🧵1/ prospective cohort @JAMANetwork >64K employees receiving @pfizer @moderna_tx #CovidVaccine dose 1, 98% had no allergy symptoms, 2% had some allergy symptoms (itching/rash/hives/swelling) & #anaphylaxis occurred 2.47/10K vaccinations. jamanetwork.com/journals/jama/…
2/Allergy symptoms were slightly more with @moderna_tx (2.20% vs 1.95%; p=0.03). Although no difference in #anaphylaxis incidence by vaccine manufacturer, but different #anaphylaxis criteria led to different estimates (Brighton/NIAID/FAAN: from 1.1-2.5/10K administrations). 
3/Similar to @CDCgov reports, the 16 #anaphylaxis patients were largely female (94%); 10 (63%) had prior allergy history and 5 (31%) had prior anaphylaxis history. BUT, we estimate that ~4K @MassGenBrigham employees with severe allergy histories were safely vaccinated.
4/#anaphylaxis onset was mean 17min although wide range (1-120 min). 14 (88%) were within 15min & 15 (94%) were within 30min. 9 (56%) received epinephrine. While we don't know mechanism (YET!), 1 @moderna_tx anaphylaxis patient bumped tryptase (4.3 baseline to 7.7 acute).
5/Only 1 patient required intensive care and all recovered (there was NO anaphylactic shock and there was NO intubation/need for a breathing tube). 3 employees, with a history of anaphylaxis, did not seek medical care (healthcare workers!).
6/Allergy CAN happen but it is rare (about the same as anaphylaxis from IV antibiotics). 15-30 min observation catches most severe reactions. All US sites can treat anaphylaxis. We need better criteria -- Brighton overestimating; NIAID/FAAN, and Ring&Messmer helpful.
7/Thanks to @PaigeWickner @landmaad @ericashenoy @LaceyRobinsonMD @AleenaBanerjiMD; @MGHAllergy @BWHAllergy @rebeccasaff @AnnaWolfsonMD @meconroy22 @WayneShreffler @sokol_mdphd @TanyaLaidlawMD @davidihong; @MassGenBrigham @TomSequist @PBiddinger #IDtwitter #MedTwitter #AIMedEd /
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