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Frequently Asked Patient Questions About the COVID-19 Vaccine

Frequently Asked Patient Questions About the COVID-19 Vaccine

 This FAQ from the American College of Allergy, Asthma and Immunology is provided to help answer patient questions about COVID-19 vaccines. These recommendations are based on best knowledge to date, but could change at any time, pending new information and further guidance from the FDA or CDC.

Updated September 29, 2021

Vaccine Basics

A: Preventing infection is essential to ending the current pandemic. A COVID-19 vaccine helps to generate immunity to the SARS-CoV-2 virus (the virus that causes COVID-19), decreasing the risk of infection with exposure.

Currently, three COVID-19 vaccines are available in the United States.

Two of the vaccines, the Pfizer/BioNTech and the Moderna, contain messenger RNA that encodes the spike protein that the SARS-CoV-2 virus uses to attach to human cells during infection. Both vaccines require two doses three or four weeks apart to achieve an optimal immune response. When muscle cells take up the mRNA and express the spike protein, it stimulates the immune system to make antibodies against it, making recipients less susceptible to contracting the SARS-CoV-2 virus.

A third vaccine for COVID-19 is made by Johnson & Johnson (J&J) and uses an adenoviral vector that cannot replicate and contains DNA for the spike protein. Then, as with the mRNA vaccines, the muscle cells produce the spike protein which stimulates the immune system to make protective antibodies. This vaccine only requires a single dose.

A: It is not possible to get COVID-19 from any of the available vaccines. The mRNA vaccines encode only the information for the spike protein of the virus. Similarly, the J&J uses an adenovirus vector which codes for the same spike protein as the mRNA vaccines. Vaccines undergo rigorous testing through clinical trials to ensure they are safe and effective for those who receive them. The COVID-19 vaccines are being held to the same rigorous safety and effectiveness standards as all other types of vaccines in the United States. 

Most side effects, if any, are similar to other vaccines, including soreness at the injection site, muscle aches, fatigue, or mild fever.

A: The CDC reports that over 386 million doses of COVID-19 vaccines have been given in the United States from December 14, 2020, through September 22, 2021.The vaccines have undergone and will continue to undergo the most intensive safety monitoring in U.S. history.  The FDA has granted full approval to the Pfizer/BioNTech COVID-19 vaccine for people ages 16 and older. To receive full approval, the vaccine had to meet FDA standards for safety, effectiveness, and manufacturing quality. Moderna completed submission for FDA full approval in August of 2021 and is awaiting FDA approval.

The safety monitoring has identified several, yet very rare, types of health problems after vaccination including: 

1. Anaphylaxis (after mRNA vaccines)

Anaphylaxis to the mRNA COVID-19 vaccines is currently estimated to occur in approximately 5 cases per 1 million doses, compared to 1.3 per 1 million doses, which is the incidence of anaphylaxis associated with other vaccines.

The anaphylaxis rate for the Johnson & Johnson COVID-19 vaccine has not been reported, but is likely to be closer to the general incidence seen with other vaccines.

The CDC has provided recommendations for COVID 19 vaccine providers about how to prepare for the possibility of a severe allergic reaction. All people who get a COVID 19 vaccine are required to be monitored on site.  People who have a history of severe allergic reactions to vaccines or other injectable therapy are monitored for at least 30 minutes after getting the vaccine.  All other people are monitored for at least 15 minutes after getting the vaccine. 

2. Thrombosis with Thrombocytopenia Syndrome (TTS) – a syndrome of blood clots occurring with low platelets (after J&J)

TTS has occurred after receiving the J& J/Janssen COVID 19 vaccine and not after the mRNA vaccines at a rate of about 7 per 1 million vaccinated women between 18 and 49 years old.  For women 50 years or older and men of all ages, this adverse event is even more rare.  

3. Myocarditis and Pericarditis (mRNA vaccines)

The FDA issued a warning in June about heart inflammation. Since April 2021, there have been more than one thousand reports to the Vaccine Adverse Reporting System (VAERS) of myocarditis and pericarditis occurring in adolescents and young adults more often after getting the second dose than after the first dose of one of the two mRNA vaccines.  Symptoms typically occur within several days after vaccination and patients have been able to return to their normal daily activities after their symptoms improve. Because the known and potential benefits of COVID 19 vaccination outweigh the known and potential risk, including the possible risk for myocarditis or pericarditis, the CDC continues to recommend COVID-19 vaccination for everyone 12 years of age and older. 

4. Guillain-Barre Syndrome

There’s a possible, but rare risk in developing Guillain-Barre syndrome after the Johnson and Johnson vaccine .To date, no cases of GBS have been seen in people vaccinated for COVID-19 with the mRNA vaccines.

Although these are the first mRNA vaccines licensed for use, researchers have been studying and working with mRNA vaccines for decades. mRNA vaccines have been studied for flu, Zika, rabies, and cytomegalovirus and no safety concerns were identified.

The following chart may prove helpful:

 

VACCINE DEVELOPER: PFIZER MODERNA JOHNSON & JOHNSON/JANSEN
Mechanism Messenger RNA Messenger RNA Inactivated adenovirus
Approval date December 11, 2020 December 18, 2020 February 27, 2021
% of people protected from getting infected in clinical studies 95% 94.1% 66.1% globally; 72% in the U.S.; 86% effective against severe disease
Who is it approved for? 12 years and older 18 years and older 18 years and older
How many doses are needed? 2 doses, 3 weeks apart 2 doses, 4 weeks apart One dose
When is full vaccination status achieved? 2 weeks after the 2nd dose 2 weeks after the 2nd dose 2 weeks after the dose
Boosters for Immunocompromised 3rd dose, at least 28 days after second dose 3rd dose, at least 28 days after second dose Not approved
Boosters for Others See CDC Statement on ACIP Booster Recommendations Not approved Not approved
Are there any warnings? The FDA issued a warning in June, 2021 about heart inflammation.  Since April, 2021, there have been more than a thousand reports of myocarditis and pericarditis. The FDA issued a warning in June, 2021 about heart inflammation.  Since April, 2021, there have been more than a thousand reports of myocarditis and pericarditis. In July, 2021, the FDA issued a warning about an increased risk for developing Guillain-Barre syndrome.
Contraindications to getting a COVID 19 vaccination People with a history of serious allergic reactions, anyone with a history of reactions to vaccine ingredients, including polyethylene glycol, and anyone with a history of allergic reactions to polysorbate People with a history of serious allergic reactions, anyone with a history of reactions to vaccine ingredients, including polyethylene glycol, and anyone with a history of allergic reactions to polysorbate Anyone who has had an allergic reaction to an ingredient in the vaccine, like polysorbate
Vaccine performance against emerging variants – alpha, beta, gamma, and delta Highly effective against hospitalization and death for a variety to strains.  Data suggest lower effectiveness against confirmed infection and symptomatic disease caused by the Beta, Gamma, and Delta strains compared with the Alpha variant. Highly effective against hospitalization and death for a variety to strains.  Data suggest lower effectiveness against confirmed infection and symptomatic disease caused by the Beta, Gamma, and Delta strains compared with the Alpha variant. Effectiveness against variants currently being studied. An August 2021 study of South African health care workers showed 71% efficacy against hospitalization and 96% efficacy in preventing death from COVID-19. 
Acquisition and transmission data for fully vaccinated people Current evidence indicates that fully vaccinated people are less likely than unvaccinated people to acquire SARS-CoV-2 or transmit it to others. Current evidence indicates that fully vaccinated people are less likely than unvaccinated people to acquire SARS-CoV-2 or transmit it to others. Currently being studied. 

 

All three COVID-19 vaccines have been shown to be highly effective in phase 3 clinical trials of diverse populations of adults. 

Shared decision making is the best option to use when guiding patients regarding which vaccine to receive if a choice is available.

  1.  In general, a patient is considered fully vaccinated ≥2 weeks after a 2-dose mRNA COVID-19 vaccine series or ≥2 weeks after a single dose of Janssen COVID-19 Vaccine. 

Immunocompromised Individuals

The CDC recommends a third mRNA COVID-19 vaccine dose for people whose immune systems are moderately to severely compromised. This recommendation applies to immunocompromised people who originally received two mRNA COVID-19 vaccines, but not to those who received the Johnson & Johnson COVID-19 vaccine. CDC recommends the third dose be administered at least four weeks after a second dose of Pfizer-BioNTech COVID-19 vaccine or Moderna COVID-19 vaccine.

CDC recommendations apply to people who have:

  • Been receiving active cancer treatment for tumors or cancers of the blood.
  • Received an organ transplant and are taking medicine to suppress the immune system.
  • Received a stem cell transplant within the last two years or are taking medicine to suppress the immune system.
  • Moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome).
  • Advanced or untreated HIV infection.
  • Active treatment with high-dose corticosteroids (i.e., ≥20mg prednisone or equivalent per day), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, tumor-necrosis (TNF) blockers, and other biologic agents that are immunosuppressive or immunomodulatory.

The CDC recommends people talk to their health care provider about their medical condition, and whether getting an additional dose is appropriate for them. 

Non-immunocompromised individuals
The CDC recommends a booster shot of the Pfizer-BioNTech COVID-19 vaccine in certain populations and also recommends a booster dose for those in high risk occupational and institutional settings. These recommendations only apply to individuals who completed the two-dose Pfizer-BioNTech COVID-19 vaccine series. Recommendations for individuals who received the Moderna or J&J vaccines will be forthcoming once additional data is available.

The CDC recommends:

  • People 65 years and older and residents in long-term care settings should receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series.
  • People aged 50–64 years with underlying medical conditions should receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series.
  • People aged 18–49 years with underlying medical conditions may receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risks.
  • People aged 18-64 years who are at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting may receive a booster shot of Pfizer-BioNTech’s COVID-19 vaccine at least 6 months after their Pfizer-BioNTech primary series, based on their individual benefits and risks.

According to the CDC, occupations at increased risk for COVID-19 exposure and transmission include front line essential workers and health care workers. The CDC previously identified the following groups in this category*:

  • First responders (healthcare workers, firefighters, police, congregate care staff)
  • Education staff (teachers, support staff, daycare workers)
  • Food and agriculture workers
  • Manufacturing workers
  • Corrections workers
  • U.S. Postal Service workers
  • Public transit workers
  • Grocery store workers

*List could be updated in the future

A: The CDC doesn’t consider asthma or inhaled corticosteroids for asthma as leading to an immunocompromised state. There’s no data to suggest that biologics and/or inhaled corticosteroids have any effect (good or bad) on response to a COVID vaccine including a booster injection.  Only patients on daily oral corticosteroids of 20mg or more are considered immunocompromised by the CDC.

A: Herd immunity is a term used to describe when enough people have protection – either from previous infection or vaccination – that it is unlikely a virus or bacteria can spread and cause disease. As a result, everyone within the community is protected even if some people don’t have any immunity themselves. The percentage of people who need to have protection to achieve herd immunity varies by disease. Experts estimate that at least 70% of the population would need to have immunity, either through infection or vaccination, to achieve herd immunity to COVID-19.  The emergence of variants with a higher transmission rate will cause the percentage of the population who need to have immunity to increase.

A:  ACAAI strongly recommends everyone age 12 or older get a COVID 19 vaccination as soon as possible.

The College recognizes that COVID 19 vaccines are safe and effective at preventing COVID 19 disease, especially severe illness, hospitalizations, and death.  And that COVID 19 vaccines reduce the risk of people spreading the SARS CoV 2 virus. The efficacy of the vaccines clearly outweighs any risk associated with receiving the vaccines.

Getting Vaccinated and Contraindications

AAccording to the CDC, people who have had an immediate allergic reaction, even if it was not severe, to a vaccine or injectable therapy (i.e., intramuscular, intravenous, or subcutaneous vaccines or therapies [excluding subcutaneous immunotherapy for allergies , i.e. “allergy shots”] not related to a component of mRNA COVID-19 vaccines or polysorbate), should consult their physicians to determine if they should get a COVID-19 vaccine. The CDC states this is a precaution and not a contraindication.

According to the CDC, COVID-19 vaccines and other vaccines may now be administered without regard to timing. This includes simultaneous administration of COVID-19 vaccines and other vaccines on the same day, as well as coadministration within 14 days. Following reports of a small number of patients experiencing anaphylaxis after getting an mRNA COVID-19 vaccine, the CDC issued guidance related to the mRNA COVID-19 vaccines and severe allergic reactions. ACAAI also published guidance on the risk of allergic reactions to mRNA COVID-19 vaccines.

Patients who have an immediate (<4 hours) or severe allergic reaction to the first dose of the mRNA COVID-19 vaccine should not receive the second dose.

The mRNA COVID-19 vaccines should not be administered to individuals with a known history of a severe allergic reaction to any component of the vaccine. Although the specific vaccine component causing anaphylaxis has not been identified, polyethylene glycol (PEG) is one of the ingredients in these vaccine products and has been known to cause anaphylaxis. The J&J vaccine should not be administered to individuals with an immediate allergic reaction to any ingredient in the vaccine (such as polysorbate).

Patients who have had COVID-19 and received monoclonal antibodies or convalescent serum to treat COVID-19 should wait 90 days before getting the vaccine.

A: The CDC recommends individuals discuss this with their doctor. After taking a detailed history, allergists will have a risk/benefit discussion with their patient and if the patient has no contraindications to the J&J vaccine, may recommend their patient use J&J as a booster vaccination; however, there is no current data on the efficacy or safety of using the J&J vaccine this way.

A: The Pfizer and Moderna COVID-19 vaccines require two doses. The J&J vaccine requires one dose.

A: The Pfizer COVID-19 vaccine dosing schedule recommends the second dose be given 21 days after the first dose (with a 4-day grace period). The Moderna vaccine schedule recommends the second dose be given 28 days after the first shot. If it is not feasible to adhere to the recommended interval, the second dose of Pfizer-BioNTech and Moderna COVID-19 vaccines may be scheduled for administration up to 6 weeks (42 days) after the first dose.

A: The efficacy of a single dose of the approved vaccines is much lower than if a patient receives the recommended 2 injections. Protection offered by a single dose of vaccine has been estimated to be at 50%, and the second dose increases this to more than 90%.

A: Yes, if possible. According to the CDC, every effort should be made to determine which vaccine product was received as the first dose, to ensure completion of the vaccine series with the same product. In exceptional situations in which the first-dose vaccine product cannot be determined or is no longer available, any available mRNA COVID-19 vaccine may be administered at a minimum interval of 28 days between doses to complete the mRNA COVID-19 vaccination series. If two doses of different mRNA COVID-19 vaccine products are administered, no additional doses of either product are recommended.

A: Yes, according to the CDC, COVID-19 vaccination should be offered regardless of whether an individual has already had COVID-19 infection. An antibody test is not required prior to vaccination. Current evidence suggests that reinfection with the virus that causes COVID-19 is uncommon in the 90 days after the initial infection. However, experts don’t know how long this protection lasts, and the risk of illness and death from COVID-19 far outweighs any benefits of natural immunity. It also appears that vaccination offers better protection and reduced transmission of the COVID-19 than the immunity that comes from having COVID-19 (natural immunity). However, anyone currently infected with COVID-19 should wait to get vaccinated until after their illness has resolved and after they have met the criteria to discontinue isolation.

If you were treated for COVID-19 with monoclonal antibodies or convalescent plasma, you should wait 90 days before getting a COVID-19 vaccine.

A: The COVID-19 vaccines will not influence the results of PCR or antigen testing for the disease. The vaccines generate antibodies to SARS-CoV-2, which are directed at the spike protein. Some available serologic assays test for this antibody; others do not. The manufacturers of the individual antibody tests should be able to provide this information, and it is often listed in the package insert.

A: When to get the second dose of COVID-19 vaccine is multifactorial and depends upon the medications used to treat the COVID-19 infection. This decision should be made using a shared decision-making model with a provider.

According to the CDC, prior receipt of an mRNA COVID vaccine should not affect treatment decisions including the use of monoclonal antibody therapy, convalescent plasma, antiviral treatment, or corticosteroid administration.

Currently, there are no data on the safety and efficacy of mRNA COVID-19 vaccines in people who received monoclonal antibodies or convalescent plasma as part of COVID-19 treatment. Based on the estimated half-life of such therapies as well as evidence suggesting that reinfection is uncommon in the 90 days after initial infection, vaccination should be deferred for at least 90 days, as a precautionary measure until additional information becomes available, to avoid potential interference of the antibody therapy with vaccine-induced immune responses. This recommendation applies to those who receive passive antibody therapy before receiving any vaccine doses. It also applies to those who receive passive antibody therapy after the first dose but before the second dose, in which case the second dose should be deferred for at least 90 days following receipt of the antibody therapy.

If no monoclonal antibody therapy is administered, then a booster dose can be administered after recovery from COVID-19 and the isolation period has ended.

A: Having had dermal filler injections is not a contraindication for mRNA vaccine administration. People who have received dermal fillers may develop swelling at or near the site of the filler injection following administration of an mRNA COVID-19 vaccine. The symptom is temporary and treatable and has been seen with other vaccines.

A: COVID-19 vaccine may be administered to people with underlying medical conditions who have no contraindications to vaccination. In fact, clinical trials demonstrated similar safety and efficacy profiles in people with some underlying medical conditions, including those that place them at increased risk for severe COVID-19. The risks and benefits should be discussed with the individual patient depending on their underlying medical condition.

Patients with a history of Guillain-Barre syndrome within six weeks of vaccine should avoid the same vaccine. GBS not associated with a vaccine is not a contraindication nor precaution for receiving the COVID-19 vaccine. Bell’s palsy is not a contraindication to receiving the vaccine.

A: Revaccination is not currently recommended after immune competence is regained in people who received COVID-19 vaccines during chemotherapy or treatment with other immunosuppressive drugs.

A: The protection someone gains from having an infection (called natural immunity) varies depending on the disease, and it varies from person to person. Since this virus is new, we don’t know how long natural immunity might last but is variable among individuals. Some evidence suggests natural immunity can last at least 6 to 8 months and, perhaps, up to a year. There have been cases where individuals have been shown to be infected twice, but most often the second illness was mild or without any symptoms. This is what we would expect with an immune response that protects against disease but not infection. 

Vaccination after recovery from a COVID infection provides up to 50 times more immunity than natural infection, so getting the vaccine is important, even if you have had the infection. 

We do not know how long protection will last following vaccination in uninfected people, but early evidence suggests it lasts at least six months in most people. It may not have the same duration of benefit in certain population, such as the elderly or others with impaired immunity.

Booster shots are recommended for the immunocompromised at this time, along with certain other populations who received the Pfizer vaccines. Approval for booster shots for Moderna and Johnson & Johnson vaccines is expected in the future once additional data is available. It continues to be critically important to monitor long-term protection in various groups of people.

A: Everyone should cover their mouth and nose with a mask when around others (except those under 2 years of age or with medical conditions that prevent wearing a mask); avoid close contact with people who are sick; stay six feet away from others; avoid crowds; and wash their hands often. Get more information about these and other steps you can take to protect yourself and others from COVID-19.

A: There is no cost. The shots are free to everyone, even if you don’t have health insurance. The federal government is covering the cost.

After Vaccination

A: According to the CDC, to maximize protection from the Delta variant and prevent possibly spreading it to others, wear a mask indoors in public if you are in an area of substantial or high transmission regardless of vaccination status.  Please note that these recommendations from the CDC don’t apply to healthcare settings including doctor’s offices and hospitals; transportation hubs like airports and train stations; correctional facilities and homeless shelters. In those settings, masks should always be worn.

More information can be found at CDC: When you’ve been fully vaccinated and CDC: Interim Public Health Recommendations for Fully Vaccinated People.

Safety

A: The side effects have been similar to other routine vaccines – sore arm, redness at the site of the vaccine, fatigue, fever, chills, headache, muscle pain and joint pain. The side effects are temporary and mostly mild or moderate. Side effects may be worse after the second dose in some.

Among the 22,000 patients who received the Pfizer-BioNTech COVID-19 vaccine as part of the phase 3 clinical trial, no serious allergic reactions to the vaccine were reported and there was no evidence of increased risk of allergic reactions to the vaccine. Similarly, in the 15,000 patients in the phase 3 Moderna COVID-19 vaccine trial, no serious allergic reactions to the vaccine were reported. After use of the vaccine began in the general population, severe allergic reactions were observed. All reactions are closely monitored, and the CDC now estimates that the rate of anaphylaxis is approximately 2 to 5 per 1,000,000 doses of COVID-19 vaccine in the U.S., compared to 1 in 1,000,000, which is the incidence of anaphylaxis associated with other vaccines. Currently, none of the available vaccines are the preferred choice in a patient with a history of severe allergic reactions. The National Institutes of Health is launching a study to understand these allergic reactions better, and the FDA and CDC are also closely monitoring.

Because of reports of anaphylactic reactions in people vaccinated outside of clinical trials, the additional following guidance has been suggested by the CDC:

  • A severe allergic reaction to any vaccine or injectable therapy (intramuscular, intravenous or subcutaneous) is a precaution to vaccination at this time and patients should discuss the risks and benefits with an allergist/immunologist.
  • Vaccine providers should observe patients after vaccination to monitor for the occurrence of immediate adverse reactions. Anyone with a history of anaphylaxis is advised to wait 30 minutes and all others should wait at least 15 minutes.

A recent study showed that of 189 patients who had an allergic reaction to mRNA vaccine (32 or 17% with anaphylaxis), all 159 patient who received a second dose tolerated the vaccine.  Sites administering the vaccine should have healthcare personnel who are trained and qualified to recognize anaphylaxis and the medications and supplies necessary to assess and manage an allergic reaction.

A: The CDC and FDA encourage the public to report possible side effects (called adverse events) to the Vaccine Adverse Event Reporting System (VAERS). This national system collects data to look for adverse events that are unexpected, appear to happen more often than expected, or have unusual patterns of occurrence. Health care providers are required to report certain adverse events following vaccination to VAERS. Health care providers also have to adhere to any revised safety reporting requirements according to the FDA’s conditions of authorized use throughout the duration of any Emergency Use Authorization; these requirements are posted on the FDA’s website.

The CDC is also implementing a new smartphone-based tool called v-safe to check in on people’s health after they receive a COVID-19 vaccine. When you receive your vaccine, you should also receive a v-safe information sheet telling you how to enroll in v-safe. If you enroll, you will receive regular text messages directing you to surveys where you can report any problems or adverse reactions you have after receiving a COVID-19 vaccine. ACAAI recommends that patients opt into the v-safe program to help all of us understand any possible side effects from the vaccines.

A: The FDA granted full approval to the Pfizer/BioNTech COVID-19 vaccine for people ages 16 and older. To receive full approval, the vaccine had to meet FDA standards for safety, effectiveness, and manufacturing quality. Moderna completed submission for FDA full approval in August of 2021 and is waiting for FDA approval.

The safety follow-up for COVID-19 vaccines is essentially the same as for all vaccine trials: two years of follow-up in phase 3 clinical trials. Given the importance of the vaccine in ending the current pandemic, both mRNA COVID-19 vaccines were authorized under Emergency Use Authorization by the FDA, and follow-up in the trials is ongoing.

We do not yet know the long-term safety profile of these vaccines. It is reassuring that long-term side effects with vaccines are quite rare and severe reactions typically occur within days to weeks after administration. Although this is the first time an mRNA vaccine has been used in the general population, they have been used in trials for rabies, influenza, cytomegalovirus, and Zika and no significant safety concerns were seen.

A: The CDC recommends COVID-19 vaccination for all people aged 12 years and older, including women who are pregnant, breastfeeding, trying to get pregnant now, or might become pregnant in the future. Pregnant and recently pregnant women are more likely to get severely ill with COVID-19 compared with non-pregnant women.

A: One of the reasons to perform vaccine trials in children is to make sure that they do not have any side effects that are pediatric-specific. There are also cases of multisystem inflammatory syndrome (MIS) in young adults, so ongoing vaccination in young adults may allow us to know whether this complication occurs in vaccinated individuals. Unfortunately, there is no known biomarker to predict an immune response that leads to MIS-C. It is also possible that protection from COVID-19 by vaccination will protect against its long-term effects. including MIS-C.

A: There are no data to suggest any major degree of weakening of the immune system due to inhaled corticosteroids used for asthma. It is important that your asthma is under control. There is no contraindication to receiving the COVID-19 vaccine while on inhaled corticosteroids.

A: There are no data to suggest any major degree of weakening of the immune system due to intranasal corticosteroids in use for allergic rhinitis and therefore there is no contraindication to receiving the COVID-19 vaccine while on inhaled corticosteroids.

A: There is no contraindication to receiving the COVID-19 vaccine while on oral corticosteroids. Presently we don’t know if regular oral corticosteroid use will limit the effectiveness of the COVID-19 vaccine as there is a potential for reduced immune responses to the vaccine. Much depends on the daily dose and for how long the patient has been on regular corticosteroids. Low-dose alternate day with short acting preparations such as prednisone probably have minimal if any depression of the immune system. Also, there is limited safety data with the COVID-19 vaccine with patients on regular oral corticosteroids at this time.

A: There are no data on effects of systemic corticosteroids and on immune response to COVID-19 vaccines. The optimal timing for COVID-19 vaccine following corticosteroids is unknown. mRNA vaccines such as COVID-19 vaccines do not represent a danger to immunocompromised persons and generally should be administered as recommended for healthy persons.

A: The ACAAI recommends that the COVID-19 vaccine and a biologic not be given the same day since, if there is a reaction after the second injection (vaccine or biologic) is given, it may be difficult to decide which one was the inciting agent. We suggest separating these injections by a minimum of 24 hours. There is no reason to stop a biologic until the patient completes the course of the COVID-19 vaccinations.

A: The ACAAI recommends that the COVID-19 vaccine and allergen immunotherapy (AIT) not be given the same day since, if there is a reaction after the second injection (vaccine or AIT), it may be difficult to decide which one it was the inciting agent. We suggest separating these injections by a minimum of 24 hours. There is no reason to stop AIT until the patient completes the course of the COVID-19 vaccinations.

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