COVID shots for someone with metal allergy

December 8, 2021 8:37 PM

I recently learned that a neighbor of mine (older lady, smoker) has been unable to get any COVID vaccine because she has an allergy to surgical steel. Does she have any options?

Our city's mass vaccination sites could not accommodate her, and unsurprisingly neither can the usual Walgreens/CVS/Kroger situations. Her primary care doctor also could not provide any assistance, and suggested she try the nearest hospital; but they too were unable to help. (Also, for various demographic reasons I wouldn't be surprised if she generally gets kind of suboptimal medical care.)

She hasn't yet attempted any of the large hospitals here (Northwestern, Rush), as her previous attempts left her very depressed.

Are there alternative metals used in needles anywhere? Some kind of facility or doctor who would be more knowledgeable about her options? I know there are some non-injection/non-needle vaccinations in the works--she would probably be willing to participate in a clinical trial if there is one local (we are in Chicago) but due to her unvaccinated status she obviously would prefer not to fly, take trains, or stay in hotels. She does drive so anything reasonably close to the city is an option.

I don't know this lady terribly well--just someone I occasionally chat with in the courtyard--so I can't speak to the type or severity of her allergy. I just know she's not terribly internet savvy and doesn't have a lot of money, so I'd love to help her find some resources if I can.

posted by We put our faith in Blast Hardcheese to Health & Fitness (23 answers total)

It is very likely that she does not have a true allergy to surgical steel and the most likely advice from a physician would be to get vaccinated while under medical supervision and possibly pre-medicate w Benedryl and have an epi pen nearby.

Is she likely to follow your advice if you give it?
posted by latkes at 8:46 PM on December 8, 2021 [6 favorites]

There is such a thing a nickle allergy but it causes a rash so a shot might cause a blister if she was very allergic but the exposure is so brief and minimal that a response is unlikely. The articles focus on jewelry and dental appliances like partials.
posted by irisclara at 8:47 PM on December 8, 2021 [3 favorites]

Response by poster: It is very likely that she does not have a true allergy to surgical steel and the most likely advice from a physician would be to get vaccinated while under medical supervision and possibly pre-medicate w Benedryl and have an epi pen nearby.

See, this is what I would have assumed her physician would have said, but I have had enough dismissive, shitty interactions with doctors that...I can also see it not happening.

So, what is the protein in surgical steel that is binding to both her IgE antibodies and mast cells?

She's allergic to the needles, there's really no need to be shitty.
posted by We put our faith in Blast Hardcheese at 8:51 PM on December 8, 2021 [5 favorites]

Can you get her to describe her allergy a bit more? Like, I cannot find any trace of an actual allergy to the steel - everything refers to the possibility of nickel causing a rash during piercing.
posted by sagc at 8:54 PM on December 8, 2021 [2 favorites]

If she is under 75, this study for a nasal spray immunization appears to have a site in Cincinnati.
posted by notquitemaryann at 9:01 PM on December 8, 2021 [3 favorites]

1) Can't we just take her at her word that she has a metal allergy?

2) Brief Googling corroborates that steel contains nickel, and that allergy to surgical steel is a thing.

3) Yes, she may technically have a "sensitivity" rather than a classic IgE-connected protein-specific "allergy", but do you really want her to go into a long description of what she means by sensitivity every time she brings this up? Especially when there are a gabillion people who know how to work with allergy but who will feel that avoiding things because of a "sensitivity" is effete and overreaction?

4) I tried Googling "silver hypodermic needle" (got jewelry links) and "non-steel syringe" and "gold syringe needle", but didn't get anything good. An expert searching through specific catalogs would probably do better, if such a thing exists. She could try looking through one or two catalogs/web sites of large medical equipment manufacturers, or contacting 2-3 medical equipment supply companies.

5) This has to be a thing for some diabetics. Maybe a forum on a diabetes site, or some other diabetes research, would give some info.
posted by amtho at 9:02 PM on December 8, 2021 [9 favorites]

Response by poster: Ok for fuck's sake, I am not a doctor, neither is she, I didn't realize "allergy" could only apply to organic substances. A sensitivity then.

Yes, it's possible that she just needs someone authoritative to tell her that her metal sensitivity will not be a serious problem. If she's getting this kind of reaction from people no fucking wonder she doesn't want to get a shot. Yikes.
posted by We put our faith in Blast Hardcheese at 9:04 PM on December 8, 2021 [81 favorites]

PS - I am sensitive to propylene glycol. Like, if I eat it I get congestion, headaches, and vomiting, if it gets on my skin I get symptoms from redness/dryness/itchiness/breakouts all the way up to horrible acne, and it's a pain and people would love to dismiss it. Even though I know the occasional pedant might call me out on it, and even though I was reading about the mechanisms of allergies for fun in elementary school, I still say I am "allergic" to propylene glycol, because language is about communication and it communicates more efficiently than anything else.
posted by amtho at 9:05 PM on December 8, 2021 [19 favorites]

The only person being shitty here is the drunk driver endangering everyone by faking a medical reason to avoid a vitally necessary vaccination. There is no such thing as an "allergy" to an inorganic substance.

Can we please try getting our minds around the fact that some folks are just medically ignorant and fearful? Unlike the ideologues, these are the folks we can try to save.

Would she be comfortable taking a Benedryl beforehand and knowing that she will be watched afterwards for at least fifteen minutes? (They probably won't run her out if she wants to wait longer.) Could you offer to accompany her to make sure she's taken care of?
posted by praemunire at 9:09 PM on December 8, 2021 [8 favorites]

Best answer: Hello! I have an actual, legitimate reaction to nickel, which is found within surgical steel. It's pretty bad, like I can't wear most earrings because it causes weeping in the pierced areas. Jeans with nickel in the buttons give me these itchy welts that sometimes blister and ooze. When I have staples after surgery everything gets pink and itchy.

As a datapoint, I have had three covid shots, and every time it's been fine. As another datapoint, I have blood draws every week, sometimes twice. It's been fine.

As an even bigger datapoint, I was a dialysis patient for four years. Which means that three days a week, 52 weeks a year, I had two 15 gauge surgical steel needles placed in my arm for 4 hours at a time, every time. And every time it's been fine. Sometimes the site would get a little pink and itchy, but nothing like what earrings will do.

Needlephobia is real, and it's super intimidating for sure. And I get that people get the heebiejeebies about shots in general, because it's really scary for folks who don't have to do a lot of medical stuff. But as someone who has a documented issue with nickel and surgical steel and who has literally been a human pincushion for the past six years, it's really been okay.

I hope your friend finds the info she needs to feel at ease with this.
posted by mochapickle at 9:22 PM on December 8, 2021 [86 favorites]

Yes, it's possible that she just needs someone authoritative to tell her that her metal sensitivity will not be a serious problem.

If that's the case, and I'm in no way qualified to assess that, she may possibly be able to get some answers from the CDC vaccine hotline [phone]) or via email since this is an unusual question, or the hotline run by your county health department (833-308-1988).

Many community health centers run vaccination clinics and are deeply engaged in having conversations with people who are having difficulty getting vaccinated. Unlike mass vaccination sites and drugstores, these clinics have physicians on site and may be able to be a bit more patient with someone who needs their concerns addressed. Perhaps connecting her with one near you could help.
posted by zachlipton at 9:26 PM on December 8, 2021 [4 favorites]

Best answer: I was thinking more about your friend, and I remembered that I have a surgical steel stint as well. It's something that that I'd waited on doing because while temporary needles were fine for me, the stint is something long-term that we couldn't undo and if I'd had some sort of reaction to it, I wasn't sure what could even be done to address it.

The next year, my decision was made for me when my aneurysm became at risk of emergent. The surgeon even called around and tried to find a stint made without metal, but there wasn't an alternative. They used to be plastic a generation ago, but over time they'd snap sometimes so now they're all metal for durability.

I genuinely struggled with this during pre-op and asked the surgeon if he'd dealt with this before. And he said that yes, it had come up before, but that the risk from an unaddressed aneurysm was higher than the risk of a reaction to the metal. And that you have to make your decision based on the risk. So we went with it. It turned out okay.

As with a lot of tricky medical decisions, it's impossible to feel 100% certain. You just kind of have to put your faith in it. ;)
posted by mochapickle at 9:55 PM on December 8, 2021 [18 favorites]

Here's a better explanation with better... bedside manners. :D

"Surgical steel" is generally considered hypoallergenic to most people, and injection needles are made of surgical steel.

It is possible that she is genuinely "sensitive" to nickel in surgical steel, but one cannot be certain without some tests by an allergist. And generally sensitivity is linked to prolonged exposure, like body jewelry and such. An injection wouldn't even last a whole second. When I got my booster shot I barely felt the pinch. The nurse had excellent injection technique.

Without seeing her in person, my feeling is she has phobia needles and used the "allergic to needle" as an excuse, but it's just my layman feeling.

I am not aware of any alternative methods for COVID vaccine delivery that is already approved.

Given the risk of COVID seems to be far greater than any discomfort from her "sensitivity", it is really up to her to figure out whether her phobia of needles is more scary than possible death from COVID.
posted by kschang at 10:14 PM on December 8, 2021 [3 favorites]

Here is a whole page on metal allergies from the Cleveland Clinic. Quote:

If you have metal allergies, you might know that touching coins, jewelry and even doorknobs can trigger a reaction, known as allergic dermatitis. . . .

“Metal allergies are similar to any other type of allergic reaction,” says Dr. Anthony.

Your skin cells pick up small molecules of metal, which travel to your lymph nodes. Your body treats the offending substance like a foreign invader and quickly mounts an immune response. The result: redness, itching, swelling or a rash, with skin blistering or scaling at the site.

I can't see any specific solutions to the current situation offered there, but their general suggestion if you are dealing with a metal allergy and are looking for help, is to talk to a dermatologist. So that might be a good suggestion in the current situation as well.

(Based on my own experience in recent times, you're going to be waiting 3-4 months to get into any specialist for a general consult. So this might not be a very quick solution, but maybe better than nothing.)
posted by flug at 10:16 PM on December 8, 2021 [1 favorite]

Mod note: Couple jerky answers removed. As an answerer, it's general possible to help the asker clarify what you see as a misstatement/ambiguity in a question in a supportive and collaborative way. Those comments were not that. Be helpful or be elsewhere.
posted by cortex (staff) at 10:22 PM on December 8, 2021 [32 favorites]

Best answer: Aside from everything else, you might stress that actual contact with the needle lasts maybe a second (I found myself genuinely unsure after the vaccines if I had actually been jabbed at all - lightly pricked would be much more accurate). It's not like having your blood taken.

Has she been able to get any accommodations for things like blood tests? If so, maybe she could speak with the nurses/doctors at the places that have accommodated her and ask if they have any suggestions.

Regarding the hospitals - would you have time to call or write them and ask if they're able to accommodate her? You might want to raise the possibility that she might also be afraid and mention that she's received dismissive treatment before, to raise the odds that you'll get a helpful response.
posted by trig at 10:24 PM on December 8, 2021 [6 favorites]

I am a health practitioner in another country who has administered, at this point, several hundred COVID vaccine doses of various flavours.

Unless this person has had an actual anaphylactic reaction to a metal needle previously, I would be very strongly inclined to vaccinate with a standard needle without any extra precautions. Maybe, after consultation, consider an antihistamine for a couple of days before and after.

Metal sensitivity is not a recognised contraindication in this country to vaccination.
posted by chiquitita at 11:10 PM on December 8, 2021 [7 favorites]

As a data point, I have a fairly severe reaction to nickle in jewlery, in that contact will cause large hives lasting days. I've definitely had issues with surgical steel jewelry.

However, I got both vaccines and a booster with no skin reaction at all. I've never had a reaction to blood draws either. If shes very concerned, she could put topical benadryl on the injection site after to make sure.
posted by ananci at 7:42 AM on December 9, 2021 [5 favorites]

My mom is allergic to basically everything, and it's sort of standard procedure for her to choose where she goes to get this stuff done as best she can to be closer to a hospital (like she gets her flu shots at a pharmacy across the street if the hospital itself isn't doing a flu clinic, but she was eager enough for her covid vax to go to the county mass-vax site nowhere near the hospital), she stays basically within line of sight of the pharmacy staff for 15-30 minutes AND - I think this is the important part - someone else drives her so that it's a clear-headed person hustling her to the ER if anything seems weird, and sitting and talking with her for the entire observation period so it's obvious fast if she's starting to faint or not making sense.

Maybe you could offer to go with your neighbor? Or help coordinate a friend or family member to take her?

My mom does, per her doctor, take an antihistamine in advance and carries liquid or chewable Benadryl in her purse. She does not have an Epi-pen, mostly because she hasn't pushed for it, but also a lot of her reactions tend to not be anaphylactic.

I'm sure she has a nickel allergy, but it's not been a barrier to injections, IVs, or surgery. If she pops out in hives, they treat it, it's manageable.
posted by Lyn Never at 8:50 AM on December 9, 2021 [2 favorites]

Another bit on the actual needles: they are by far the smallest diameter needle I've ever been jabbed with. You can look up the specifics but I'd guess it's even less of an allergy/sensitivity issue bc there's even less metal in contact with the skin, compared to most 'normal' shots.
posted by SaltySalticid at 9:12 AM on December 9, 2021 [1 favorite]

My sister also has this sensitivity (quite badly) and got three shots. She doesn’t generally worry about blood draws or anything (though certain face masks cause her to break out). I would think her doctor would have the best advice.
posted by stoneandstar at 9:53 AM on December 9, 2021

I am also one of those weeping sores nickel allergy people and have had all three Covid shots now. The time just isn’t long enough to get a reaction for me; I have to be a little sweaty and rubbed up against it for some amount of time.
posted by St. Peepsburg at 9:53 AM on December 9, 2021 [2 favorites]

Hello. I do not have a metals allergy/sensitivity, but I do to the COVID vaccine. Which I found out when I got my first vaccine shot.

Here's how my GP and I handled my second shot and booster (all three were Pfizer):

1. I go to a place where I know I have constant supervision, for more than an hour.
2. I explain that I have had reactions in the past, and what they were. In my case, asthma.
3. I bring my portable Nebulizer with me, with liquid albuterol.
4. I pretreat with my allergy and asthma medications; in my case it's an extra Claritin, and some puffs of my rescue inhaler about 30 minutes before.
5. Right after the shot? I start sipping on a heavily caffeinated drink. Usually a stout tea or drip coffee does the trick.

For my second shot of the vaccine, the mass vax site in Seattle was able to accomidate me. But for my booster? I had to go to a hospital to get it done. The hospital didn't give me any flack for going there to get the shot, and they had the conditions that I needed to make sure I was safe.

One suggestion is to see if maybe you could call the hospitals and advocate for her? It looks like Rush only vaccinates Rush patients only, but Northwest will vaccinate everyone, in an Immediate Care Clinic. And Immediate Care might be better equipped to handle any reactions that come up.

Info here: https://www.nm.org/conditions-and-care-areas/immediate-care. Their phone number is: 312.694.CARE (2273).
posted by spinifex23 at 12:42 PM on December 9, 2021 [3 favorites]