Allergic reactions during childhood vaccination and management

Background. Vaccination is one of the most effective public health tools to prevent a variety of infectious diseases. However, concerns about vaccine related adverse effects cause difficulties in clinical practice. Methods. This review was prepared based on the latest literature available in the PUBMED database in English language (as of March 2021), and all articles with the keywords pediatric vaccine, allergy, hypersensitivity, adverse reaction were evaluated to prepare the article. Results. Vaccine related confirmed allergic reactions are rare in children, ranging between 0,65-1.45 cases per million vaccine doses. Most of the allergic reactions are self-limited local reactions although in some cases severe anaphylaxis with multisystem involvement can be observed. Allergic reactions may occur because of either the active component (the antigen) of the vaccine, or additional components, such as preservatives, adjuvants, antimicrobials, stabilizers and other substances. Finding the culprit allergen is necessary to prevent future exposure to the allergen and to use alternative vaccines if possible. Diagnosis is largely based on a detailed history and clinical manifestation; also in vivo and in vitro tests may be helpful. Conclusions. In this review we provide information about hypersensitivity reactions to allergen components of childhood vaccines along with the diagnosis and management of vaccine allergy. Besides the tremendous benefits of vaccination for the health of children, we emphasized that the risk of adverse effects is rare and poses a negligible threat

___

1. Murphy TV, Gargiullo PM, Massoudi MS, et al; for the Rotavirus Intussusception Investigation Team. Intussusception among infants given an oral rotavirus vaccine. N Engl J Med 2001; 344: 564-572. https://doi.org/10.1056/NEJM200102223440804

2. Simonsen L, Viboud C, Elixhauser A, Taylor RJ, Kapikian AZ. More on RotaShield and intussusception: the role of age at the time of vaccination. J Infect Dis 2005; 192(Suppl 1): S36-S43. https://doi.org/10.1086/431512

3. Rothman KJ, Young-Xu Y, Arellano F. Age dependence of the relation between reassortant rotavirus vaccine (RotaShield) and intussusception. J Infect Dis 2006; 193: 898. https://doi.org/10.1086/500217

4. Bohlke K, Davis RL, Marcy SM, et al; Vaccine Safety Datalink Team. Risk of anaphylaxis after vaccination of children and adolescents. Pediatrics 2003; 112: 815-820. https://doi.org/10.1542/peds.112.4.815

5. McNeil MM, Weintraub ES, Duffy J, et al. Risk of anaphylaxis after vaccination in children and adults. J Allergy Clin Immunol 2016; 137: 868-878. https:// doi.org/10.1016/j.jaci.2015.07.048

6. Caubet JC, Ponvert C. Vaccine allergy. Immunol Allergy Clin North Am 2014; 34: 597-613. https://doi. org/10.1016/j.iac.2014.04.004

7. Kelso JM. Potential food allergens in medications. J Allergy Clin Immunol 2014; 133: 1509-1518. https:// doi.org/10.1016/j.jaci.2014.03.011

8. Lasley MV. Anaphylaxis after booster influenza vaccine due to gelatin allergy. Pediatr Asthma Allergy Immunol 2007; 20: 201-205. https://doi. org/10.1089/pai.2007.014

9. Sakaguchi M, Nakayama T, Inouye S. Food allergy to gelatin in children with systemic immediate- type reactions, including anaphylaxis, to vaccines. J Allergy Clin Immunol 1996; 98(6 Pt 1): 1058-1061. https://doi.org/10.1016/S0091-6749(96)80191-6

10. Miyazawa H, Inouye S, Sakaguchi M. Sensitization to gelatin in children with systemic non-immediate- type reactions to varicella vaccines. Ann Allergy Asthma Immunol 2000; 84: 341-344. https://doi. org/10.1016/S1081-1206(10)62784-6

11. 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(2 Pt 1): 321-325. https://doi.org/10.1016/S0091-6749(99)70508-7

12. Kumagai T, Yamanaka T, Wataya Y, et al. A strong association between HLA-DR9 and gelatin allergy in the Japanese population. Vaccine 2001; 19: 3273- 3276. https://doi.org/10.1016/S0264-410X(00)00555-7

13. Sakaguchi M, Yoshida M, Kuroda W, Harayama O, Matsunaga Y, Inouye S. Systemic immediate-type reactions to gelatin included in Japanese encephalitis vaccines. Vaccine 1997; 15: 121-122. https://doi. org/10.1016/S0264-410X(96)00170-3

14. Mullins RJ, James H, Platts-Mills TA, Commins S. Relationship between red meat allergy and sensitization to gelatin and galactose-α-1, 3-galactose. J Allergy Clin Immunol 2012; 129: 1334- 1342.e1. https://doi.org/10.1016/j.jaci.2012.02.038

15. Stone Jr CA, Commins SP, Choudhary S, et al. Anaphylaxis after vaccination in a pediatric patient: further implicating alpha-gal allergy. J Allergy Clin Immunol Pract 2019; 7: 322-324.e2. https://doi. org/10.1016/j.jaip.2018.06.005

16. Zent O, Hennig R. Post-marketing surveillance of immediate allergic reactions: polygeline-based versus polygeline-free pediatric TBE vaccine. Vaccine 2004; 23: 579-584. https://doi.org/10.1016/j. vaccine.2004.07.016

17. Franceschini F, Bottau P, Caimmi S, et al. Vaccination in children with allergy to non active vaccine components. Clin Transl Med 2015; 4: 3. https://doi. org/10.1186/s40169-014-0043-0

18. Allen CW, Kemp AS, Campbell DE. Dietary advice, dietary adherence and the acquisition of tolerance in egg-allergic children: a 5-yr follow-up. Pediatr Allergy Immunol 2009; 20: 213-218. https://doi. org/10.1111/j.1399-3038.2008.00784.x

19. Eggesbø M, Botten G, Halvorsen R, Magnus P. The prevalence of allergy to egg: a population-based study in young children. Allergy 2001; 56: 403-411. https://doi.org/10.1034/j.1398-9995.2001.056005403.x

20. Sicherer SH, Wood RA, Vickery BP, et al. The natural history of egg allergy in an observational cohort. J Allergy Clin Immunol 2014; 133: 492-499. https://doi. org/10.1016/j.jaci.2013.12.1041

21. Yavuz ST, Sahiner UM, Buyuktiryaki B, et al. Phenotypes of IgE-mediated food allergy in Turkish children. Allergy Asthma Proc 2011; 32: 47-55. https://doi.org/10.2500/aap.2011.32.3481

22. Akarsu A, Ocak M, Koken G, Sahiner UM, Soyer O, Sekerel BE. IgE mediated food allergy in Turkey: different spectrum, similar outcome. Turk J Pediatr 2021; 63: 554-563. https://doi.org/10.24953/ turkjped.2021.04.002

23. Upton JEM, Hummel DB, Kasprzak A, Atkinson AR. No systemic reactions to influenza vaccination in egg-sensitized tertiary-care pediatric patients. Allergy Asthma Clin Immunol 2012; 8: 2. https://doi. org/10.1186/1710-1492-8-2

24. Carballo IC, Pastor MD, Zavala BB, Cano MS, de la Hoz Caballer B. Safety of measles-mumps-rubella vaccine (MMR) in patients allergic to eggs. Allergol Immunopathol (Madr) 2007; 35: 105-109. https://doi. org/10.1157/13106778

25. Cheng DR, Perrett KP, Choo S, Danchin M, Buttery JP, Crawford NW. Pediatric anaphylactic adverse events following immunization in Victoria, Australia from 2007 to 2013. Vaccine 2015; 33: 1602-1607. https://doi.org/10.1016/j.vaccine.2015.02.008

26. Khakoo G, Lack G. Recommendations for using MMR vaccine in children allergic to eggs. BMJ 2000; 320: 929-932. https://doi.org/10.1136/bmj.320.7239.929

27. Turner PJ, Southern J, Andrews NJ, Miller E, Erlewyn- Lajeunesse M; SNIFFLE Study Investigators. Safety of live attenuated influenza vaccine in atopic children with egg allergy. J Allergy Clin Immunol 2015; 136: 376-381. https://doi.org/10.1016/j.jaci.2014.12.1925

28. Turner PJ, Southern J, Andrews NJ, Miller E, Erlewyn- Lajeunesse M; SNIFFLE-2 Study Investigators. Safety of live attenuated influenza vaccine in young people with egg allergy: multicentre prospective cohort study. BMJ 2015; 351: h6291. https://doi. org/10.1136/bmj.h6291

29. Grohskopf LA, Olsen SJ, Sokolow LZ, et al; Centers for Disease Control and Prevention. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP)-United States, 2014- 15 influenza season. MMWR Morb Mortal Wkly Rep 2014; 63: 691-697.

30. McNeil MM, DeStefano F. Vaccine-associated hypersensitivity. J Allergy Clin Immunol 2018; 141: 463-472. https://doi.org/10.1016/j.jaci.2017.12.971

31. Kattan JD, Konstantinou GN, Cox AL, et al. Anaphylaxis to diphtheria, tetanus, and pertussis vaccines among children with cow’s milk allergy. J Allergy Clin Immunol 2011; 128: 215-218. https://doi. org/10.1016/j.jaci.2011.04.046

32. Parisi CAS, Smaldini PL, Gervasoni ME, Maspero JF, Docena GH. Hypersensitivity reactions to the Sabin vaccine in children with cow’s milk allergy. Clin Exp Allergy 2013; 43: 249-254. https://doi.org/10.1111/ cea.12059

33. Bergfors E, Trollfors B. Sixty-four children with persistent itching nodules and contact allergy to aluminium after vaccination with aluminium- adsorbed vaccines-prognosis and outcome after booster vaccination. Eur J Pediatr 2013; 172: 171-177. https://doi.org/10.1007/s00431-012-1841-2

34. Bergfors E, Hermansson G, Kronander UN, Falk L, Valter L, Trollfors B. How common are long-lasting, intensely itching vaccination granulomas and contact allergy to aluminium induced by currently used pediatric vaccines? A prospective cohort study. Eur J Pediatr 2014; 173: 1297-1307. https://doi. org/10.1007/s00431-014-2318-2

35. Kwittken PL, Rosen S, Sweinberg SK. MMR vaccine and neomycin allergy. Am J Dis Child 1993; 147: 128-129. https://doi.org/10.1001/ archpedi.1993.02160260018005

36. Rietschel RL, Bernier R. Neomycin sensitivity and the MMR vaccine. JAMA 1981; 245: 571. https://doi. org/10.1001/jama.1981.03310310017008

37. Huang S, Zhu Z, Cai L, et al. Analysis on the risks of severe adverse events in rabies post-exposure prophylaxis and appropriate decision-making procedure. Hum Vaccin Immunother 2019; 15: 2121- 2125. https://doi.org/10.1080/21645515.2018.1533779

38. Russell M, Pool V, Kelso JM, Tomazic-Jezic VJ. Vaccination of persons allergic to latex: a review of safety data in the Vaccine Adverse Event Reporting System (VAERS). Vaccine 2004; 23: 664-667. https:// doi.org/10.1016/j.vaccine.2004.06.042

39. DiMiceli L, Pool V, Kelso JM, Shadomy SV, Iskander J, Team V. Vaccination of yeast sensitive individuals: review of safety data in the US vaccine adverse event reporting system (VAERS). Vaccine 2006; 24: 703- 707. https://doi.org/10.1016/j.vaccine.2005.07.069

40. FDA. Vaccines, Blood & Biologics. Thimerosal and Vaccines.Available at: https://www.fda.gov/vaccines- blood-biologics/safety-availability-biologics/ thimerosal-and-vaccines#:~:text=Thimerosal%20 i n % 2 0 Va c c i n e s - , T h i m e r o s a l % 2 0 a s % 2 0 a % 2 0 Preservative,threatening%20contamination%20 with%20harmful%20microbes (Accessed on July 3, 2013).

41. Dórea JG. Low-dose Thimerosal (ethyl-mercury) is still used in infants’ vaccines: should we be concerned with this form of exposure? J Trace Elem Med Biol 2018; 49: 134-139. https://doi.org/10.1016/j. jtemb.2018.05.010

42. Kuritzky LA, Pratt M. Systemic allergic contact dermatitis after formaldehyde-containing influenza vaccination. J Cutan Med Surg 2015; 19: 504-506. https://doi.org/10.1177/1203475415582306

43. Ring J. Exacerbation of eczema by formalin- containing hepatitis B vaccine in formaldehyde- allergic patient. Lancet 1986; 2: 522-523. https://doi. org/10.1016/S0140-6736(86)90397-1

44. Sampath V, Rabinowitz G, Shah M, et al. Vaccines and allergic reactions: the past, the current COVID-19 pandemic, and future perspectives. Allergy 2021; 76: 1640-1660. https://doi.org/10.1111/all.14840

45. Georgitis JW, Fasano MB. Allergenic components of vaccines and avoidance of vaccination-related adverse events. Curr Allergy Rep 2001; 1: 11-17. https://doi.org/10.1007/s11882-001-0091-6

46. Badiu I, Geuna M, Heffler E, Rolla G. Hypersensitivity reaction to human papillomavirus vaccine due to polysorbate 80. BMJ Case Rep 2012; 2012: bcr0220125797. https://doi.org/10.1136/ bcr.02.2012.5797

47. Banerji A, Wickner PG, Saff R, et al. mRNA vaccines to prevent COVID-19 disease and reported allergic reactions: current evidence and suggested approach. J Allergy Clin Immunol Pract 2021; 9: 1423-1437. https://doi.org/10.1016/j.jaip.2020.12.047

48. Lear JT, English JS. Anaphylaxis after hepatitis B vaccination. Lancet 1995; 345: 1249. https://doi. org/10.1016/S0140-6736(95)92039-0

49. Echeverría-Zudaire LA, Ortigosa-del Castillo L, Alonso-Lebrero E, et al. Consensus document on the approach to children with allergic reactions after vaccination or allergy to vaccine components. Allergol Immunopathol (Madr) 2015; 43: 304-325. https://doi.org/10.1016/j.aller.2015.01.004

50. Grange J. Complications of Bacille Calmette-Guerin (BCG) vaccination and immunotherapy and their management. Commun Dis Public Health 1998; 1: 84-88.

51. Rudin C, Günthard J, Halter C, Staehelin J, Berglund A. Anaphylactoid reaction to BCG vaccine containing high molecular weight dextran. Eur J Pediatr 1995; 154: 941-942. https://doi.org/10.1007/BF01957516

52. Pönnighaus J, Fine PE, Moreno C. Hypersensitivity to dextran in BCG vaccine. Lancet 1991; 337: 1039. https://doi.org/10.1016/0140-6736(91)92697-Z

53. Cuello-García CA, Pérez-Gaxiola G, Gutiérrez CJ. Treating BCG-induced disease in children. Cochrane Database Syst Rev 2013; 2013: CD008300. https://doi. org/10.1002/14651858.CD008300.pub2

54. Jacobson RM. Routine childhood vaccines given in the first 11 months of life. Mayo Clin Proc 2020; 95: 395- 405. https://doi.org/10.1016/j.mayocp.2019.06.007

55. Martı́n-Muñoz MF, Pereira MJ, Posadas S, Sánchez- Sabaté E, Blanca M, Álvarez J. Anaphylactic reaction to diphtheria-tetanus vaccine in a child: specific IgE/ IgG determinations and cross-reactivity studies. Vaccine 2002; 20: 3409-3412. https://doi.org/10.1016/ S0264-410X(02)00228-1

56. Mayorga C, Torres MJ, Corzo JL, et al. Immediate allergy to tetanus toxoid vaccine: determination of immunoglobulin E and immunoglobulin G antibodies to allergenic proteins. Ann Allergy Asthma Immunol 2003; 90: 238-243. https://doi. org/10.1016/S1081-1206(10)62148-5

57. Kumagai T, Ozaki T, Kamada M, et al. Gelatin- containing diphtheria-tetanus-pertussis (DTP) vaccine causes sensitization to gelatin in the recipients. Vaccine 2000; 18: 1555-1561. https://doi. org/10.1016/S0264-410X(99)00441-7

58. Arroabarren E, Anda M, Sanz ML. Anaphylaxis to pneumococcal vaccine; CRM (197): novel cause of vaccine allergy. Pediatr Allergy Immunol 2016; 27: 433-437. https://doi.org/10.1111/pai.12548

59. Ponvert C, Ardelean-Jaby D, Colin-Gorski AM, et al. Anaphylaxis to the 23-valent pneumococcal vaccine in child: a case-control study based on immediate responses in skin tests and specific IgE determination. Vaccine 2001; 19: 4588-4591. https:// doi.org/10.1016/S0264-410X(01)00257-2

60. Ponvert C, Scheinmann P, de Blic J. Anaphylaxis to the 23-valent pneumococcal vaccine: a second explored case by means of immediate-reading skin tests with pneumococcal vaccines. Vaccine 2010; 28: 8256-8257. https://doi.org/10.1016/j.vaccine.2010.10.031

61. Rosloff D, Sundquist B. Gelatin-induced vaccine anaphylaxis misattributed to egg allergy. Ann Allergy Asthma Immunol 2018; 121(Suppl): S77. https://doi.org/10.1016/j.anai.2018.09.251

62. Andersen DV, Jørgensen IM. MMR vaccination of children with egg allergy is safe. Dan Med J 2013; 60: A4573.

63. Yavuz ST, Sahiner UM, Sekerel BE, Tuncer A, Kalayci O, Sackesen C. Anaphylactic reactions to measles- mumps-rubella vaccine in three children with allergies to hen’s egg and cow’s milk. Acta Paediatr 2011; 100: e94-e96. https://doi.org/10.1111/j.1651- 2227.2011.02165.x

64. Nilsson L, Brockow K, Alm J, et al. Vaccination and allergy: EAACI position paper, practical aspects. Pediatr Allergy Immunol 2017; 28: 628-640. https:// doi.org/10.1111/pai.12762

65. Clark A, Skypala I, Leech SC, et al; British Society for Allergy and Clinical Immunology. British Society for Allergy and Clinical Immunology guidelines for the management of egg allergy. Clin Exp Allergy 2010; 40: 1116-1129. https://doi.org/10.1111/j.1365- 2222.2010.03557.x

66. Halsey NA, Griffioen M, Dreskin SC, et al; The Hypersensitivity Working Group of the Clinical Immunization Safety Assessment Network. Immediate hypersensitivity reactions following monovalent 2009 pandemic influenza A (H1N1) vaccines: reports to VAERS. Vaccine 2013; 31: 6107- 6112. https://doi.org/10.1016/j.vaccine.2013.09.066

67. Coop CA, Balanon SK, White KM, Whisman BA, Rathkopf MM. Anaphylaxis from the influenza virus vaccine. Int Arch Allergy Immunol 2008

68. Nagao M, Fujisawa T, Ihara T, Kino Y. Highly increased levels of IgE antibodies to vaccine components in children with influenza vaccine- associated anaphylaxis. J Allergy Clin Immunol 2016; 137: 861-867. https://doi.org/10.1016/j. jaci.2015.08.001

69. Kang JH. Effectiveness and safety of seasonal influenza vaccination in children with underlying respiratory diseases and allergy. Korean J Pediatr 2014; 57: 164-170. https://doi.org/10.3345/ kjp.2014.57.4.164

70. AAAAI. Egg Allergy and the Flu Vaccine. Available at: https://www.aaaai.org/tools-for-the-public/ conditions-library/allergies/egg-allergy-and-the-flu- vaccine (Accessed on September 15, 2021).

71. Wise RP, Salive ME, Braun MM, et al. Postlicensure safety surveillance for varicella vaccine. JAMA 2000; 284: 1271-1279. https://doi.org/10.1001/ jama.284.10.1271

72. Kumagai T, Yamanaka T, Wataya Y, et al. Gelatin- specific humoral and cellular immune responses in children with immediate-and nonimmediate- type reactions to live measles, mumps, rubella, and varicella vaccines. J Allergy Clin Immunol 1997; 100: 130-134. https://doi.org/10.1016/S0091- 6749(97)70204-5

73. Singer S, Johnson CE, Mohr R, Holowecky C. Urticaria following varicella vaccine associated with gelatin allergy. Vaccine 1999; 17: 327-329. https://doi. org/10.1016/S0264-410X(98)00209-6

74. Committee on Infectious Diseases; American Academy of Pediatrics. Prevention of rotavirus disease: updated guidelines for use of rotavirus vaccine. Pediatrics 2009; 123: 1412-1420. https://doi. org/10.1542/peds.2009-0466

75. Brotherton JM, Gold MS, Kemp AS, McIntyre PB, Burgess MA, Campbell-Lloyd S; New South Wales Health HPV Adverse Events Panel. Anaphylaxis following quadrivalent human papillomavirus vaccination. CMAJ 2008; 179: 525-533. https://doi. org/10.1503/cmaj.080916

76. Wood R, Setse R, Halsey N. Assessment of irritant skin test reactions to common vaccines. J Allergy Clin Immunol 2007; 119(Suppl): S271. https://doi. org/10.1016/j.jaci.2006.12.429

77. Kelso JM, Greenhawt MJ, Li JT, et al. Adverse reactions to vaccines practice parameter 2012 update. J Allergy Clin Immunol 2012; 130: 25-43. https://doi. org/10.1016/j.jaci.2012.04.003
Turkish Journal of Pediatrics-Cover
  • ISSN: 0041-4301
  • Yayın Aralığı: Yılda 6 Sayı
  • Başlangıç: 1958
  • Yayıncı: Hacettepe Üniversitesi Çocuk Sağlığı Enstitüsü Müdürlüğü
Sayıdaki Diğer Makaleler

Microbiological characteristics and outcomes of children with pleural empyema admitted to a tertiary hospital in southeast China, 2009-2018

Xueya ZHANG, Hailin ZHANG

Investigation of immunity against Bordetella pertussis in pregnant women and an overview of the vaccination schedule in Turkey

Serdar GÜL, Cemile SÖNMEZ, Gökçe AYVAZ, Selçuk KILIÇ

Cost and length of hospital stay for healthcare facility- onset Clostridioides Difficile infection in pediatric wards: a prospective cohort analysis

Sevliya ÖCAL DEMİR, Eda KEPENEKLİ, Gülşen AKKOÇ, Nurhayat YAKUT, Ahmet SOYSAL

The rare reason of pain in hip girdle: Mucolipidosis type 3 gamma

Abdulkerim KOLKIRAN, Beren KARAOSMANOĞLU, Zihni Ekim TAŞKIRAN, Pelin Özlem ŞİMŞEK KİPER, Gülen Eda UTİNE

Clinical characteristics, late effects and outcomes in pineoblastomas in children: a single center experience

Ömer GÖRGÜN, Başak KOÇ, Rejin KEBUDİ, Johannes E WOLFF, Abut KEBUDİ, Emin DARENDELİLER

Thiol / disulfide balance and oxidative stress parameters in pediatric patients diagnosed with acute and chronic idiopathic thrombocytopenic purpura

Yeter DÜZENLİ KAR, Zeynep Canan ÖZDEMİR, Özcan BÖR

Turkish reference ranges for the left fetal modified myocardial performance index

Kadriye YAKUT, Doğa Fatma ÖCAL, Filiz ÖZTÜRK, Merve ÖZTÜRK, Cem YAŞAR SANHAL, Şevki ÇELEN, Yaprak ÜSTÜN

A case of pediatric psoriasis achieving remission after allogenic bone marrow transplantation

Dilara GÜLER, Gülhan GÜREL, Gülsüm Şeyma YALÇIN, İbrahim EKER, İrem Nur DURUSU, Çiğdem ÖZDEMİR, Özge VURAL

Clinical follow-up of children with high vitamin B12 values: should we worry?

Davut ALBAYRAK, Canan ALBAYRAK

Tuberculosis risk in the biologic era: tuberculin skin test conversion rates in children with rheumatologic diseases

Canan ÖZLÜ, Serkan TÜRKUÇAR, Hatice KARAOĞLU ASRAK, Hatice Adıgüzel DÜNDAR, Şevket Erbil ÜNSAL, Nurşen BELET