advisory board for Pfizer and Bausch Health. M. Greenhawt has served as a consultant for the Canadian Transportation Agency, Thermo Fisher, Intrommune, and Aimmune Therapeutics; is a member of physician/medical advisory boards for Aimmune Therapeutics, DBV Technologies, Sanofi/Genzyme, Genentech, Nutricia, Kaleo Pharmaceutical, Nestle, Acquestive, Allergy Therapeutics, Pfizer, US World Meds, Allergenis, Aravax, and Monsanto; is a member of the scientific advisory council for the National Peanut Board; has received honorarium for lectures from Thermo Fisher, Aimmune, DBV, Before Brands, multiple state allergy societies, the American College of Allergy Asthma and Immunology, the European Academy of Allergy and Clinical Immunology; is an associate editor for the Annals of Allergy, Asthma, and Immunology; and is a member of the Joint Task Force on Allergy Practice Parameters.

The rest of the authors declare that they have no relevant conflicts of interest.

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