Booster dosing after benign delayed onset subjective symptoms associated with COVID-19 mRNA vaccination

Question:

3/21/2021
I have recently seen a 72-year-old female with no prior history of allergic reactions to vaccinations who recently received the Pfizer vaccine. She reports a history of both food and drug allergies. She reports within 30 minutes after receipt of the vaccination she felt a fullness in her throat. She attempted to swallow sips of water but had difficulty swallowing the water. She proceeded back into the center where she received the vaccination. She was treated with Benadryl and an hour and a half observation. Within an hour of receipt of the Benadryl her symptoms had significantly diminished. She did not receive epinephrine. She does not report any itching, hives, or rash.in association with her throat symptoms They are apparently were no visible symptoms of a reaction. She was discharged to home. The following day she experienced similar symptoms and again took Benadryl and after approximately half an hour to hour her symptoms resolved. On the day following the receipt of the vaccination she also did not have any visible symptoms of a reaction. There is no rash, itching, or hives.

Given her history and following the protocol recently published in JACI (In Practice) we proceeded with skin testing to COVID-19 vaccine components i.e., PEG 3350 in MiraLAX and methylprednisolone (depo -Medrol) and to Polysorbate (Refresh Optive Advanced Lubricant eye drop) using Solu- Medrol as a control. She tested negative to all components. I would appreciate your thoughts regarding her second dose of vaccination whether we should attempt a second dose of the Pfizer vaccine or instead consider administering, the Johnson & Johnson vaccine given her history.