Experience of the first 1127 COVID-19 Vaccine Allergy Safety patients in Hong Kong-Clinical outcomes, barriers to vaccination, and urgency for reform

被引:16
作者
Chiang, Valerie [1 ]
Mok, Sabrina Wing Shan [2 ]
Chan, June King Chi [2 ]
Leung, Wai Yan [3 ]
Ho, Carmen Tze Kwan [3 ]
Au, Elaine Y. L. [1 ]
Lee, Chak Sing [3 ]
Lee, Tak Hong [2 ]
Li, Philip Hei [3 ,4 ]
机构
[1] Queen Mary Hosp, Dept ofPathol, Div Clin Immunol, Hong Kong, Peoples R China
[2] Hong Kong Sanat & Hosp, Allergy Ctr, Hong Kong, Peoples R China
[3] Univ Hong Kong, Queen Mary Hosp, Dept Med, Div Rheumatol & Clin Immunol, Hong Kong, Peoples R China
[4] Queen Mary Hosp, Dept Med, TheUnivers Hong Kong, 102 Pokfulam Rd, Hong Kong, Peoples R China
关键词
COVID-19; Vaccine; Allergy; Hypersensitivity; Safety; Hong Kong; Anaphylaxis;
D O I
10.1016/j.waojou.2021.100622
中图分类号
R392 [医学免疫学];
学科分类号
100102 ;
摘要
Introduction: Hong Kong has had a low incidence of COVID-19 vaccine related anaphylaxis, partly due to its Vaccine Allergy Safety (VAS) guidelines for screening those at higher risk of COVID-19 vaccine-associated allergic reactions. We characterize the initial experience of the VAS clinics, as well as the impact of unnecessary referrals to the vaccination program. Methods: All patients attending the VAS Clinics of the public and private health services between February and June 2021 were reviewed. Results: Out of 1127 patients assessed at VAS clinics, 1102 (97.8%) patients were recommended for vaccination. Out of those contacted, more than 80% (450/558) received vaccination successfully; the remaining had not yet booked their vaccinations. The majority (87.5%) of patients not recommended was due to potential excipient allergies. Males were significantly more likely to be recommended (OR = 5.822, 95% CI = 1.361-24.903, p = 0.007), but no other features were associated with recommendation for vaccination. Almost half (45.1%) of public service referrals were rejected due to insufficient information or incorrect indications for referral. The majority of cases (56.2%) of patients referred for suspected "anaphylaxis " did not fulfil diagnostic criteria. Discussion: COVID-19 vaccination is very safe and 98% of high-risk patients were recommended for vaccination. Barriers to VAS include a high proportion of inappropriate referrals, inaccurate diagnoses of anaphylaxis and inability to diagnose excipient allergies. Our data validates that a prior history of COVID-vaccine unrelated anaphylaxis should be removed as a precaution for vaccination. Closer collaborations between primary care and allergy specialists and changes in pharmaceutical legislation should be made a priority to promote vaccination uptake.
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