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Gerhardt CMB, Castro APBM, Pastorino AC, Dorna MDB, Nunes-Santos CDJ, Aquilante BP, Miyaji KT, Lopes MH. Safety of yellow fever vaccine administration in confirmed egg-allergic patients. Vaccine 2020; 38:6539-6544. [PMID: 32829980 DOI: 10.1016/j.vaccine.2020.08.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/25/2020] [Accepted: 08/10/2020] [Indexed: 11/24/2022]
Abstract
Yellow fever vaccine (YFV) is recommended in endemic areas but represents a risk for egg-allergic patients, as it is cultivated in embryonated eggs. This study aims to describe the outcomes of yellow fever vaccination in patients with confirmed egg allergy (EA). Methods:A prospective study was conducted from January 2018 to September 2019. EA was diagnosed through positive oral food challenge (OFC), recent history of anaphylaxis following egg contact (anaphylaxis in the last 6 months) or immediate allergic reaction in the last 2 months with positive specific IgE. A skinprick test (SPT) with YFV was performed. If the SPT was negative, an intradermal test (ID) was performed at a 1:100 dilution. If the ID was negative, a full dose of YFV was administered. If the skin prick test or ID were positive, the YFV was administered using a graded dosing protocol. Results: It was included 58 patients with confirmed egg allergy (36 M:22F), with a median age of 2.3 years (0.7-13.9 y/o). Forty-two patients had a positive OFC. Nine reported recent anaphylaxis. The other 7 had reactions in the last 2 months with positive specific IgE. During OFC, 15 presented anaphylaxis, while the other 27 presented hives and/or angioedema or vomiting. SPT with YFV was negative in all patients. ID was negative in 48 patients who uneventfully received a full dose of YFV. Ten patients had a positive ID and received YFV in graded doses. Six patients presented a mild reaction controlled with antihistamines, and 4 patients received the vaccine without reactions. Positive ID was significantly related to the vaccine reaction (p < 0.0001). Administration of YFV using a specific protocol was safe even in anaphylactic patients. However, we recommend performing the ID, which can help predict a higher risk of vaccine reaction. An appropriate setting is required to control adverse events.
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Affiliation(s)
- Clarissa Morais Busatto Gerhardt
- Allergy and Immunology Division, Pediatric Department, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil.
| | - Ana Paula Beltran Moschione Castro
- Allergy and Immunology Division, Pediatric Department, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | - Antonio Carlos Pastorino
- Allergy and Immunology Division, Pediatric Department, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | - Mayra de Barros Dorna
- Allergy and Immunology Division, Pediatric Department, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | - Cristiane de Jesus Nunes-Santos
- Allergy and Immunology Division, Pediatric Department, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | - Bruna Pultrini Aquilante
- Allergy and Immunology Division, Pediatric Department, Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | - Karina Takesaki Miyaji
- Infectious and Parasitic Diseases Clinic Division, Centro de Referência para Imunobiológicos Especiais, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
| | - Marta Heloisa Lopes
- Infectious and Parasitic Diseases Clinic Division, Centro de Referência para Imunobiológicos Especiais, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP), São Paulo, SP, Brazil
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Dumortier B, Nosbaum A, Ponvert C, Nicolas JF, Bérard F. Bonne tolérance de la vaccination rougeole-oreillons-rubéole chez un enfant allergique à l’œuf et sensibilisé à la gélatine. Arch Pediatr 2013; 20:867-70. [DOI: 10.1016/j.arcped.2013.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 04/21/2013] [Accepted: 05/28/2013] [Indexed: 10/26/2022]
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