To address incidents of severe allergic reaction to COVID vaccines, the Centers for Disease Control is recommending that all vaccine distribution centers include trained personnel qualified to recognize and treat patients who suffer from anaphylaxis.

The CDC updates do not explain why it recommends all vaccine stations have trained personnel to deal with anaphylaxis – an acute and potentially life-threatening allergic reaction – but the agency did state that anaphylaxis has been reported “rarely following COVID-19 vaccination.”

The new guidelines were issued on Feb. 10 and updated on March 3. They provide specific information on how to treat anaphylactic reactions among those who are, pregnant, have underlying health conditions or who are homebound.

The CDC’s VAERS website is used by medical providers and the general public to report adverse reactions experienced after a vaccine shot. In Alaska, there have been 79 reported instances of specific anaphylactic reaction following a COVID vaccination. Of these 43 required an emergency room or emergency department visit. There are likely many more as the VAERS website only captures a small fraction of the total instances, according to a 2012 study by Harvard.

‘Symptoms of anaphylaxis often occur within 15-30 minutes of vaccination, though it can sometimes take several hours for symptoms to appear,’ the CDC states.

Equipment and supplies which the CDC says should be “immediately available” at all vaccine centers are epinephrine pins (at least three), antihistamine, blood pressure monitors and heart rate monitors. If feasible vaccine centers should also have oxygen, IV fluids, intubation kits, CPR masks and medications that relax the muscles that tighten around airways.

The CDC notes that anaphylaxis requires “immediate treatment,” and that symptoms can include sensations of tightness and closing of the throat, difficulty breathing, coughing, sneezing, drooling, nausea, vomiting, diarrhea, abdominal pain, cramps, dizziness, fainting, abnormal heart rate, low blood pressure, weak pulse, bluish discoloration, flushing of the face, hives, redness and itching of the skin, swelling of the eyes, lips, tongue, mouth and face, sudden secretions from eyes, nose or mouth, urinary incontinence, convulsions, and a “sense of impending doom.”

“Symptoms of anaphylaxis often occur within 15-30 minutes of vaccination, though it can sometimes take several hours for symptoms to appear,” the CDC advisory states. “Early signs of anaphylaxis can resemble a mild allergic reaction, and it is often difficult to predict whether initial, mild symptoms will progress to become an anaphylactic reaction.”

The CDC guidelines include specific instruction on how to treat people who are homebound, a population which the CDC says, “might be at increased risk for anaphylaxis following vaccination.” These individuals should consider whether they “could be vaccinated in a setting where medical care is immediately available if they experience anaphylaxis.” If this is not feasible, however, the CDC recommends that they get the shot anyway because “the benefits of vaccination outweigh the potential risk for anaphylaxis.”

When homebound vaccinations take place, which are occuring in Alaska, the CDC advises that health care workers ensure that they can deal with anaphylactic reactions, and that they have the ability to call for emergency medical services.

In treating anaphylaxis with epinephrine, the CDC warns that older adults with high blood pressure or heart disease may be more susceptible to heart attacks. Nonetheless, the agency says epinephrine should still be the “first-line treatment for anaphylaxis.”

Alaska has made COVID vaccines available to older residents (55 and above) and to those who suffer from underlying medical conditions, which the CDC says might make them more susceptible to severe illness if they get COVID. The same risk factors, however, also make these individuals more susceptible to severe reactions from the vaccine or to treatment needed to address anaphylaxis.

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