What are allergists saying about the Covid-19 vaccine in children with allergies? – CVBJ


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12/14/2021 at 7.20 p.m. CET

Currently in Spain, there are around 3.3 million registered children between 5 and 11 years old who are now likely to receive the protection against COVID-19.

Additionally, we already know that at present, children under 12 are the age group with the highest cumulative incidence of COVID-19 cases.

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Is it true that nothing happens to children?

The epidemiological analysis of COVID-19 in the population aged 5 to 11 years during the fifth pandemic wave in Spain, showed that 99.7% of the cases diagnosed presented a benign condition, half of which even asymptomatic.

0.21% of cases required hospitalization and 0.016% required admission to the pediatric ICU. Very low percentages, but which, when converted into the number of children, cease to be an insignificant number, they become a worrying number.

0.21% assumes that almost 7,000 children (6,930) should be hospitalized. And the 0.016 would be 528 children who would eventually be admitted to the pediatric ICU.

And for people who think that all is well with the children, those numbers represent a very significant number of children. And better not to despise him.

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Pediatric doses are ready

With pediatric doses of the Covid-19 vaccine already prepared to begin immunizing children, many parents continue to consult with pediatricians and experts to find out if they have to immunize their children.

And to the already common doubts are added those of those who have children with a certain type of allergy.

So to clarify the doubts, the Childhood Allergy Committee of the Spanish Society of Allergology and Clinical Immunology (SEAIC has developed a series of recommendations for the vaccination of allergic children.

What is the risk of allergic reactions to the Covid-19 vaccine?

The first thing experts clarify is that in the clinical trial of the Comirnaty BNT162b2 (Pfizer / BioNTech) vaccine in the 12-15 age group, there were no reports of serious allergic reactions.

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The most commonly reported side effects after the SARS-CoV-2 vaccine are mild (about 1 in 10 people get it) and include:

Pain at the injection site (80%) Fatigue (50%) Headache (30%) Redness and swelling at the injection site (20%) Muscle pain and chills (10%).

In addition, we are not the first country to vaccinate its young. In some countries like the United States and Israel, among others, they have already started immunizing children between the ages of 5 and 11. And more specifically in the United States, more than 5 million doses have been administered so far.

And although an analysis of the safety of the vaccine after its large-scale use and its real-life relevance is not yet available, to date there have been no red flags about the vaccine. safety of vaccination in these children.

What is clear is that allergic reactions they are rare. For the Comirnaty vaccine (Pfizer / BioNTech), only 5 cases of anaphylactic reactions were recorded per 1 million doses administered.

In addition, all of these cases were treated effectively and with a full recovery.

What are the vaccine recommendations for children with allergies?

SEAIC experts stress that the vaccination of all children who have suffered severe allergic reactions with drugs and / or food cannot be avoided.

Thus, allergy experts recommend that, as has been done so far, all patients who are to be vaccinated against the coronavirus be monitored by healthcare personnel for the relevant time after administration:

It will be 15 minutes, as defined in the general public technical sheet.

In the case of patients with any allergic disease common (pollens, others like rhinoconjunctivitis, food allergy or drug allergy among others) or a family history of severe allergy (anaphylaxis), this time will increase until the 30 minutes.

In the event of a personal history of anaphylaxis, severe allergy to other vaccines, mastocytosis or other mast cell disease, the waiting time after vaccination will be 60 minutes.

Vaccine components

Allergic reactions which may appear after administration of a vaccine will depend on its composition (active ingredient and excipients).

In general, vaccines against viruses can vary in their composition, both in active principle and in their excipients:

As an active ingredient, the Pfizer vaccine contains 10 g of mRNA, which codes for a protein called S (spike) carried in lipid nanoparticles of polyethylene glycol among other components.

The vaccine licensed for children 5 to 11 years old contains one-third of the mRNA of vaccines licensed for older children and adults (30 µg).

As excipients, this vaccine contains polyethylene glycol, (a substance found in some cosmetics, bath gels and medicines) and Trometamol (it may appear as an excipient in some medicines).

And yet, it does not contain traces of egg or other drugs like antibiotics.

Thus, given its composition, the SEIAC experts conclude that the Pfizer vaccine has no more contraindications in allergic children than in any other child in the general population.

As contraindications, only subjects who have previously experienced allergic reactions to its components or those who have had a severe reaction to the first dose of the coronavirus vaccine are listed in absolute terms.

And allergists point out that allergy to these excipients is exceptional in children.

Special situations concerning vaccination against SARS-CoV-2 in allergic children

Food allergy, aeroallergens, poisons or drugs against Hymenoptera, as well as inhaled corticosteroid treatments for asthma or topical corticosteroids for atopic dermatitis, are not contraindicated with the administration of the vaccine against the SARS-CoV-2. Moderate or severe uncontrolled asthma, or an asthma attack. In these cases, there is no contraindication, except that asthma should be controlled before vaccination. Children with immunosuppression or other changes in immunity. According to FACME, the child may receive the vaccine as antibody formation may not be optimal. Hereditary angioedema and other forms of angioedema are also not a risk. The vaccine can be administered to patients with these pathologies regardless of the control treatment they receive to treat them. Children with mastocytosis. In these cases, experts recommend pretreatment with an antihistamine one hour before the vaccine is given and subsequent monitoring at the health center for 60 minutes. Co-administration with other vaccines on the children’s immunization schedule: SARS-CoV-2 mRNA vaccines for children can be given at the same time as another vaccine, yes, by clicking somewhere else . If they are not administered concomitantly, there is no need to wait an interval between the different vaccines. Optimal protection is not obtained until 7 days after administration of the second dose of the vaccine.

Allergists defend vaccination of children

Once the doubts have been raised, the CEAIC conclusion on the vaccination of children with allergies is:

In children who have experienced severe allergic reactions to foods or drugs, it is not necessary to perform a routine allergy study with the SARS-CoV-2 vaccine prior to its administration. the case where a child suffers from allergic reactions following his vaccination against Covid-19.

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