Individuals who have an allergic reaction after receiving a vaccine may be able to safely receive that vaccine again in the future provided proper precautions are taken, according to recommendations laid out in a new guideline released October 8.
The guideline’s authors said that physicians should strive to overcome allergy-related issues surrounding a particular vaccine, not only to protect the individual from certain infectious diseases but also to reduce the risk of infection in the general population. The guideline, Adverse Reactions to Vaccines, was issued by the Joint Task Force on Practice Parameters, a group representing the American Academy of Allergy, Asthma and Immunology; the American College of Allergy, Asthma and Immunology; and the Joint Council of Allergy, Asthma and Immunology (Kelso JM et al. Ann Allergy Asthma Immunol. 2009;103[4],[suppl 2]:1-14).
The authors noted that immunization is safe and that anaphylactic reactions to vaccines are rare, occurring at a rate of about 1 per million doses. Adverse reactions following most vaccinations are mediated by immunoglobulin E antibodies and are most often caused by vaccine components, such as gelatin or egg protein, rather than the immunizing agent itself.
According to the guideline, an allergist or immunologist should evaluate patients with suspected allergy to a vaccine or vaccine components by assessing immunoglobulin G (IgG) antibody levels following administration of the vaccine that caused the allergic episode. If IgG antibodies are at protective levels, the patient can avoid receiving subsequent doses; if the patient lacks protective IgG levels and future vaccination is required, the guideline recommends administering the vaccine in graded doses under observation. For example, if a usual vaccine dose is 0.5 mL, escalating doses (eg, 0.05 mL of 1:10 dilution, 0.05 mL of full strength, 0.10 mL of full strength, 0.15 mL of full strength, and 0.20 mL of full strength) should be administered at 15-minute intervals.
The guideline noted that following vaccination, mild local reactions and constitutional symptoms such as fever are common and do not contraindicate future doses. However, for patients with a history suggestive of an anaphylactic reaction, the guideline said that administering vaccine under observation, with epinephrine and other treatments available, is prudent.
In addition, the guideline warned that live vaccines should not be given to individuals who are immunocompromised because such vaccines pose a risk of generalized infection with the immunizing agent. Likewise, pregnant women should not be given a live vaccine, but they should receive inactivated influenza vaccine, as well as tetanus and hepatitis B vaccines if otherwise indicated.
The authors added that all serious adverse events following vaccine administration should be reported to the Vaccine Adverse Event Reporting system (http://vaers.hhs.gov/esub/index). They also reminded readers that epidemiological studies have not supported claims that specific vaccines or vaccination in general have such long-term consequences as atopy, autism, and multiple sclerosis.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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