Jan. 27, 2021 -- As the number of COVID-19 vaccine doses increases, so does the advice about how best to prepare so your body will have a strong immune response and minimal reaction.

Among the suggestions circulating online, including some with little or no research backing them up, are recommendations to pre-dose with allergy medicine, take common painkillers ahead of time, skip alcohol the day before, and many others.

What’s credible and what’s not?

Overall, most advice about how to prepare hasn’t been directly tested with COVID vaccines, of course, says Blanka Kaplan, MD, a specialist in adult and pediatric allergy and immunology at Northwell Health in Great Neck, NY. Information on allergic reactions to the vaccines, for instance, is unfolding as more data comes in.

“In general, there is nothing specific a person should do prior to taking the COVID-19 vaccine,” says Aaron E. Glatt, MD, hospital epidemiologist and chief of infectious diseases at Mount Sinai South Nassau in Oceanside, NY. He says anyone with serious allergic reactions should tell personnel at the vaccine site “so they can be prepared for any eventuality.”

As for the other suggestions, here is what the experts say:

Boost your allergy medications: Since allergic reactions, some severe, have been reported after doses of both the Moderna and Pfizer vaccines, some people with allergies say they’re intending to “pre-medicate” with extra antihistamines or other allergy medications. Not a good idea, experts say.

If you already take medications for allergies, such as antihistamine medicines, “you shouldn’t stop them before your vaccination,” Kaplan says.

There are no specific recommendations to take allergy medications like Benadryl before the vaccination, she says. Antihistamine medications, unless advised by your doctor, are not likely to prevent a severe allergic reaction to the vaccine, “but may blunt the allergic symptoms and make it harder to diagnose the allergic reaction and delay treatment.” But if you have a history of a severe allergic reaction to a previous vaccine, or anything in a vaccine, Kaplan says to discuss what to do with your doctor beforehand.

More information is coming out about the allergic reactions that have occurred with COVID vaccines, says Tara Vijayan, MD, an infectious disease specialist and assistant professor of medicine at the UCLA David Geffen School of Medicine.

A recent report in JAMA detailed 21 allergic reactions reported after 1.8 million first doses of the Pfizer vaccine. People had different allergic histories, and some had none, she says. The allergies involved penicillin and other medications, eggs, milk, nuts, cats, dogs, and other triggers. “There is probably no clear signal between [types of] prior allergic reactions and your likelihood [of reacting to the vaccine].”

No deaths occurred among the 21 people. And if a person is going to have a severe reaction, Vijayan says, anaphylaxis usually happens right away, within minutes. Under CDC guidelines, vaccine dispensers are advised to watch those with a history of anaphylaxis from any cause for 30 minutes; others for 15. “I think people should find some solace in that,” she says. Vaccine dispensing sites have epinephrine auto-injectors on site; anyone prescribed one is also advised to carry it with them always.

Take painkillers before so you’ll hurt less later. Alternate advice: avoid them so they won’t interfere with your immune response: Some people think taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or aspirin before a vaccination “will interfere with the immune response to the vaccine,” Kaplan says. “There is no scientific data to substantiate this. However, NSAIDs may precipitate an allergic reaction in some people. Since we do not know with any certainty if and how NSAIDs affect allergic reactions to the COVID vaccines, I advise against taking NSAIDs before and for 2 hours after your vaccination, unless instructed [otherwise] by your physician.”

“There is no need to ‘pre-medicate’ with any medications for the vast majority of people,” agrees Glatt, who’s also a professor of medicine at Icahn School of Medicine at Mount Sinai. For aches, chills, and mild allergic reactions that may occur after the vaccination, taking acetaminophen or an NSAID is generally OK, he says.

Don’t drink alcohol before the vaccination. “In some circumstances, alcohol can accelerate allergic reactions,” Kaplan says. “Since we do not yet know enough about the influence of alcohol on allergic reactions to the COVID-19 vaccines, I recommend avoiding drinking alcohol for 24 hours before and after your vaccination.”

Don’t exercise strenuously before the jab: Until more is known, Kaplan advises avoiding vigorous exercise 2 hours before and after the vaccination. She also advises avoiding hot showers 2 hours before and after, as exercise and vigorous showers can trigger allergic reactions in some people.

Prime your immune system: Others say having the healthiest immune system possible before getting vaccinated is crucial, and that taking the right mix of vitamins and minerals can help strengthen it. Prompted by the COVID pandemic, a Boston-based company is marketing Vacci-Prep, a mix of vitamins C, A, and D3, along with zinc, selenium, amino acids, and probiotics.

“We recommend starting it 7 days before the vaccine and 7 days after,” says Martin Floreani, president and CEO of Dentovations, the company making the new drug combination, which is expected to be available online in mid-February. He acknowledges no research exists to verify it can increase the immune response to the COVID vaccines, but he says the list of vitamins and minerals was chosen based on other research suggesting the supplements helped immune response with other vaccinations.

For instance, he cites a study finding that having a healthy level of vitamin D was linked with a better response to the flu vaccine in a small study of prostate cancer patients. Another study found that giving children vitamins A and D when they were low in those vitamins improved responses to the flu vaccine.

Kaplan is skeptical. “There is no scientific data that shows that taking any vitamins, mineral, or probiotics prior to the vaccination will prevent an allergic reaction or will improve the immune response to the vaccine,” she says. She recommends getting enough sleep, staying physically active and well-hydrated, along with eating well to give your immune system the best chance to “do its job.”

Get a good night’s sleep: Vijayan agrees that the sleep advice may be one of the best tips offered, along with taking the next day off if possible. “There is a spectrum of reactions, and honestly, if you have fever, it’s an overall positive thing,” indicating your immune system is responding to the vaccine. She didn’t take her own advice, she admits. She got the first dose in the morning, then put in a full workday. “I was wiped out that evening.”

That advice to sleep well and take it easy the next day might be especially important after the second dose, she says. She had a more intense reaction after the second dose, with body aches, chills, and a low-grade fever.

Show Sources

CDC: “Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States.”

Blanka Kaplan, MD, adult and pediatric allergy and immunology specialist, Northwell Health, Great Neck, NY.

Aaron E. Glatt, MD, chief, infectious diseases and hospital epidemiologist, Mount Sinai South Nassau; professor of medicine, Icahn School of Medicine at Mount Sinai, Oceanside, NY.

Tara Vijayan, MD, infectious disease specialist and assistant professor of medicine, UCLA David Geffen School of Medicine.

Martin Floreani, president and CEO, Dentovations, Boston.

The Journal of the American Medical Association: “Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine.”

Prostate: “Effect of 25-hydroxyvitamin D status on serological response to influenza vaccine in prostate cancer patients.”

Viruses: “Baseline Serum Vitamin A and D Levels Determine Benefit of Oral Vitamin A&D Supplements to Humoral Immune Responses Following Pediatric Influenza Vaccination.”

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