CME review
Allergic reactions after immunization

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Reactions to Vaccination vs Preexisting Allergy to a Vaccine Constituent

Generally, 2 circumstances bring patients to allergists for evaluation of immunization allergy. The first is patients who have experienced what are best described as adverse events following immunization.8 This phrase accurately captures what is being described, namely, that the patient received an immunization and subsequently experienced an adverse event. The immunization may or may not have caused the adverse event. If causal, the mechanism may or may not have been immunologic. If

History of an Apparently Allergic Reaction After Vaccination

If the patient has experienced an apparently IgE-mediated reaction to a vaccine, skin testing with the vaccine should be performed.[7], [9], [10] The testing should be performed with the same brand and dosage form administered before the reaction. The skin testing can be performed first by the prick method with undiluted vaccine, and if the result is negative, an intradermal skin test can be performed with the vaccine diluted 1:100 in normal saline. This 1:100 dilution has been determined to be

Gelatin

Gelatin is the vaccine constituent responsible for most allergic reactions to vaccines.[17], [18], [19], [20], [21], [22], [23], [24] Although most such reports have come from Japan,[20], [21], [22] they have also come from the United States,[17], [18], [23] Finland,19 and Germany.24 Gelatin used in vaccines is of either bovine or porcine origin, which are extensively cross-reactive.[17], [20], [25] It is added to numerous vaccines as a stabilizer in microgram to milligram quantities (Table 2).

Conclusions

Patients with suspected allergy to vaccines or vaccine components should be evaluated by an allergist. A careful history should determine the nature and timing of the reaction to the vaccine in question and other vaccines and vaccine constituents, such as gelatin, egg, yeast, and latex. If the history suggests a possible type 1, immediate-type hypersensitivity reaction, the evaluation should include evaluation for IgE antibodies to the suspect vaccine and components, either by skin testing or

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  • Cited by (16)

    • True and false contraindications to vaccines

      2018, Allergologia et Immunopathologia
      Citation Excerpt :

      By definition, an anaphylactic reaction is caused by mastocyte degranulation and it is very likely to occur in the presence of respiratory and/or cardiovascular symptoms. Although an anaphylactic reaction due to vaccines might occur up to 4 h after administration, it generally occurs within 1 h.6–8 Since anaphylactic reactions are life-threatening, vaccinations with the same product or vaccines sharing any possibly implicated substances must be avoided when disease-related risks are mild to moderate. If the risk of infection for potentially lethal or disabling diseases is high, and specific antibody titres are not protective, the patient should be referred to an allergist to perform skin tests with the vaccine and its components.7

    • International Consensus (ICON): Allergic reactions to vaccines

      2016, World Allergy Organization Journal
      Citation Excerpt :

      Latex is present in the rubber stoppers on some vaccine vials, and on the plungers in some prefilled vaccines syringes (see Table 2). There are reports of immediate hypersensitivity reactions to latex in this setting, but in most instances, specific studies have not been done to determine that latex was the cause of the immediate hypersensitivity reaction [43, 115]. Nevertheless, patients with severe latex allergy should avoid vaccines packaged with latex-containing stoppers and syringe plungers if possible.

    • Consensus document on the approach to children with allergic reactions after vaccination or allergy to vaccine components

      2015, Allergologia et Immunopathologia
      Citation Excerpt :

      The determination of IgG antibodies against the vaccine may be useful if the patient has received fewer than the recommended doses, in order to assess the level of immunisation. In the presence of disease-protecting antibody titres, further doses could be obviated, although the duration of immunisation may be shorter than if all the indicated doses were administered.18 Such titres have been defined for some vaccines (Table 5).

    • Vaccine Allergy

      2014, Immunology and Allergy Clinics of North America
      Citation Excerpt :

      These reactions are not discussed in this article.24 The main cause of consultation with an allergist regarding vaccine allergy is an adverse event following vaccine administration,78 including systemic immediate or nonimmediate hypersensitivity reactions. Rarely, hypersensitivity to a microbial component itself has been incriminated in patients who develop systemic allergic reactions after immunization.

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