Gastrointestinal reflux contributes to laryngopharyngeal symptoms that mimic anaphylaxis: COVID-19 vaccination experience
Background: The sensation of throat closure after vaccination is concerning for anaphylaxis and leads to vaccine hesitancy. Objectives: We characterized patients who developed laryngopharyngeal symptoms (LPhS) after coronavirus disease 2019 (COVID-19) vaccination and assessed risk factors for these...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-02-01
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| Series: | Journal of Allergy and Clinical Immunology: Global |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772829323001017 |
| _version_ | 1797317073797382144 |
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| author | Blanka Kaplan, MD Gina Coscia, MD Joanna S. Fishbein, MPH Amanda Innamorato, BS Aaqil Ali, BS Sherry Farzan, MD |
| author_facet | Blanka Kaplan, MD Gina Coscia, MD Joanna S. Fishbein, MPH Amanda Innamorato, BS Aaqil Ali, BS Sherry Farzan, MD |
| author_sort | Blanka Kaplan, MD |
| collection | DOAJ |
| description | Background: The sensation of throat closure after vaccination is concerning for anaphylaxis and leads to vaccine hesitancy. Objectives: We characterized patients who developed laryngopharyngeal symptoms (LPhS) after coronavirus disease 2019 (COVID-19) vaccination and assessed risk factors for these symptoms. Methods: The study analyzed data from the COVID-19 vaccines adverse reactions registry (December 14, 2020, to June 13, 2022). Outcomes included the incidence of postvaccination LPhS and use of epinephrine. We identified and compared risk factors for COVID-19 postvaccination reactions between subjects with and without LPhS. Results: A total of 158 subjects were enrolled onto the registry. LPhS were reported in 61 subjects (38.6%), of whom 52 (85.2%) received a subsequent dose. With initial vaccination, the use of epinephrine was higher in subjects with LPhS (20%) compared to those without (6%; P = .0094). Fifty-two subjects (85.2%) with LPhS received a subsequent COVID-19 vaccine dose with milder or no symptoms, and none needed treatment with epinephrine. Those with LPhS were more likely to have a history of drug allergies (P = .02), severe medication allergies (P = .03), gastroesophageal reflux disease (P = .018), and need for antireflux medications (P = .0085) compared to controls. Conclusions: In our registry, postvaccination LPhS were common. LPhS can mimic anaphylaxis and lead to more frequent use of epinephrine. Gastroesophageal reflux disease was more frequent in these subjects. Patients with subjective throat closure sensation can safely receive subsequent vaccine doses with close observation and reassurance. LPhS are not unique to COVID-19 vaccines. Patient and provider education regarding the role of gastroesophageal reflux disease as a risk factor for LPhS with vaccination can improve vaccine uptake. |
| first_indexed | 2024-03-08T03:29:36Z |
| format | Article |
| id | doaj.art-af01fdaad8d644adabd143baac66d354 |
| institution | Directory Open Access Journal |
| issn | 2772-8293 |
| language | English |
| last_indexed | 2024-03-08T03:29:36Z |
| publishDate | 2024-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Allergy and Clinical Immunology: Global |
| spelling | doaj.art-af01fdaad8d644adabd143baac66d3542024-02-11T05:12:56ZengElsevierJournal of Allergy and Clinical Immunology: Global2772-82932024-02-0131100176Gastrointestinal reflux contributes to laryngopharyngeal symptoms that mimic anaphylaxis: COVID-19 vaccination experienceBlanka Kaplan, MD0Gina Coscia, MD1Joanna S. Fishbein, MPH2Amanda Innamorato, BS3Aaqil Ali, BS4Sherry Farzan, MD5Division of Allergy and Immunology, Northwell Health, Great Neck, NY; Departments of Medicine and Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Corresponding author: Blanka Kaplan, MD, 865 Northern Blvd, Suite 101, Manhasset, NY 11021.Division of Allergy and Immunology, Northwell Health, Great Neck, NY; Departments of Medicine and Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NYOffice of Academic Affairs, Northwell Health, New Hyde Park, NYFeinstein Institutes for Medical Research, Northwell Health, Manhasset, NYDivision of Allergy and Immunology, Northwell Health, Great Neck, NYDivision of Allergy and Immunology, Northwell Health, Great Neck, NY; Departments of Medicine and Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY; Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NYBackground: The sensation of throat closure after vaccination is concerning for anaphylaxis and leads to vaccine hesitancy. Objectives: We characterized patients who developed laryngopharyngeal symptoms (LPhS) after coronavirus disease 2019 (COVID-19) vaccination and assessed risk factors for these symptoms. Methods: The study analyzed data from the COVID-19 vaccines adverse reactions registry (December 14, 2020, to June 13, 2022). Outcomes included the incidence of postvaccination LPhS and use of epinephrine. We identified and compared risk factors for COVID-19 postvaccination reactions between subjects with and without LPhS. Results: A total of 158 subjects were enrolled onto the registry. LPhS were reported in 61 subjects (38.6%), of whom 52 (85.2%) received a subsequent dose. With initial vaccination, the use of epinephrine was higher in subjects with LPhS (20%) compared to those without (6%; P = .0094). Fifty-two subjects (85.2%) with LPhS received a subsequent COVID-19 vaccine dose with milder or no symptoms, and none needed treatment with epinephrine. Those with LPhS were more likely to have a history of drug allergies (P = .02), severe medication allergies (P = .03), gastroesophageal reflux disease (P = .018), and need for antireflux medications (P = .0085) compared to controls. Conclusions: In our registry, postvaccination LPhS were common. LPhS can mimic anaphylaxis and lead to more frequent use of epinephrine. Gastroesophageal reflux disease was more frequent in these subjects. Patients with subjective throat closure sensation can safely receive subsequent vaccine doses with close observation and reassurance. LPhS are not unique to COVID-19 vaccines. Patient and provider education regarding the role of gastroesophageal reflux disease as a risk factor for LPhS with vaccination can improve vaccine uptake.http://www.sciencedirect.com/science/article/pii/S2772829323001017COVID-19vaccineadverse reactionmRNAGERDLPR |
| spellingShingle | Blanka Kaplan, MD Gina Coscia, MD Joanna S. Fishbein, MPH Amanda Innamorato, BS Aaqil Ali, BS Sherry Farzan, MD Gastrointestinal reflux contributes to laryngopharyngeal symptoms that mimic anaphylaxis: COVID-19 vaccination experience Journal of Allergy and Clinical Immunology: Global COVID-19 vaccine adverse reaction mRNA GERD LPR |
| title | Gastrointestinal reflux contributes to laryngopharyngeal symptoms that mimic anaphylaxis: COVID-19 vaccination experience |
| title_full | Gastrointestinal reflux contributes to laryngopharyngeal symptoms that mimic anaphylaxis: COVID-19 vaccination experience |
| title_fullStr | Gastrointestinal reflux contributes to laryngopharyngeal symptoms that mimic anaphylaxis: COVID-19 vaccination experience |
| title_full_unstemmed | Gastrointestinal reflux contributes to laryngopharyngeal symptoms that mimic anaphylaxis: COVID-19 vaccination experience |
| title_short | Gastrointestinal reflux contributes to laryngopharyngeal symptoms that mimic anaphylaxis: COVID-19 vaccination experience |
| title_sort | gastrointestinal reflux contributes to laryngopharyngeal symptoms that mimic anaphylaxis covid 19 vaccination experience |
| topic | COVID-19 vaccine adverse reaction mRNA GERD LPR |
| url | http://www.sciencedirect.com/science/article/pii/S2772829323001017 |
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