Skip to Content

Antibody Response to COVID-19 mRNA Vaccine After Allergic Reaction

July 6, 2022

Members from the UPMC Division of Pulmonary, Allergy and Critical Care Medicine, Division of Rheumatology and Clinical Immunology, and Department of Pharmacy recently published an article in the journal Annals of Allergy, Asthma and Immunology on the antibody response to graded dosing of COVID-19 mRNA vaccines after allergic reaction to the first dose.

After Emergency Use Authorization was issued for COVID-19 vaccines in December 2020, allergic reactions — including anaphylaxis — to the vaccine were identified. While initial rates of anaphylaxis were reported at 11.1 cases per million doses administered, continued safety monitoring has shown lower rates of anaphylaxis. Systemic reactions have occurred, though rare, making second doses problematic in some patients. This issue has led to vaccine hesitancy resulting in patients declining a second dose though it was reported to be safe in patients that had a reaction to the first dose.

Authors present a pilot study showing that graded COVID-19 mRNA vaccination is safe and effective in patients with prior allergic reactions compared to healthy controls who received full dose vaccination.

The data set includes eight patients who had an immediate reaction to the first dose who underwent a second graded dose vaccination — making up approximately 15% of patients evaluated for COVID vaccine reaction at the clinic from December 2020 to February 2021.

Symptom onset occurred with 5-60 minutes of receiving vaccination and reported symptoms included cutaneous, oropharyngeal, respiratory, gastrointestinal, and hemodynamic changes. Four patients met diagnostic criteria for anaphylaxis based on the Brighton Collaboration case definition and three met the criteria based on National Institute for Allergy and Infectious Disease definition.

All patients were counseled on the low risk of a second dose, but all patients declined to receive one. Patients were then offered a graded and monitored vaccine dosing administration, which all patients consented to.

Approximately six months after graded dosing, antibody levels were compared to a healthy control group for six of the eight patients. The graded dosing group had no difference in qualitative assessment of response, higher level of antibodies, and a longer time between doses than the control group.

While vaccine hesitancy may be due to prior reactions during the first dose, authors showed in this small pilot study that graded dosing administration with COVID-19 mRNA vaccines is safe and effective.


Van Meerbeke S, Fajt M, Marini R, Domsic R, Petrov A. Antibody Response to Graded Dosing of COVID-19 mRNA Vaccines After Allergic Reaction to First Dose. Ann. Allergy Asthma Immunol. 2022 May 17. 


Sara Van Meerbeke, MD
Fellow, Department of Internal Medicine

Merritt Fajt, MD 
Assistant Professor, Division of Pulmonary, Allergy and Critical Care Medicine

Rachel V. Marini, PharmD
Department of Pharmacy

Robyn Domsic, MD
Associate Professor, Division of Rheumatology and Clinical Immunology

Andrej A. Petrov, MD
Associate Professor, Pulmonary, Allergy, and Critical Care Medicine
Section Chief of Allergy