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Patients with vaccine allergies may still safely receive doses
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Patients with vaccine allergies should have adverse reactions investigated further rather than avoiding vaccines in the future, and may still opt to receive required doses in an allergy specialist’s office, according to new guidelines from the American College of Allergy, Asthma and Immunology.
"Local injection site reactions and constitutional symptoms, especially fever, are common after vaccinations and do not contraindicate future doses," John M. Kelso, MD, of the division of allergy, asthma and immunology at Scripps Clinic in San Diego, and chief editor of the practice parameter, said in a press release.
Patients who experience anaphylaxis after receiving a vaccine should see an allergist to determine which allergen is causing the reaction, as most result from a vaccine component — such as gelatin, egg protein, yeast, latex, neomycin or thimerosal — rather than the immunizing agent itself.
The presence of any one of these components varies by vaccine, according to Kelso, and remaining aware of what vaccines contain which component, as well as a history of a patient’s allergies, should inform vaccine decisions.
For example, because gelatin is added to many vaccines as a stabilizer, Kelso recommends obtaining a history of allergy resulting from gelatin ingestion. Children with egg allergies can receive vaccines such as measles, mumps, rubella and one type of rabies vaccines without skin testing, as these vaccines contain negligible or no egg protein, but should visit an allergist for evaluation before receiving yellow fever or influenza vaccines, which contain higher amounts of this ingredient.
"However rare, if a patient gives a history of an immediate-type reaction to yeast, latex neomycin or thimerosal, we recommend that it be investigated with skin testing before immunization with a vaccine containing these constituents," Kelso said.
The new recommendations, developed by ACAAI’s Joint Task Force on Practice Parameters, the American Academy of Allergy, Asthma and Immunology and the Joint Council of Allergy, Asthma and Immunology, have important implications for patients who have had vaccine reactions in the past but are interested in receiving this year’s influenza A H1N1 vaccine.
"I believe that anyone with this concern should check with their doctor and consult with an allergist," said James T. Li, MD, professor of medicine and chair in the division of allergy and immunology at the Mayo Clinic, Rochester, Minn., and another editor of the guidelines.
Both he and Kelso emphasized the importance of reporting all serious adverse events that occur after vaccine administration to the Vaccine Adverse Event Reporting System, so that possible associations can be evaluated for causation.