Q + A with Dr. Sanjeev Jain :: Vaccines + Allergies

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We are delighted to partner with Columbia Allergy to bring you the important information in this Q + A.

Portland Mom Collective is committed to sharing resources and information with families living in the PDX area. In our Q + A Sessions series, we talk to local experts in their fields about common topics relevant to our readers.

In this session, we discuss vaccines and allergies with Dr. Sanjeev Jain, renowned allergist and immunologist, and CEO of Columbia Allergy. Dr. Jain shares with us what we need to know about allergic reactions to vaccines (rare!), options for those concerned about potential reactions, and options for treatment.

Dr. Sanjeev Jain, MD, PHD, FACAAI, is a renowned immunologist and allergist, as well as founder and CEO of Columbia Allergy. With 12 clinics throughout the Pacific Northwest, Columbia Allergy is the leading center for allergies and asthma in our region.

Dr. Jain,  is double board-certified in allergy and immunology and internal medicine. At Columbia Allergy, his team specializes in Oral Immunotherapy (OIT) and was the first to desensitize patients to many different foods including coconut, garlic, shrimp, fish, oat, and buckwheat. Read more about Dr. Jain’s background and expertise here.

PMC
Welcome Dr. Jain. We are doing this as part of our Q + A series, so I would love if you would first introduce yourself to our readers so they know who you are and what you do.

Dr. Jain
Yes, my name is Sanjeev Jain. I am a physician and asthma and allergy specialist, and I also specialize in desensitization to foods and medications. That’s one of our major part of our practice, and I work at Columbia Allergy clinic.

PMC
Yeah and for those who don’t know, Columbia Allergy has – how many locations do you have in the Portland area?

Dr. Jain
So we have between Vancouver and Portland, we have about six locations, and Longview is another location, so seven in this region.

PMC
Ok. We’ve decided to connect with you today to talk about vaccines. Kind of a hot topic these days, but there’s a lot to know with your specialty. So we gathered up a couple questions and if you’re open to answering them, we’d love to ask you.

Dr. Jain
Wonderful, yes.

PMC
Ok, so, first is just the concern that people might have with allergic reactions to vaccines in general. What should we know, how prevalent is it?

Dr. Jain
Vaccine allergies are typically rare. What the published data would report is that the incidents of anaphylactic or life-threatening reactions to a vaccines is about one in a million. So it’s quite rare. However, minor allergic reactions may happen more frequently.

PMC
What happens with a mild allergic reaction to a vaccine?

Dr. Jain
So minor allergic reactions may represent hives, cough, or difficulty breathing, so those types of reactions are more common than the truly anaphylactic reactions.

PMC
So is there anything that we need to know about the COVID-19 vaccines, specifically, as far as allergic reactions – minor or, I guess, major?

Dr. Jain
Yes, COVID-19 vaccine is very important for reducing the risk of having severe complications of COVID. For that reason, we have to look at everything from a risk versus benefit ratio. When it comes to COVID vaccine, it received a lot of media attention when a few people in England had an allergic reaction to the Pfizer vaccine, when it was first introduced, and since then it has been researched significantly and what we are discovering is that it is primarily one component of Pfizer and Moderna vaccines, namely polyethylene glycol, which is a chemical that’s present in the vaccine, and the vast majority of allergic reactions are to this ingredient in the vaccine.

PMC
Ok, so if there is somebody who has a concern about that ingredient or an ingredient in another vaccine, are there ways they can work around that? Is there a treatment they can do and still get the vaccine without that concern?

Dr. Jain
Yes, so our approach in somebody who has a risk for allergic reaction with the vaccine is to evaluate them for the possibility of an allergy to polyethylene glycol. If it turns out that they DO have that allergy, then we have a protocol for desensitizing those individuals so that they can still receive the vaccine.

PMC
How do you test somebody for the allergy?

Dr. Jain
We perform skin prick testing for allergies, where we take some of this chemical and prick the skin with that, and look at the size of the reaction, where we would look at the bump and the redness that develops in about twenty minutes after pricking the skin with that. This is a very safe procedure, even if somebody has very severe allergies, they are unlikely to have any complications from the testing itself. And we also perform what we would call oral challenges. As it turns, polyethylene glycol is an ingredient of many medications and its also an ingredient in some of the over the counter medication such as MiraLax. So we’re using that as a way to test if they are allergic to polyethylene glycol.

PMC
And so if somebody does find they are allergic to it and they go through densitization, does that mean they can safely get the vaccine? What does that look like for them?

Dr. Jain
So the desensitization protocol is the same as what has been used for decades. For example, there has been a protocol for densitizing to pencillin for decades. And there, what one does, even if somebody is allergic to penicillin but they still need to receive penicillin, then we can densitize that individual to penicillin and then they can receive the medication. In the same way, for COVID-19, we developed a desensitization protocol for polyethylene glycol so that after they get the desensitization, they can safely receive the vaccine.

PMC
How long does the desensitization process take?

Dr. Jain
It ends ups taking pretty much a whole day in our office, but this is still an office procedure that we perform in our clinics at Columbia Allergy. One has to stay in the office for pretty much the whole day prior to getting the vaccine, and the vaccine has to be administered within a day of receiving this desensitization.

PMC
So it’s like a two-day process overall, from densitization to vaccination?

Dr. Jain
The vaccination itself takes only a few minutes, but the densitization takes a whole day.

PMC
The Pfizer and Moderna ones are two-part vaccines. Would you then have to desensitize again or is it considered ok for the second dose?

Dr. Jain
No, desensitization protocol does not have long-term effectiveness, so one needs to do it each time one gets the vaccine, so it would require two treatments.

PMC
Gotcha. Ok, so I am wondering if this works, we’re starting to see that we know the vaccine is available for people 16 and over and there is potential for a younger population having the vaccine as well. Would this work the same way for kids?

Dr. Jain
In principle, it can work for kids of any age group. We, of course, need to be more cautious the younger the child is. Currently COVID vaccine is not available or kids less than 16 years of age, but we expect that this summer and fall, they will get FDA approval for younger kids as well.

**NOTE: The COVID-19 vaccine was approved for children ages 12-16 days after this interview was recorded.

PMC
For parents who have concerns about their kids’ reactions to vaccine – potential allergic reaction to the COVID-19 or any other vaccine – where can they go for information about how to go through this procedure?

Dr. Jain
They need to consult with an allergy specialist. For other vaccines, we have of course managed allergic reactions for a long time. For example, when it comes to MMR vaccine, we recognized for awhile that kids who are allergic to gelatin might have an allergic reaction to the MMR vaccine. So those kids can be evaluated for an allergy to gelatin and then can be treated and receive their vaccine even if they have allergy to gelatin. The same way for the flu vaccine, it’s been recognized for a long time that anyone might have a severe allergy to egg, then they may have problems with the flu vaccine. And, when it comes to DTAP, people recognize that there was a very small chance of having a severe reaction to the DTAP vaccine if they have allergy to dairy. And so all those things have been recognized for awhile, and so there are treatment for managing those allergies even in young kids and we have done that over the years for many kids.

PMC
So a parent would start with an allergist and determine the level of sensitivity if they are concerned about that. Would that be their first step?

Dr. Jain
I think that would be a very good first step, yes. Now, one has to recognize that vaccine allergies, even in that population, is very very rare. So for example, somebody who is allergic to egg, the vast majority of those kids can still receive flu vaccine. It’s very rare that somebody with an egg allergy can have an allergic reaction to the flu vaccine, for example. The thing about COVID-19 vaccines, is that they don’t appear to have any common ingredient to a food, so if somebody is allergic to a food such as egg or milk or any other food, they don’t have to worry so much about possible allergy to COVID-19 vaccine.

PMC
That is good news. I think that we have covered a lot of it. Is there anything else that you think parents specifically need to know about the COVID-19 vaccine or allergic reactions to vaccines in general that we haven’t covered?

Dr. Jain
I think we have covered most of the important points. I again want to re-emphasized that we have to look at everything from a risk versus benefit perspective, and the benefit of the vaccine far outweigh the risks. And, one common question we receive is my child is allergic to lots of different things, so is it safe for that person to receive the vaccine? In the vast majority of cases, even if a child may have an allergy to multiple things, even i they have allergies to environmental things such as pollen or dander, that does not necessarily increase their risk of allergic reaction to the COVID-19 vaccine.

PMC
That’s good news for parents of kids with allergies for sure. Thank you so much for coming and answering some of our questions, we’ll hopefully get to talk to you a little bit more about some other things in the future. In the meantime, if people want more information, they can learn from your website, which is Columbia Allergy, right, dot com?

Dr. Jain
Exactly, yes, it’s columbiaallergy.com.

PMC
Ok, perfect. Thank you so much!

Dr. Jain
Thank you so much.

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