DISCUSSION
Only 6 of 387 (1.6%), reacted moderately to severely to a COVID-19
vaccine after a previous reaction. 4 of these 6 persons have reacted
severely on the previous dose. A severe immediate reaction, consisting
of anaphylaxis or objectived angioedema on a Covid-19 vaccine therefore
seems the only risk factor for a moderate to severe reaction on a
following dose. All other patients reacted mildly or not at all and
never needed epinephrine.
Most persons that had a reaction on a Covid-19 vaccine, treated with
epinephrine, did not need treatment on a second dose. Some of these
non-life threatening symptoms may be perceived as severe and treated by
health care workers with epinephrine. As long as the person is not
wheezing, you can converse normally with a person pulse and blood
pressure are within normal limits it is often better to reassure the
patient and do not give any treatment. Therefore we advise only
referring persons to an allergist in case of objectived angioedema or
anaphylaxis after a previous Covid-19 vaccine. Although In daily
practice, it will be hard to implement this advice because most
healthcare workers that administer the vaccines, have no experience in
distinguishing between reactions that are truly life-threatening and
those that appear life-threatening.