ACAAI Guidelines on Risk of Allergy Reactions to Pfizer-BioNTech COVID 19 Vaccine (Dec 14, 2020)


  1. Patients with history of allergic reactions to medications, food, outdoor allergens, insects, and latex do not have an increased risk compared to the general population.
  2. Observation in a health care setting for 20 – 30 minutes after injection is ideal to monitor for any adverse effects. (IM Epinephrine is the first line of treatment).
  3. Pfizer-BioNTech COVID 19 Vaccine is NOT a live vaccine. It can be administered to immunocompromised patients.
  4. These recommendations are based on best knowledge to date but can change at any time, pending new information and further guidance from the FDA or CDC.
  5. Arizona Asthma and Allergy Institute does not have the vaccine and is not planning to administer the vaccine.

CAUTIONARY CONCERNS: Please discuss risks vs. benefits with your provider.

  1. Patients with history of allergy to L-Polyethelene Glycol (component of the vaccine)
  2. Patients with history of allergic reactions to previous vaccinations/ mast cell activation syndrome/idiopathic anaphylaxis. (Limited data)
  3. Immunocompromised patients may have a diminished immune response.


  1. McNeil MM, Weintraub ES, Duffy J, et al. Risk of anaphylaxis after vaccination in children and adults. J Allergy Clin Immunol. 2016;137(3):868-878.
  2. Dreskin et al. International Consensus (ICON): allergic reactions to vaccines World Allergy Organization Journal (2016) 9:32.
  3. Wylon, K., Dölle, S. & Worm, M. Polyethylene glycol as a cause of anaphylaxis. Allergy Asthma Clin Immunol 12,67 (2016).
  4. Stone CA, Liu Y, et al. Immediate Hypersensitivity to Polyethylene Glycols and Polysorbates: More Common Than We Have Recognized.  J Allergy Clin Immunol Pract. 2019; 7(5): 1533–1540