Reviews and feature articleAdverse reactions to vaccines practice parameter 2012 update
Section snippets
Contributors
The Joint Task Force has made a concerted effort to acknowledge all contributors to this parameter. If any contributors have been excluded inadvertently, the Task Force will ensure that appropriate recognition of such contributions is made subsequently.
Chief editors
John M. Kelso, MD
Division of Allergy, Asthma and Immunology
Scripps Clinic
San Diego, California
Matthew Greenhawt, MD, MBA
Department of Internal Medicine
Division of Allergy and Clinical Immunology
University of Michigan Medical School
University of Michigan Health System
Ann Arbor, Michigan
James T. Li, MD, PhD
Department of Medicine
Mayo Clinic College of Medicine
Rochester, Minnesota
Task force reviewers
David I. Bernstein, MD
Department of Medicine and Environmental Health
Division of Immunology, Allergy and Rheumatology
University of Cincinnati College of Medicine
Cincinnati, Ohio
Joann Blessing-Moore, MD
Department of Immunology
Stanford University Medical Center
Palo Alto, California
Linda Cox, MD
Department of Medicine
Nova Southeastern University
Davie, Florida
David A. Khan, MD
Department of Medicine
Division of Allergy & Immunology
University of Texas Southwestern Medical Center
Dallas, Texas
David M.
Invited Reviewers
Alnoor Malick, MD
Pasadena, Texas
Shahzad Mustafa, MD
Rochester, New York
Ketan K. Sheth, MD, MBA
Lafayette, Indiana
Jonathan Spergel, MD
Philadelphia, Pennsylvania
Classification of recommendations and evidence
Category of evidence: Ia Evidence from meta-analysis of randomized controlled trials Ib Evidence from at least 1 randomized controlled trial IIa Evidence from at least 1 controlled study without randomization IIb Evidence from at least 1 other type of quasiexperimental study III Evidence from nonexperimental descriptive studies, such as comparative studies IV Evidence from expert committee reports or opinions or clinical experience of respected authorities or both Strength of recommendation: A Directly based
Abstract
Mild local reactions and fever after vaccinations are common and do not contraindicate future doses. Anaphylactic reactions to vaccines are rare and should be evaluated with skin tests to the vaccine and its components. If the skin test results are negative, subsequent doses can be administered in the usual manner but under observation. If the skin test results are positive and the patient requires subsequent doses, the vaccine can be administered in graded doses under observation. Some
Executive summary
Mild local reactions and constitutional symptoms, such as fever, after vaccinations are common and do not contraindicate future doses. Rarely, delayed-type hypersensitivity to a vaccine constituent can cause an injection-site nodule, but this is not a contraindication to subsequent vaccination. Anaphylactic reactions to vaccines are estimated to occur at a rate of approximately 1 per million doses. There are approximately 220 million doses of vaccines distributed in the United States each year.
Preface
This practice parameter provides a practical, peer-reviewed, evidence-based guide for evaluation and management of patients with suspected allergic or other adverse reactions to vaccines. It also addresses patients with preexisting allergies or other health conditions that might preclude or alter vaccination. It contains updates since the first publication in 2009.
The practice parameter offers both general and vaccine-specific recommendations for (1) skin testing to vaccines and components, (2)
Summary statements
Summary Statement 1: Mild local reactions and constitutional symptoms, such as fever, after vaccinations are common and do not contraindicate future doses. Rarely, delayed-type hypersensitivity to a vaccine constituent can cause an injection-site nodule, but this is not a contraindication to subsequent vaccination. (C)
Local injection-site reactions (swelling, redness, and/or soreness) and constitutional symptoms, especially fever, are common after the administration of most vaccines and are not
Administering influenza vaccine to recipients with egg allergy
Influenza vaccines are grown on embryonated chicken eggs, leading to concern that residual egg protein (ovalbumin) could provoke an allergic reaction in a recipient with egg allergy. However, all studies to date have suggested that the risk of such reactions is very low.52, 53, 54, 55, 56, 57, 58 This addendum to the practice parameter update reflects changes to recommendations for administration of TIV to patients with egg allergy based on several studies completed since the original focused
References (137)
- et al.
Safe MMR vaccination despite neomycin allergy
Lancet
(1991) - et al.
Reactions to thimerosal in hepatitis B vaccines
Dermatol Clin
(1990) - et al.
Hypersensitivity to thiomersal in hepatitis B vaccine
Lancet
(1991) - et al.
Allergic contact dermatitis from mercury antiseptics and derivatives: study protocol of tolerance to intramuscular injections of thimerosal
Am J Contact Dermatitis
(2002) - et al.
A generalized reaction to thimerosal from an influenza vaccine
Ann Allergy Asthma Immunol
(2005) - et al.
Unexpectedly high incidence of persistent itching nodules and delayed hypersensitivity to aluminium in children after the use of adsorbed vaccines from a single manufacturer
Vaccine
(2003) - et al.
A case of recurrent sterile abscesses following vaccination: delayed hypersensitivity to aluminum
J Pediatr
(2008) - et al.
The Vaccine Adverse Event Reporting System (VAERS)
Vaccine
(1994) - et al.
Anaphylaxis to measles, mumps, and rubella vaccine mediated by IgE to gelatin
J Allergy Clin Immunol
(1993) - et al.
Food allergy to gelatin in children with systemic immediate-type reactions, including anaphylaxis, to vaccines
J Allergy Clin Immunol
(1996)
IgE-mediated systemic reactions to gelatin included in the varicella vaccine
J Allergy Clin Immunol
Change in gelatin content of vaccines associated with reduction in reports of allergic reactions
J Allergy Clin Immunol
Post-marketing surveillance of immediate allergic reactions: polygeline-based versus polygeline-free pediatric TBE vaccine
Vaccine
Bovine and porcine gelatin sensitivity in children sensitized to milk and meat
J Allergy Clin Immunol
Egg hypersensitivity and adverse reactions to measles, mumps, and rubella vaccine
J Pediatr
Measles immunization in children with a history of egg allergy
Vaccine
Safe administration of influenza vaccine to patients with egg allergy
J Pediatr
Safe vaccination of patients with egg allergy with an adjuvanted pandemic H1N1 vaccine
J Allergy Clin Immunol
The safety of the H1N1 influenza A vaccine in egg allergic individuals
Ann Allergy Asthma Immunol
Higher-ovalbumin-content influenza vaccines are well tolerated in children with egg allergy
J Allergy Clin Immunol
Safe administration of seasonal influenza vaccine to children with egg allergy of all severities
Ann Allergy Asthma Immunol
Single-dose influenza vaccination of patients with egg allergy in a multicenter study
J Allergy Clin Immunol
Ovalbumin content of influenza vaccines
J Allergy Clin Immunol
Ovalbumin content of 2010-2011 influenza vaccines
J Allergy Clin Immunol
Raw egg allergy—a potential issue in vaccine allergy
J Allergy Clin Immunol
Common allergens in avian meats
J Allergy Clin Immunol
Vaccination of yeast sensitive individuals: review of safety data in the US vaccine adverse event reporting system (VAERS)
Vaccine
Anaphylaxis after hepatitis B vaccination
Lancet
Vaccination of persons allergic to latex: a review of safety data in the Vaccine Adverse Event Reporting System (VAERS)
Vaccine
Thimerosal in influenza vaccine: an immediate hypersensitivity reaction
Ann Allergy Asthma Immunol
Anaphylaxis to diphtheria, tetanus, and pertussis vaccines among children with cow's milk allergy
J Allergy Clin Immunol
Comments on cow's milk allergy and diphtheria, tetanus, and pertussis vaccines
J Allergy Clin Immunol
Irritant skin test reactions to common vaccines
J Allergy Clin Immunol
IgE synthesis in man. II. Comparison of tetanus and diphtheria IgE antibody in allergic and nonallergic children
J Allergy Clin Immunol
Allergy diagnostic testing: an updated practice parameter
Ann Allergy Asthma Immunol
Safe administration of influenza vaccine in asthmatic children hypersensitive to egg proteins
J Pediatr
Guillain-Barre syndrome after exposure to influenza virus
Lancet Infect Dis
Guillain-Barre syndrome after vaccination in United States a report from the CDC/FDA Vaccine Adverse Event Reporting System
Vaccine
Adverse events following influenza A (H1N1) 2009 monovalent vaccines reported to the Vaccine Adverse Event Reporting System, United States, October 1, 2009-January 31, 2010
Vaccine
Anonymous. Ten great public health achievements—United States, 1900-1999
MMWR Morb Mortal Wkly Rep
Historical comparisons of morbidity and mortality for vaccine-preventable diseases in the United States
JAMA
Health consequences of religious and philosophical exemptions from immunization laws: individual and societal risk of measles
JAMA
A large rubella outbreak with spread from the workplace to the community
JAMA
Anonymous. Update: outbreak of poliomyelitis—Dominican Republic and Haiti, 2000-2001
MMWR Morb Mortal Wkly Rep
Anonymous. Two fatal cases of adenovirus-related illness in previously healthy young adults—Illinois, 2000
MMWR Morb Mortal Wkly Rep
Implications of a 2005 measles outbreak in Indiana for sustained elimination of measles in the United States
N Engl J Med
General recommendations on immunization—recommendations of the Advisory Committee on Immunization Practices (ACIP)
MMWR Morb Mortal Wkly Rep
Cited by (239)
Chronic urticaria after Moderna COVID-19 vaccine boosters: A case series
2024, JAAD Case ReportsGastrointestinal reflux contributes to laryngopharyngeal symptoms that mimic anaphylaxis: COVID-19 vaccination experience
2024, Journal of Allergy and Clinical Immunology: GlobalEgg allergy and yellow fever vaccination
2024, Jornal de PediatriaAn Update in COVID-19 Vaccine Reactions in 2023: Progress and Understanding
2023, Journal of Allergy and Clinical Immunology: In PracticeEndotyping of IgE-Mediated Polyethylene Glycol and/or Polysorbate 80 Allergy
2023, Journal of Allergy and Clinical Immunology: In Practice
Disclosure of potential conflict of interest: M. Greenhawt is on the Phadia/Thermo Fisher Scientific specialty advisory board and speakers' bureau; is on the advisory boards for Nutricia and Sunovion; has received research support from the American College of Allergy, Asthma & Immunology (ACAAI), a private foundation, and from the National Institutes of Health (NIH)/Clinical and Translational Science Awards (CTSA); is a medical advisor for the Kids with Food Allergies Foundation; is on the American Academy of Allergy, Asthma & Immunology's (AAAAI) Adverse Reactions to Foods Committee, Anaphylaxis Committee, and EGID Committee; and has received nonfinancial support from the Food Allergy & Anaphylaxis Network (FAAN). J. T. Li has stock shares in Abbott, Novartis, and Johnson & Johnson. J. M. Kelso declares that he has no relevant conflicts of interest.
Corresponding author: Joint Council of Allergy, Asthma & Immunology, 50 N Brockway St, #3-3, Palatine, IL 60067. E-mail: [email protected].