Abstract
This study examines healthcare practitioners' decision-making processes when managing vaccine-hesitant patients concerned about allergic reactions to COVID-19 vaccines. A multi-methods secondary data analysis was conducted combining quantitative referral trends and qualitative thematic analysis of health practitioner recorded notes. Anonymized data from 326 individuals referred to an interim COVID-19 vaccine allergy advice service based in Herefordshire and Worcestershire, UK, were analyzed. Quantitative data included referral patterns and vaccination outcomes, while qualitative data consisted of thematic analysis of free-text health practitioner notes documenting patient concerns and practitioner decision-making. Of the referred cases, 23.3% were advised to proceed with vaccination in primary care without precaution, 29% with additional precautions such as antihistamines and extended observation. Hospital-based vaccination was only recommended for 0.9%, typically for individuals with complex allergy histories. In 22.7%, cases were escalated to a multidisciplinary team that mainly advised vaccination in primary care with precautions or in hospital settings. Notably, no cases resulted in recommendations against vaccination. The qualitative analysis of health practitioner free text notes developed three themes: diverse presentation of allergies, complex allergy histories, and patient anxiety and lack of trust. Themes suggest healthcare practitioners face significant challenges in clinical decision-making with these patients and highlight the complexity of managing vaccine hesitancy. This study underscores the need for enhanced training and standardized documentation processes to support healthcare practitioners in managing allergy-related vaccine hesitancy. Public health messaging should proactively address misconceptions about vaccines as they relate to allergies, to build trust and reduce hesitancy.