Anaphylaxis and COVID-19: Summary information for health care professionals

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Anaphylaxis is a severe allergic reaction and a medical emergency. As with any medicines and vaccines, allergic reactions are very rare but can occur. The estimated historical frequency of anaphylaxis is about 1.3 episodes per million doses of vaccine administered. Anaphylaxis can be easily recognized and prompt treatment improves outcomes.

Quick recognition and management can be life saving. The progression and severity can be difficult to predict. Every vaccine provider should be familiar with the signs and symptoms of anaphylaxis and be prepared to act quickly. Anaphylaxis management kits should be readily available wherever vaccines are administered.

Advance preparation for emergency management of anaphylaxis is essential. It is recommended that vaccine providers develop, post, and regularly rehearse a written anaphylaxis emergency management protocol. Protocols should specify the necessary emergency equipment, drugs and dosages, and medical personnel necessary to safely and effectively manage anaphylaxis.

Symptoms of anaphylaxis

Symptoms of anaphylaxis can start within minutes of exposure to an allergen (such as a vaccine ingredient).

Symptoms vary from person to person. The same person can have different symptoms each time they have an allergic reaction.

Symptoms of a severe allergic reaction can include any of the following:

Anaphylaxis usually involves two or more body systems. Isolated respiratory or gastrointestinal symptoms are rare.

Symptoms of anaphylaxis in infants and young children

It may be challenging to identify anaphylaxis in infants and young children because they are unable to describe their symptoms. Behavioural changes (e.g. irritability and inconsolable crying) should be watched for. Infants may present with:

Risk factors for severe anaphylaxis

Anaphylaxis is a rare, acute and severe allergic reaction that can be triggered by allergens such as food, medications, or vaccines. Risk factors for increased severity of anaphylactic events include:

How anaphylaxis should be managed

Steps for basic management of anaphylaxis in a community setting:

Death can occur within minutes. Rapid intervention, including administration of Epinephrine, is extremely important. Steps 1 to 4 should be done immediately and simultaneously.

  1. Direct someone to call 9-1-1 (where available) or emergency medical services.
  2. Assess airway, breathing, circulation, mental status, skin, and body weight. Secure an oral airway if necessary
    • Airway: look specifically at lips, tongue and throat for swelling.
  3. Place individual on his/her back and elevate lower extremities. The client should remain in this position. Exceptions include:
    • If in respiratory distress, place in a position of comfort (elevate head and chest).
    • If vomiting or unconscious, place lying on the patient's side.
    • If pregnant, place lying down on their left side.
  4. Inject epinephrine. There are no contraindications to the use of epinephrine for anyone.
    • Dose: 0.01 mg/kg body weight of 1:1000 (1 mg/mL) solution, to a maximum total dose of 0.5 mg.
    • Route: intramuscular (IM) in mid-anterolateral thigh.
    • Repeat every 5-15 minutes if symptoms persist - most cases improve in 1-2 doses.
    • Record the time of each dose.
    • Stabilize and monitor client.

Vaccine anaphylaxis is not an indication to carry an epinephrine auto-injector (e.g. EpiPen, Allerject, Emerade) long term. However, if an epinephrine auto-injector is available, it can be used in place of a dose of injectable epinephrine.

Epinephrine is the only medication that reduces hospitalization and death, and it should be administered promptly following the onset of anaphylaxis.

What happens after a case of anaphylaxis is identified following vaccination

Anaphylaxis following vaccine administration must be reported to local public health authorities.

Provincial/territorial public health authorities will then remove all personal identifying information and forward reports to the Public Health Agency of Canada as part of the national vaccine surveillance program.

Additional resources

Anaphylaxis management

COVID-19 vaccines

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