International Journal of Clinical Case Reports, 2025, Vol.15, No.6, 271-282 http://medscipublisher.com/index.php/ijccr 277 individual's allergy history and underlying diseases to identify those at high risk of vaccine allergies. When stratifying risks, it is important to focus on asking about past reactions to vaccines, drugs, foods, insect bites, whether there have been any allergic reactions, or if there have been any mast cell diseases. International and national guidelines recommend that people be classified into low, medium and high risk levels based on their medical records. Special attention should be paid to common allergens, such as polyethylene glycol (PEG) and polysorbate 80 (PS80), which are commonly used excipients in many vaccines (Sokolowska et al., 2021; Lyons et al., 2022; Nicola et al., 2025). This way, risks can be controlled in a targeted manner, preventing people from getting vaccinated for no reason and ensuring that the majority of people get vaccinated safely. When actually seeking medical treatment, for most people, if they only have a history of allergies unrelated to the vaccine components (such as food or environmental allergies), the risk of vaccine allergy will not increase, and they can follow the regular vaccination process. If someone is allergic to a specific vaccine component or has had adverse reactions to the vaccine before, a thorough assessment is required. If necessary, a skin test can be conducted or an allergist can be consulted for a judgment (Sokolowska et al., 2021; Nicola et al., 2025). Systematic risk assessment can not only make vaccination safer, but also reduce people's concerns about vaccines by clarifying individual risks and prevention methods (Lyons et al., 2022). 6.2 Contraindications and alternative vaccine options for people with allergies For individuals who have been confirmed to be allergic to a certain vaccine or its components, they should be prohibited from continuing to receive this product, and alternative vaccines that do not contain allergenic excipients or antigens should be selected as much as possible. Evidence suggests that the majority of high-risk allergy patients can safely receive alternative formulations under appropriate medical supervision, with few true contraindications, mainly limited to those who are simultaneously allergic to PEG and PS80 (Aytekin et al., 2021; Nicola et al., 2025). When there are multiple vaccine options available, individualized decisions and vaccination arrangements should be made based on the specific allergy spectrum of the patient. There is no suitable alternative vaccine. Further judgment can be made through skin tests or in vitro examinations. Under the care of professional medical staff, it is also possible to use stratified drug administration or desensitization methods based on the situation to identify risks and assist in deciding whether to vaccinate (Aytekin et al., 2021; Nicola et al., 2025). In general, it is necessary to avoid making overly strict judgments about vaccine allergies, so as not to let everyone miss the opportunity to get vaccinated. At the same time, as many people as possible should be vaccinated to reduce the risk of severe allergies, and not casually allow those who meet the vaccination conditions not to be vaccinated (Sokolowska et al., 2021; Lyons et al., 2022). 6.3 Choose facilities with resuscitation capabilities, extend the observation period People who are allergic to vaccines or their components, or have severe allergic diseases, can be called high-risk groups and should receive vaccinations in places where emergency treatment is available at any time. Such places should be equipped with professional medical staff, emergency drugs (such as epinephrine), and complete allergy treatment plans (Nicola et al., 2025). For such people, the observation period after vaccination is usually extended to 30 to 60 minutes to facilitate the timely detection and handling of adverse reactions. This approach has been proven to be safe for people with a complex history of allergies to receive vaccinations, and most of the vaccinated individuals can tolerate it without experiencing serious problems (Paoletti et al., 2021; Sokolowska et al., 2021; Lyons et al., 2022). In addition to facility preparation, pre-medication strategies (such as antihistamines) can be considered as appropriate in some patients, but the current evidence is limited and such measures cannot replace standardized risk stratification and contingency plans (Restivo et al., 2021). By fully communicating with patients on strengthening prevention, extending observation and their necessity, anxiety can be alleviated, vaccination compliance can be improved, and the risk of rare but serious anaphylactic shock can be minimized while taking into account the prevention and control of vaccine-preventable diseases (Lyons et al., 2022).
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