Evidence map›Paper›PMID 34153517›Full record

SynthesisThe journal of allergy and clinical immunology. In practice2021

The Risk of Allergic Reaction to SARS-CoV-2 Vaccines and Recommended Evaluation and Management: A Systematic Review, Meta-Analysis, GRADE Assessment, and International Consensus Approach.

Matthew Greenhawt, Elissa M Abrams, Marcus Shaker, Derek K Chu, David Khan, Cem Akin, Waleed Alqurashi, Peter Arkwright, James L Baldwin, Moshe Ben-Shoshan and 53 more

Open access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in The journal of allergy and clinical immunology. In practice, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 114 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
114citing papers in PubMed, 7 pooled it
12.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

114 citing papers in PubMed, 7 syntheses or guidelines pooled it, 209 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. The adverse reactions to vaccines practice parameter 10 years on-what have we learned?Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology · 2022
    Guideline
  7. Pooled it
  8. Trial
  9. Article
  10. Immunology of RNA-based vaccines: The critical interplay between inflammation and expression.Molecular therapy : the journal of the American Society of Gene Therapy · 2025
    Review
  11. Article
  12. Review
  13. Article
  14. COVID-19 Vaccine-Induced Severe Pneumonitis.Respirology case reports · 2025
    Article
  15. Article
  16. Outcomes of pediatric patients with suspected allergies to COVID-19 vaccines.The journal of allergy and clinical immunology. Global · 2025
    Article
  17. Gels (Basel, Switzerland) · 2025
    Review
  18. Article
  19. Article
  20. Article

54 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

63 authors at 20 institutions in 9 countries.

Matthew GreenhawtSection of Allergy and Clinical Immunology, Food Challenge and Research Unit, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo. Electronic address: Matthew.Greenhawt@childrenscolorado.org.
Elissa M AbramsDepartment of Pediatrics and Child Health, Section of Allergy and Immunology, The University of Manitoba, Winnipeg, Man, Canada.
Marcus ShakerDartmouth-Hitchcock Medical Center, Section of Allergy and Immunology, Lebanon; Dartmouth Geisel School of Medicine, Hanover, NH.
Derek K ChuDepartment of Medicine, McMaster University Department of Health Research Methods, Evidence and Impact, McMaster University; The Research Institute of St. Joe's Hamilton; Evidence in Allergy Group, McMaster University, Hamilton, Ont, Canada.
David KhanDivision of Allergy and Immunology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
Cem AkinDivision of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan School, Ann Arbor, Mich.
Waleed AlqurashiDepartment of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ont, Canada.
Peter ArkwrightLydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK.
James L BaldwinDivision of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan School, Ann Arbor, Mich.
Moshe Ben-ShoshanDivision of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Center-Montreal Children's Hospital, Montreal, Quebec, Canada.
Jonathan BernsteinDivision of Immunology, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio.
Theresa BingemannDivision of Allergy, Immunology, and Rheumatology, University of Rochester School of Medicine and Dentistry, Rochester, NY.
Katharina BlumchenDepartment of Paediatric and Adolescent Medicine, Paediatric Pneumology, Allergology, and Cystic Fibrosis, University Hospital Frankfurt, Frankfurt am Main, Germany.
Aideen ByrneChildren's Health Ireland at Crumlin, Crumlin, Ireland.
Antonio BognanniDepartment of Health Research Methods, Evidence and Impact, Evidence in Allergy Group, McMaster University, Hamilton, Ont, Canada.
Dianne CampbellThe Children's Hospital at Westmead, Sydney, New South Wales, Australia.
Ronna CampbellDepartment of Emergency Medicine, Mayo Clinic, Rochester, Minn.
Zain ChaglaDivision of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ont, Canada.
Edmond S ChanBC Children's Hospital, Division of Allergy and Immunology, The University of British Columbia, Vancouver, BC, Canada.
Jeffrey ChanDepartment of Emergency Medicine, Southlake Regional Medical Center, Newmarket, Ont, Canada.
Pasquale ComberiatiDepartment of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, Pisa, Italy, Department of Clinical Immunology and Allergology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
Timothy E DribinDivision of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Anne K EllisDivision of Allergy and Immunology, Department of Medicine, Queen's University, Kingston, Ont, Canada.
David M FleischerSection of Allergy and Clinical Immunology, Food Challenge and Research Unit, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo.
Adam FoxGuy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
Pamela A Frischmeyer-GuerrerioLaboratory of Allergic Diseases, Food Allergy Research Section, National Institutes of Allergy and Infectious Diseases, the National Institutes of Health, Bethesda, Md.
Remi GagnonClinique Spécialisée en Allergie de la Capitale, Quebec, Quebec, Canada.
Mitchell H GraysonDivision of Allergy and Immunology, Department of Clinical Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.
Caroline C HornerDivision of Allergy and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Mo.
Jonathan HourihaneDepartment of Paediatrics, Royal College of Surgeons, Dublin, Ireland.
Constance H KatelarisCampbelltown Hospital, Western Sydney University, New South Wales, Australia.
Harold KimWestern University, Londo, McMaster University, Hamilton, Ont, Canada.
John M KelsoDivision of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, Calif.
David LangDepartment of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
Dennis LedfordDivision of Allergy and Immunology, Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla.
Michael LevinDivision of Paediatric Allergology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Jay LiebermanDivision of Allergy and Immunology, The University of Tennessee, Memphis, Tenn.
Richard LohImmunology Department, Perth Children's Hospital, Perth, Western Australia, Australia.
Doug MackMcMaster University Hamilton, Halton Pediatric Allergy, Burlington, Ont, Canada.
Bruce MazerDivision of Allergy, Immunology, and Dermatology, Department of Pediatrics, McGill University Health Center-Montreal Children's Hospital, Montreal, Quebec, Canada.
Giselle MosnaimDivision of Pulmonary, Allergy, and Critical Care, Department of Medicine, NorthShore University Health System, Evanston, Ill.
Daniel MunblitDepartment of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia, Inflammation, Repair, Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK.
S Shahzad MustafaRochester Regional Health, University of Rochester School of Medicine and Dentistry, Rochester, NY.
Anil NandaAsthma and Allergy Center, Lewisville and Flower Mound, Texas, Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas.
John OppenheimerUMDMJ Rutgers University School of Medicine, New Brunswick, NJ.
Kirsten P PerrettMurdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Royal Children's Hospital, Parkville, Victoria, Australia.
Allison RamseyRochester Regional Health, University of Rochester School of Medicine and Dentistry, Rochester, NY.
Matthew RankDivision of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, Scottsdale, Division of Pulmonology, Phoenix Children's Hospital, Phoenix, Ariz.
Kara RobertsonDivision of Clinical Immunology and Allergy, St. Joseph's Health Care, the Schulich School of Medicine and Dentistry, Western University, London, Ont, Canada.
Javed SheikhKaiser Permanente Los Angeles Medical Center, Los Angeles, Calif.
Jonathan M SpergelDivision of Allergy and Immunology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa.
David StukusDivision of Allergy and Immunology, Department of Clinical Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio.
Mimi L K TangMurdoch Children's Research Institute, University of Melbourne, Royal Children's Hospital, Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia.
James M TracyAllergy, Asthma, and Immunology Associates, PC, Associate Professor of Pediatrics, University of Nebraska School of Medicine, Omaha, Neb.
Paul J TurnerImperial College Healthcare NHS Trust and Royal Brompton and Harefield NHS Foundation Trust, London, UK.
Anna Whalen-BrowneDivision of Clinical Immunology and Allergy, Department of Medicine, Evidence in Allergy Group, McMaster University, Hamilton, Ont, Canada.
Dana WallaceNova Southeastern University College of Allopathic Medicine, Fort Lauderdale, Fla.
Julie WangDivision of Pediatric Allergy and Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, the Jaffe Food Allergy Institute, New York, NY.
Susan WasermanDepartment of Medicine, Clinical Immunology, and Allergy, McMaster University, Hamilton, Ont, Canada.
John K WitryDivision of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Margitta WormDivision of Allergology and Immunology, Department of Dermatology, Venereology, and Allergology, Charité- Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
Timothy K Vander LeekPediatric Allergy and Asthma, Department of Pediatrics, University of Alberta, Edmonton, Alta, Canada.
David B K GoldenDivision of Allergy and Clinical Immunology, Johns Hopkins University School of Medicine, Baltimore, Md.
McMaster University · CAImpact · CAThe University of Texas Southwestern Medical Center · USUnity Health System · USUniversity of Cincinnati · USUniversity of Michigan · USCamden and Campbelltown Hospitals · AUChildren's Health Ireland at Crumlin · IEChildren's Hospital at Westmead · AUChildren's Hospital Colorado · USChildren's Hospital of Philadelphia · USCincinnati Children's Hospital Medical Center · USCleveland Clinic · USDartmouth College · USFreie Universität Berlin · DEGuy's and St Thomas' NHS Foundation Trust · GBIcahn School of Medicine at Mount Sinai · USImperial College Healthcare NHS Trust · GBJohns Hopkins Medicine · USLos Angeles Medical Center · US

Funding

COVID vaccine-associated allergic reactionsZIAAI001336 · NIAID · NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES · PI FRISCHMEYER-GUERRERIO, PAMELA · 2021 to 2025
$1.9M
6 · The paper itself

Abstract

Concerns for anaphylaxis may hamper severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunization efforts. We convened a multidisciplinary group of international experts in anaphylaxis composed of allergy, infectious disease, emergency medicine, and front-line clinicians to systematically develop recommendations regarding SARS-CoV-2 vaccine immediate allergic reactions. Medline, EMBASE, Web of Science, the World Health Organizstion (WHO) global coronavirus database, and the gray literature (inception, March 19, 2021) were systematically searched. Paired reviewers independently selected studies addressing anaphylaxis after SARS-CoV-2 vaccination, polyethylene glycol (PEG) and polysorbate allergy, and accuracy of allergy testing for SARS-CoV-2 vaccine allergy. Random effects models synthesized the data to inform recommendations based on the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach, agreed upon using a modified Delphi panel. The incidence of SARS-CoV-2 vaccine anaphylaxis is 7.91 cases per million (n = 41,000,000 vaccinations; 95% confidence interval [95% CI] 4.02-15.59; 26 studies, moderate certainty), the incidence of 0.15 cases per million patient-years (95% CI 0.11-0.2), and the sensitivity for PEG skin testing is poor, although specificity is high (15 studies, very low certainty). We recommend vaccination over either no vaccination or performing SARS-CoV-2 vaccine/excipient screening allergy testing for individuals without history of a severe allergic reaction to the SARS-CoV-2 vaccine/excipient, and a shared decision-making paradigm in consultation with an allergy specialist for individuals with a history of a severe allergic reaction to the SARS-CoV-2 vaccine/excipient. We recommend further research to clarify SARS-CoV-2 vaccine/vaccine excipient testing utility in individuals potentially allergic to SARS-CoV2 vaccines or their excipients.

Indexed as

AnaphylaxisCOVID-19ConsensusConsensus Statements as TopicCOVID-19 VaccinesGRADE ApproachHumansRNA, ViralSARS-CoV-2COVID-19 VaccinesRNA, ViralAdenovirus-vector vaccineAllergic reactionsAllergyAllergy specialistAnaphylaxisCOVID-19GRADEmRNA vaccinePolyethylene glycolPolysorbate 80SARS-CoV-2Shared decision makingSkin testingVaccination

Identifiers

PMID34153517
PMCPMC8248554
OpenAlexW3175982156

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.