학술논문
Experience of the first 1127 COVID-19 Vaccine Allergy Safety patients in Hong Kong – Clinical outcomes, barriers to vaccination, and urgency for reform
Document Type
article
Author
Valerie Chiang; Sabrina Wing Shan Mok, MA, RD; June King Chi Chan, MSc, RD; Wai Yan Leung; Carmen Tze Kwan Ho, MBBS (HK), FRCP (Edin, London), FHKCP, FHKAM (Medicine); Elaine Y.L. Au, MBBS, FHKAM (Medicine), FRCPA, FHKAM (Pathology), D (ABMLI); Chak Sing Lau, MBChB, MD (Hons), FRCP (Edin, Glasg, Lond), FHKCP, FHKAM (Medicine); Tak Hong Lee, MBBChir (Cantab), MD (Cantab), ScD (Cantab), MRCP (UK), MRCPath, FRCP (Lond), FRCPath, FHKCP; Philip Hei Li, MB BS (HK), M Res (Med) (HK), PDipID (HK), MRCP (UK), FHKCP, FHKAM (Medicine)
Source
World Allergy Organization Journal, Vol 15, Iss 1, Pp 100622- (2022)
Subject
Language
English
ISSN
1939-4551
Abstract
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.