Quick reference guide on use of COVID-19 vaccines for children 5 to 11 years of age: Contraindications, precautions and allergic reactions

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Table 2. Management options for contraindications and precautions
Contraindication or precaution Management options
Contraindications Management options

Severe allergic reaction (for example, anaphylaxis) after previous administration of a COVID-19 vaccine

Consultation with an allergist or other appropriate physician should be sought

  • If re-vaccinated, vaccine administration should be in a controlled setting with expertise in managing anaphylaxis. Observe the patient for at least 30 minutes after revaccination.

Severe allergy to any component of the specific COVID-19 vaccine

(Refer to Table 3 entitled “Ingredients of available COVID-19 vaccines that have been associated with allergic reactions and some other products where they may be found” for more information on allergens)

For children who are allergic to polyethylene glycol (PEG) or tromethamine (trometamol, Tris), a consultation with an allergist is recommended

People who experienced inflammation of the heart or lining of the heart (myocarditis or pericarditis) after a previous dose of mRNA vaccine

  • Should not receive the another dose at this time
  • More information will become available in this area
Precautions Management options

Mild to moderate immediate allergic reactions after a previous dose of authorized COVID-19 vaccines or any of its components

(Refer to Table 3 entitled “Ingredients of available COVID-19 vaccines that have been associated with allergic reactions and some other products where they may be found” for more information on allergens)

  • Vaccination with the same platform may be considered if:
    • benefits outweigh the potential risks
    • informed consent is provided
  • Assessment by a physician or nurse with expertise in immunization may be warranted
  • If revaccinated, observe for at least 30 minutes after vaccination

Proven severe allergic reaction (for example, anaphylaxis) to injectable therapy not related to a component of authorized COVID-19 vaccines (for example, related to other intramuscular or subcutaneous vaccines or injectable or intravenous therapies)

  • May be routinely vaccinated without the need for a specific assessment
  • Observe for at least 30 minutes after vaccination

Suspected but unproven allergy to a vaccine component
(Refer to Table 3 entitled “Ingredients of available COVID-19 vaccines that have been associated with allergic reactions and some other products where they may be found” for more information on allergens)

  • May be routinely vaccinated without the need for a specific assessment
  • Observe for at least 30 minutes after vaccination

History of allergy not related to a component of authorized COVID-19 vaccines or other injectable therapy (for example, related to foods, oral drugs, insect venom or environmental allergens)

  • Can receive COVID-19 vaccines without any special precautions
  • Observe for 15 minutes after vaccination

Previous history of myocarditis or pericarditis unrelated to mRNA vaccines

  • Consult their clinical team for individual considerations and recommendations
  • If they are no longer being followed clinically for cardiac issues, they may receive the mRNA vaccine
Table 3. Ingredients of available COVID-19 vaccines that have been associated with allergic reactions and some other products where they may be found
Vaccine product Potential allergen included in the vaccine Other products where the potential allergen may be foundFootnote 1

Pfizer-BioNTech Comirnaty COVID-19 vaccine for children 5 to 11 years of age (orange cap and label)

Polyethylene glycol (PEG)Footnote aFootnote b

Over the counter (for example, cough syrup, laxatives) and prescription medications, medical bowel preparation products for colonoscopy, skin care products, dermal fillers, cosmetics, contact lens care solutions, products such as ultrasound gelFootnote c

TromethamineFootnote d
(trometamol or Tris)

Contrast media, oral and parenteral medications

Footnotes

Footnote 1

This is not a complete list of products.

Return to footnote 1 referrer

Footnote a

Medications that contain PEG are described in Stone and others. DOI:10.1016/j.jaip.2018.12.003

Return to footnote a referrer

Footnote b

A review of immediate type hypersensitivity reactions to PEG is available in Wenande and others. DOI: 10.1111/cea.12760

Return to footnote b referrer

Footnote c

PEG is an additive in some food and drinks but allergic reactions to PEG in food or drinks have not been documented

Return to footnote c referrer

Footnote d

One case report of anaphylaxis to tromethamine has been described in Lukawska and others. DOI: 10.1016/j.jaip.2018.08.035

Return to footnote d referrer

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