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Allergen immunotherapy and COVID-19/SARS-CoV-2 vaccination


We are a Covid-19 vaccination site for our college community. Some of our immunotherapy patients are eligible for vaccination with Pfizer Or Moderna vaccine. It is advised to separate Covid-19 vaccination by two-four weeks for other required vaccinations. Is there any protocol for immunotherapy and the Covid-19 vaccines?


The development and implementation of COVID19 vaccination has occurred at an historical pace, and the situation remains fluid as new information becomes available. The concern about other vaccinations within two to four weeks is a matter of caution to avoid attributing a side-effect to the wrong vaccine. Allergen immunotherapy, although utilizing extracts which are referred to as vaccines, are not included in the two to four week caution as the historical experience is extensive with allergen immunotherapy, allergy injection adverse events are immediate and the dose is much lower with allergy treatment than with vaccines administered to reduce infection. The CDC also recommends that COVID-19 vaccination may be administered within the two week interval if the benefits of vaccination are deemed to outweigh any risk (COVID-19 Vaccines and Allergic Reactions | CDC). Thus, there is no reason to preclude allergen immunotherapy recipients from receipt of the SARS-CoV-2 vaccines.

Atopic individuals who are receiving allergen immunotherapy may be at a theoretically increased risk of having anaphylaxis from many events, including COVID-19 vaccines. The CDC recommendations are NOT to restrict COVID-19 vaccination in subjects with food, pet, insect, venom environmental, or latex allergy or individuals with a history of allergy to oral antibiotics, non-serious allergy to prior, alternative vaccines, family history of anaphylaxis or personal history of anaphylaxis not related to vaccinations or other injectable therapy (COVID-19 Vaccines and Allergic Reactions | CDC).

The AAAAI web site, Practice Matters and The COVID-19 Task Force have a wealth of information addressing questions related to allergy/immunotherapy practice and COVID-19. The question of allergen immunotherapy is addressed there (Answers to Your Questions about Administering Immunotherapy | AAAAI Education Center):

“Question: Should a patient delay allergen immunotherapy (AIT) because they are receiving one of the mRNA COVID-19 vaccines?

Answer: The COVID-19 Task Force does not anticipate any contraindication for patients on AIT. However, it would be best to not get the two shots within 48 hours of each other to avoid confusion should a reaction occur.”

In summary, I would recommend that allergen immunotherapy be administered two days before or after the COVID-19 vaccine. This is not based upon evidence of harm with closer administration but more of added caution, since COVID-19 vaccine reactions that are likely to be confused with allergen immunotherapy will not occur later than 48 hours.

I hope this information is of help to you and your practice.

All my best.
Dennis K. Ledford, MD, FAAAAI