Yumurta alerjisi olan çocuklarda kızamık-kızamıkçık-kabakulak aşılaması sonrası reaksiyon durumunun değerlendirilmesi

Amaç: Yumurta alerjisi olan çocuklara içerisinde yumurta proteini bulunan kızamık-kızamıkçık-kabakulak (KKK) aşısının doğrudan uygulanması önerilmesine rağmen hekimler genellikle çekince yaşamakta, bu durum hekim ve ailelerde sıkıntılara yol açmaktadır. Bu çalışmamızda, kliniğimizde yumurta alerjisi nedeniyle izlenen hastalarda, KKK aşısı sonrası aşı reaksiyon sıklığının değerlendirilmesi amaçlanmıştır. Gereç ve yöntem: Kliniğimizde yumurta alerjisi tanısı ile izlenen hastaların Ocak 2019-Ocak 2020 tarihleri arasında KKK aşı kayıtları incelendi. KKK aşısı yapılan hastaların demografik ve klinik özellikleri, laboratuvar bulguları değerlendirildi. Bulgular: Tanı anında yaş ortalaması 6,1±2,7 ay olan 80 hastanın %62,5’i (n=50) erkek idi. Hastaların %68,8’inde (n=55) atopik dermatit, %18,8’inde (n=15) ürtiker- anjioödem, %25’inde (n=20) reaktif hava yolu hastalığı, %15’inde (n=12) anafilaksi, %16,3’ünde (n=13) proktokolit mevcuttu. Tüm hastalara KKK aşısı aşı ile test yapılmadan, tek dozda uygulandı. Bir hastada aşıdan 30 dakika sonra aşırı ağlama, huzursuzluk ve yüzde kızarıklık şeklinde reaksiyon gözlenirken antihistaminik sonrası 1 saat içinde şikayetleri geriledi. Diğer hastalarda izlemlerinde sorun yaşanmadı. Sonuç: Yumurta alerjili hastalarda KKK aşısı sonrası herhangi bir ciddi reaksiyon gözlenmemiştir. Bağışıklama ve yapılma zamanı önemli olması nedeniyle yumurta alerjisi olan hastalarda KKK aşısının güvenle yapılabileceğini düşünüyoruz. Ancak aşı yapılan merkezlerde olası reaksiyonlara müdahale edilebilir uygun koşullar sağlanmalı ve aşı sonrası hastalar uygun süre gözlem altında bulundurulmalıdır.

The evaluation of allergic reaction in children with egg allergy after measles-mumpsrubella vaccination

Purpose: Although direct administration of the measles-mumps-rubella (MMR) vaccine which contains egg protein is recommended to children with egg allergy, physicians often have reservations, this situation leads to problems in physicians and families. In this study, we aimed to evaluate the frequency of reaction after the MMR vaccine in patients who were monitored for egg allergy in our clinic. Materials and methods: MMR vaccination records were examined between January 2019 and January 2020 of patients diagnosed with egg allergy in our clinic. Demographic and clinical characteristics, laboratory findings were evaluated in patients vaccinated with MMR. Results: The average age was 6.1±2.7 months, and 62.5% (n=50) of the cases were male. According to their diagnostic distribution, the patients had atopic dermatitis (n=55; 68.8%), urticaria (n=15; 18.8%), reactive airway disease (n=20; 25%), proctocolitis (n=13; 16.3%) and anaphylaxis (n=12; 15%). A whole dose of vaccine was administered to all cases. Flushing and crying was observed in one patient 30 minutes after vaccination, while her complaints resolved 1hour after antihistamine. No problems were observed in the follow-up of other patients. There was no severe side effect in any of the cases. Conclusion: No serious reactions have been observed in patients with egg allergy after the MMR vaccine. We believe that the MMR vaccine can be safely administered in patients with egg allergy in vaccinated centers, as immunization and delivery time are important. However, appropriate conditions can be intervened in possible reactions and patients should be kept under observation for the appropriate period after vaccination.

PDF

___

Chafen JJS, Newberry SJ, Riedl MA, et al. Diagnosing and managing common food allergies: a systematic review. JAMA 2010;303:1848-1856. https://doi. org/10.1001/jama.2010.582
Burks AW, Tang M, Sicherer S, et al. ICON: food allergy. J Allergy Clin Immunol 2012;129,906-920. https://doi. org/10.1016/j.jaci.2012.02.001
Muraro A, Werfel T, Hoffmann Sommergruber K. EAACI Food allergy and Anaphylaxis Guidelines Group. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy 2014;69:1008-1025. https://doi.org/10.1111/all.12429
Boyce JA, Assa’ad A, Burks AW, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol 2010;126:1105-1118. https://doi.org/10.1016/j.jaci.2010.10.008
Rona RJ, Keil T, Summers C, et al. The prevalence of food allergy: a meta-analysis. J Allergy Clin Immunology 2007;120:638-646. https://doi.org/10.1016/j. jaci.2007.05.026
Dreskin SC, Halsey NA, Kelso JM, et al. International Consensus (ICON): allergic reactions to vaccines. World Allergy Organ J 2016;9:32. https://doi. org/10.1186/s40413-016-0120-5
Chow WC, Eyw K, Lau YL. Measles-mumps-rubella vaccination and egg allergy. HK J Pediatr 2003;8:35- 39.
Dumortier B, Nosbaum A, Ponvert C, Nicolas JF, Bérard F. Measles-Mumps-Rubella vaccination of an egg-allergic child sensitized to gelatin. Arch Pediatr 2013;20:867-870. https://doi.org/10.1016/j. arcped.2013.05.006
Freitas DR, Moura E, Araújo G, et al. Investigation of an outbreak of hypersensitivity-type reactions during the 2004 national measles-mumps-rubella vaccination campaign in Brazil. Vaccine 2013;31:950-954. https:// doi.org/10.1016/j.vaccine.2012.11.095
Nakayama T, Aizawa C, Kuno Sakai H. A clinical analysis of gelatin allergy and determination of its causal relationship to the previous administration of gelatin-containing acellular pertussis vaccine combined with diphtheria and tetanus toxoids. J Allergy Clin Immunol 1999;103:321-325. https://doi.org/10.1016/ s0091-6749(99)70508-7
Carapetis JR, Curtis N, Royle J. MMR immunisation. True anaphylaxis to MMR vaccine is extremely rare. BMJ 2001;323:869.
Kuno Sakai H, Kimura M. Removal of gelatin from live vaccines and DTaP-an ultimate solution for vaccinerelated gelatin allergy. Biologicals 2003;31:245-249. https://doi.org/10.1016/s1045-1056(03)00063-0
Patja A, Davidkin I, Kurki T, Kallio MJ, Valle M, Peltola H. Serious adverse events after measles-mumpsrubella vaccination during a fourteen-year prospective follow-up. Pediatr Infect Dis J 2000;19:1127-1134. https://doi.org/10.1097/00006454-200012000-00002
van der Maas, NA, Woudenberg T, Hahné SJ, de Melker HE. Tolerability of early measles-mumpsrubella vaccination in infants aged 6-14 months during a measles outbreak in the netherlands in 2013- 2014. J Infect Dis 2016;213:1466-1471. https://doi. org/10.1093/infdis/jiv756
Bruno G, Giampietro PG, Grandolfo ME, Milita O, Businco L. Safety of measles immunisation in children with IgE-mediated egg allergy. Lancet 1990;335:739. https://doi.org/10.1016/0140-6736(90)90863-z 16. vaccine in children allergic to eggs. BMJ 2000;320:929- 932.
Esteghamati A, Keshtkar A, Heshmat R, et al. Adverse reactions following immunization with MMR vaccine in children at selected provinces of Iran. Arch Iran Med 2011;14:91-95. https://doi.org/011142/AIM.005
Andersen DV, Jorgensen IM. MMR vaccination of children with egg allergy is safe. Dan Med J 2013;60:4573.
Final Aviles F, Campins Marti M, Martinez Gomez X, et al. MMR vaccine and egg allergy. Experience in a hospital immunization unit. An Pediatr (Barc) 2007;67:362-367. https://doi.org/10.1016/s1695- 4033(07)70654-9
Bahceci S, Nacaroğlu HT, Arı HF, et al. Yumurta allerjisi olan olgularda kızamık-kızamıkçık-kabakulak aşılaması öncesi aşı ile deri prick testi gerekli mi? Aşı güvenle yapılabilir mi? İzmir Dr. Behçet Uz Çocuk Hast Derg 2017;7:129-132. https://doi.org/10.5222/ buchd.2017.129
Sayar EH. Yumurta alerjisi olan süt çocuklarında kızamık kızamıkçık kabakulak aşılama deneyimi. Acta Medica Alanya 2019;3:283-286. https://doi. org/10.30565/medalanya.562772
Çöğürlü MT, Şimşek IE. Is skin prik test necessery before Measles-Mumps-Rubella vaccination in children with egg allergy? How safe is the vaccine? Kocaeli Med J 2019;8;1:220-225. https://doi.org/10.5505/ ktd.2019.03411
Çapanoğlu M, Giniş T, Büyüktiryaki AB, et al. The evaluation of allergic reaction in patients with egg allergy after measles mumps-rubella vaccination. Asthma Allergy Immunol 2015;13:71-75. https://doi. org/10.5578/aai.9215
Elitok GK, Çelikboya E, Bulbul L, et al. Does food allergy require any change in Measles-Mumps-Rubella vaccination? Indian J Pediatr 2019;86:915-920. https:// doi.org/10.1007/s12098-019-02981-w
Yavuz ST, Sahiner UM, Sekerel BE, Tuncer A, Kalayci O, Sackesen C. Anaphylactic reactions to measlesmumps rubella vaccine in three children with allergies to hen’s egg and cow’s milk. Acta Paediatr 2011;100:94- 96. https://doi.org/10.1111/j.1651-2227.2011