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Sayed AA. Uneventful Coadministration of Seasonal Influenza and COVID-19 BNT162b2 Vaccines Two Weeks Post-Influenza Vaccination in an Egg-Allergic Subject: A Case Report. Vaccines (Basel) 2023; 11:vaccines11050950. [PMID: 37243054 DOI: 10.3390/vaccines11050950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023] Open
Abstract
The COVID-19 pandemic took the world by storm, and although it has taken the world's attention, it did not stop the spread of other communicable diseases. Seasonal influenza is a viral infection that could cause severe disease; therefore, annual influenza vaccination is highly recommended, especially among patients with a weakened immune system. However, such vaccination is contraindicated for people with hypersensitivity to the vaccine or any of its components, e.g., eggs. This paper describes a case of an egg-allergic individual who received an influenza vaccine containing egg protein, which only caused mild tenderness at the site of injection. Two weeks later, the subject received a double vaccination of a second booster dose of Pfizer-BioNTech and the seasonal influenza vaccine. The patient reported no local or systemic adverse reactions to the vaccine. This case report suggests vaccination safety for subjects with mild allergies to vaccine components.
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Affiliation(s)
- Anwar A Sayed
- Department of Medical Microbiology and Immunology, College of Medicine, Taibah University, Madinah 42353, Saudi Arabia
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Perez Chacon G, Ramsay J, Brennan-Jones CG, Estcourt MJ, Richmond P, Holt P, Snelling T. Whole-cell pertussis vaccine in early infancy for the prevention of allergy in children. Cochrane Database Syst Rev 2021; 9:CD013682. [PMID: 34693993 PMCID: PMC8543786 DOI: 10.1002/14651858.cd013682.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Atopic diseases are the most common chronic conditions of childhood. The apparent rise in food anaphylaxis in young children over the past three decades is of particular concern, owing to the lack of proven prevention strategies other than the timely introduction of peanut and egg. Due to reported in vitro differences in the immune response of young infants primed with whole-cell pertussis (wP) versus acellular pertussis (aP) vaccine, we systematically appraised and synthesised evidence on the safety and the potential allergy preventive benefits of wP, to inform recommendation for future practice and research. OBJECTIVES To assess the efficacy and safety of wP vaccinations in comparison to aP vaccinations in early infancy for the prevention of atopic diseases in children. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Embase, and grey literature. The date of the search was 7 September 2020. SELECTION CRITERIA We included randomised controlled trials (RCTs) and non-randomised studies of interventions (NRSIs) that reported the occurrence of atopic diseases, and RCTs only to assess safety outcomes. To be included studies had to have at least six months follow-up, and involve children under 18 years old, who received a first dose of either wP (experimental intervention) or aP (comparator) before six months of age. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies for eligibility, extracted the data, and assessed risk of bias using standard Cochrane methods. We assessed the certainty of the evidence using GRADE. Our primary outcomes were diagnosis of IgE-mediated food allergy and all-cause serious adverse events (SAEs). Secondary outcomes included: diagnosis of not vaccine-associated anaphylaxis or urticaria, diagnosis of asthma, diagnosis of allergic rhinitis, diagnosis of atopic dermatitis and diagnosis of encephalopathy. Due to paucity of RCTs reporting on the atopic outcomes of interest, we assessed a broader outcome domain (cumulative incidence of atopic disease) as specified in our protocol. We summarised effect estimates as risk ratios (RR) and 95% confidence intervals (CI). Where appropriate, we pooled safety data in meta-analyses using fixed-effect Mantel-Haenszel methods, without zero-cell corrections for dichotomous outcomes. MAIN RESULTS We identified four eligible studies reporting on atopic outcomes, representing 7333 children. Based on a single trial, there was uncertain evidence on whether wP vaccines affected the risk of overall atopic disease (RR 0.85, 95% CI 0.62 to 1.17) or asthma only (RR 1.04, 95% CI 0.59 to 1.82; 497 children) by 2.5 years old.Three NRSIs were judged to be at serious or critical risk of bias due to confounding, missing data, or both, and were ineligible for inclusion in a narrative synthesis. We identified 21 eligible studies (137,281 children) that reported the safety outcomes of interest. We judged seven studies to be at high risk of bias and those remaining, at unclear risk. The pooled RR was 0.94 for all-cause SAEs (95% CI 0.78 to 1.15; I2 = 0%; 15 studies, 38,072 children). For every 1000 children primed with a first dose of wP, 11 had an SAE. The corresponding risk with aP was 12 children (95% CI 9 to 13). The 95% CI around the risk difference ranged from three fewer to two more events per 1000 children, and the certainty of the evidence was judged as moderate (downgraded one level for imprecision). No diagnoses of encephalopathy following vaccination were reported (95% CI around the risk difference - 5 to 12 per 100,000 children; seven primary series studies; 115,271 children). The certainty of the evidence was judged as low, since this is a serious condition, and we could not exclude a clinically meaningful difference. AUTHORS' CONCLUSIONS There is very low-certainty evidence that a first dose of wP given early in infancy, compared to a first dose of aP, affects the risk of atopic diseases in children. The incidence of all-cause SAEs in wP and aP vaccinees was low, and no cases of encephalopathy were reported. The certainty of the evidence was judged as moderate for all-cause SAEs, and low for encephalopathy. Future studies should use sensitive and specific endpoints of clinical relevance, and should be conducted in settings with high prevalence of IgE-mediated food allergy. Safety endpoints should prioritise common vaccine reactions, parental acceptability, SAEs and their potential relatedness to the dose administered.
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Affiliation(s)
- Gladymar Perez Chacon
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- School of Public Health, Curtin University, Perth, Australia
| | - Jessica Ramsay
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | | | - Marie J Estcourt
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Peter Richmond
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- Division of Paediatrics, The University of Western Australia, Perth, Australia
| | - Patrick Holt
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Tom Snelling
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
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Navaratna S, Estcourt MJ, Burgess J, Waidyatillake N, Enoh E, Lowe AJ, Peters R, Koplin J, Dhamage SC, Lodge CJ. Childhood vaccination and allergy: A systematic review and meta-analysis. Allergy 2021; 76:2135-2152. [PMID: 33569761 DOI: 10.1111/all.14771] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 12/04/2020] [Accepted: 12/23/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND OBJECTIVE As the rise in prevalence of allergic diseases worldwide corresponds in time with increasing infant vaccination, it has been hypothesized that childhood vaccination may increase the risk of allergic disease. We aimed to synthesize the literature on the association between childhood vaccination and allergy. DESIGN We searched the electronic databases PubMed and EMBASE (January 1946-January 2018) using vaccination and allergy terms. METHODS Two authors selected papers according to the inclusion criteria. Pooled effects across studies were estimated using random-effects meta-analysis. Due to inadequate number of homogeneous publications on newer and underused vaccines, meta-analysis was limited to allergic outcomes following administration of (Bacillus Calmette-Guérin) BCG, measles or pertussis vaccination. The review was prospectively registered in the PROSPERO systematic review registry (NO: CRD42017071009). RESULTS A total of 35 publications based on cohort studies and 7 publications based on randomized controlled trials (RCTs) met the inclusion criteria. RCTs: From 2 studies, early vaccination with BCG vaccine was associated with a reduced risk of eczema (RR = 0.83; 95% CI = 0.73-0.93; I2 = 0%) but not food allergy or asthma. No association was found between pertussis vaccine and any allergic outcome based on a single RCT. COHORT STUDIES Childhood measles vaccination was associated with a reduced risk of eczema (RR = 0.65; 95% CI = 0.47-0.90, I2 = 0.0%), asthma (RR = 0.78; 95% CI = 0.62-0.98, I2 = 93.9%) and, with a similar, statistically non-significant reduction in sensitization (RR = 0.78; 95% CI = 0.61-1.01, I2 = 19.4%). CONCLUSIONS We found no evidence that childhood vaccination with commonly administered vaccines was associated with increased risk of later allergic disease. Our results from pooled analysis of both RCTs and cohort studies suggest that vaccination with BCG and measles vaccines were associated with a reduced risk of eczema.
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Affiliation(s)
- Samidi Navaratna
- Faculty of Medicine Department of Community Medicine University of Peradeniya Kandy Sri Lanka
| | - Marie J. Estcourt
- Wesfarmers Centre of Vaccines & Infectious Diseases Telethon Kids InstitutePerth Children's Hospital Nedlands Australia
| | - John Burgess
- Allergy and Lung Health Unit Centre for Epidemiology and Biostatistics Melbourne School of Population and Global Health The University of Melbourne Parkville Vic. Australia
| | - Nilakshi Waidyatillake
- Allergy and Lung Health Unit Centre for Epidemiology and Biostatistics Melbourne School of Population and Global Health The University of Melbourne Parkville Vic. Australia
| | - Elizabeth Enoh
- Reproductive Health Programme United Nations Population Fund (UNFPA) Yaounde Cameroon
| | - Adrian J. Lowe
- Allergy and Lung Health Unit Centre for Epidemiology and Biostatistics Melbourne School of Population and Global Health The University of Melbourne Parkville Vic. Australia
- Murdoch Children's Research InstituteRoyal Children’s Hospital Parkville Vic. Australia
| | - Rachel Peters
- Murdoch Children's Research InstituteRoyal Children’s Hospital Parkville Vic. Australia
- Department of Paediatrics The University of Melbourne Parkville Vic. Australia
| | - Jennifer Koplin
- Allergy and Lung Health Unit Centre for Epidemiology and Biostatistics Melbourne School of Population and Global Health The University of Melbourne Parkville Vic. Australia
- Murdoch Children's Research InstituteRoyal Children’s Hospital Parkville Vic. Australia
- Department of Paediatrics The University of Melbourne Parkville Vic. Australia
| | - Shyamali C. Dhamage
- Allergy and Lung Health Unit Centre for Epidemiology and Biostatistics Melbourne School of Population and Global Health The University of Melbourne Parkville Vic. Australia
- Murdoch Children's Research InstituteRoyal Children’s Hospital Parkville Vic. Australia
- Centre for Food and Allergy Research (CFAR) Murdoch Children’s Research Institute Parkville Vic. Australia
| | - Caroline J. Lodge
- Allergy and Lung Health Unit Centre for Epidemiology and Biostatistics Melbourne School of Population and Global Health The University of Melbourne Parkville Vic. Australia
- Murdoch Children's Research InstituteRoyal Children’s Hospital Parkville Vic. Australia
- Centre for Food and Allergy Research (CFAR) Murdoch Children’s Research Institute Parkville Vic. Australia
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Primary Prevention of Food Allergy-Environmental Protection beyond Diet. Nutrients 2021; 13:nu13062025. [PMID: 34204606 PMCID: PMC8231128 DOI: 10.3390/nu13062025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 02/07/2023] Open
Abstract
A food allergy is a potentially life-threatening disease with a genetic and environmental background. As its prevalence has increased significantly in recent years, the need for its effective prevention has been emphasized. The role of diet modifications and nutrients in food allergy reduction has been extensively studied. Much less is known about the role of other environmental factors, which can influence the incidence of this disease. Changes in neonates gut microbiome by delivery mode, animal contact, inhalant allergens, oral and then cutaneous allergen exposure, air pollution, smoking, infections and vaccinations can be the potential modifiers of food allergy development. There is some data about their role as the risk or preventive factors, but yet the results are not entirely consistent. In this paper we present the current knowledge about their possible role in primary prevention of food allergies. We discuss the mechanisms of action, difficulties in designing accurate studies about food allergy and the potential biases in interpreting the connection between environmental factors and food allergy prevention. A better understanding of the role of environmental factors in food allergies development may help in implementing practical solutions for food allergy primary prevention in the future.
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Gidengil C, Goetz MB, Newberry S, Maglione M, Hall O, Larkin J, Motala A, Hempel S. Safety of vaccines used for routine immunization in the United States: An updated systematic review and meta-analysis. Vaccine 2021; 39:3696-3716. [PMID: 34049735 DOI: 10.1016/j.vaccine.2021.03.079] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Understanding the safety of vaccines is critical to inform decisions about vaccination. Our objective was to conduct a systematic review of the safety of vaccines recommended for children, adults, and pregnant women in the United States. METHODS We searched the literature in November 2020 to update a 2014 Agency for Healthcare Research and Quality review by integrating newly available data. Studies of vaccines that used a comparator and reported the presence or absence of key adverse events were eligible. Adhering to Evidence-based Practice Center methodology, we assessed the strength of evidence (SoE) for all evidence statements. The systematic review is registered in PROSPERO (CRD42020180089). RESULTS Of 56,603 reviewed citations, 338 studies reported in 518 publications met inclusion criteria. For children, SoE was high for no increased risk of autism following measles, mumps, and rubella (MMR) vaccine. SoE was high for increased risk of febrile seizures with MMR. There was no evidence of increased risk of intussusception with rotavirus vaccine at the latest follow-up (moderate SoE), nor of diabetes (high SoE). There was no evidence of increased risk or insufficient evidence for key adverse events for newer vaccines such as 9-valent human papillomavirus and meningococcal B vaccines. For adults, there was no evidence of increased risk (varied SoE) or insufficient evidence for key adverse events for the new adjuvanted inactivated influenza vaccine and recombinant adjuvanted zoster vaccine. We found no evidence of increased risk (varied SoE) for key adverse events among pregnant women following tetanus, diphtheria, and acellular pertussis vaccine, including stillbirth (moderate SoE). CONCLUSIONS Across a large body of research we found few associations of vaccines and serious key adverse events; however, rare events are challenging to study. Any adverse events should be weighed against the protective benefits that vaccines provide.
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Affiliation(s)
- Courtney Gidengil
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA 02116, United States; Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Matthew Bidwell Goetz
- VA Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90073, United States
| | - Sydne Newberry
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Margaret Maglione
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Owen Hall
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Jody Larkin
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Aneesa Motala
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States; Southern California Evidence Review Center, University of Southern California, Keck School of Medicine, 2001 N Soto Street, Los Angeles, CA 90033, United States
| | - Susanne Hempel
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States; Southern California Evidence Review Center, University of Southern California, Keck School of Medicine, 2001 N Soto Street, Los Angeles, CA 90033, United States
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Ayasse M, Ahmed A, McCullum C, Espinosa ML, Paller AS, Silverberg JI. Vaccines do not cause atopic dermatitis: A systematic review and meta-analysis. Vaccine 2021; 39:1805-1811. [PMID: 33648762 DOI: 10.1016/j.vaccine.2021.02.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/11/2021] [Accepted: 02/13/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Previous studies found conflicting results about the association of vaccinations and likelihood of atopic dermatitis (AD). OBJECTIVES To determine whether vaccinations increase the likelihood of AD. METHODS A systematic review was performed of all published studies in MEDLINE, EMBASE, LILACS, Scopus, and Web of Science databases. At least 2 reviewers conducted title/abstract, full-text review, and data extraction. Quality of evidence was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS Forty-four studies met inclusion criteria; 37 had sufficient data for meta-analysis. There were no associations any vaccine regimen (random-effects logistic regression: odds ratio [95% confidence interval]: 0.961 [0.822-1.124]; n = 21 studies) BCG (0.927 [0.701-1.226]; n = 8), pertussis (0.790 [0.416-1.499]; n = 4), single (1.031 [0.920-1.155]; n = 17) or multiple vaccines (0.902 [0.608-1.338]; n = 7) with likelihood of AD. This remained true in studies with high-quality (NOS ≥ 7) (OR [95% CI]: 0.941 [0.793-1.117]; n = 13 studies) or low-quality (NOS < 7) (OR [95% CI]: 1.058 [0.669-1.674]; n = 8 studies). LIMITATIONS No randomized controlled trials. CONCLUSIONS No vaccine regimen was consistently associated with developing AD.
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Affiliation(s)
- Marissa Ayasse
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Adnan Ahmed
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Catherine McCullum
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Maria L Espinosa
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Amy S Paller
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
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Gehrt L, Rieckmann A, Kiraly N, Jensen AKG, Aaby P, Benn CS, Sørup S. Timeliness of DTaP-IPV-Hib Vaccination and Development of Atopic Dermatitis Between 4 Months and 1 Year of Age-Register-Based Cohort Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1520-1528.e8. [PMID: 33011301 DOI: 10.1016/j.jaip.2020.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 08/24/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND An Australian study including 4433 children found that delayed Diphtheria-Tetanus-acellular Pertussis-containing vaccination was associated with reduced risk of developing atopic dermatitis (AD) before age 1 year. OBJECTIVE We assessed whether delayed vaccination against diphtheria, tetanus, acellular pertussis, polio, and Haemophilus influenzae type b (Diphtheria, Tetanus, acellular Pertussis - Inactivated Polio vaccine - Haemophilus influenzae type b [DTaP]) was associated with a reduced risk of new cases of AD before age 1 year in Denmark. METHODS We used nationwide registers to follow 883,160 children born in Denmark from 1997 to 2012. Binary regression models adjusting for potential confounding factors were applied to estimate relative risks (adjusted relative risks [aRRs]) of developing AD among children with delayed DTaP vaccination (defined as given 1 month or more after the recommended age) compared with timely vaccinated children. RESULTS Among 143,429 children with a delayed first dose of DTaP, 4,847 (3.4%) developed AD between age 4 months and 1 year, compared with 27,628 (3.7%) among 739,731 children not having delayed DTaP (aRR 0.94; 95% CI, 0.91-0.97). The aRR was 0.94 (95% CI, 0.90-0.99) for children with a delayed second dose, and the aRR was 0.88 (95% CI, 0.82-0.93) when comparing children with delayed first and second doses with all timely vaccinated children. CONCLUSIONS The results support the hypothesis that delayed vaccination with DTaP is associated with reduced risk of developing new cases of AD after age 4 months. The dose-dependent relationship strengthens the evidence of a causal relationship. Some countries are introducing maternal pertussis vaccination and delaying the first dose of DTaP, providing a possibility for further testing the hypothesis.
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Affiliation(s)
- Lise Gehrt
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Copenhagen, Denmark; OPEN, Open Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Andreas Rieckmann
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Copenhagen, Denmark; Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nicholas Kiraly
- Gastro and Food Allergy, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia
| | - Aksel Karl Georg Jensen
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Copenhagen, Denmark; Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Peter Aaby
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Copenhagen, Denmark; Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau
| | - Christine Stabell Benn
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Copenhagen, Denmark; OPEN, Open Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
| | - Signe Sørup
- Research Center for Vitamins and Vaccines (CVIVA), Statens Serum Institut, Copenhagen, Denmark; Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
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Yamoah P, Bangalee V, Oosthuizen F. A review of the safety of vaccines used in routine immunization in Africa. Afr Health Sci 2020; 20:227-237. [PMID: 33402911 PMCID: PMC7750064 DOI: 10.4314/ahs.v20i1.28] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite the significant role played by vaccines in global health, concerns over vaccine safety have increased tremendously over the years. There have been occasions where vaccines have caused rare, adverse reactions some of which have led to hospitalizations and even death. It is therefore important to establish the safety profile of routinely used vaccines in order to allay fears pertaining to their use. OBJECTIVES This review was aimed at pooling together the safety data of selected vaccines used for routine immunization in Africa, a region of the world with paucity of vaccine safety data. METHODS Adverse Events Following Immunization safety data was searched for rotavirus, yellow fever, measles, rubella, tuberculosis (Bacillus Calmette Guerin-BCG), pneumococcal, Haemophilus Influenza type b, polio, meningococcal and the influenza A (H1N1) vaccines in PUBMED, Google Scholar, Clinical trials.gov and Cochrane controlled register of trials databases. RESULTS A total of twenty-four serious AEFIs and twenty-three minor AEFIs were identified from the review. The strength of association between AEFIs and vaccine was high for tuberculosis vaccine and moderate for all other vaccines. CONCLUSION Even though AEFIs (including mild and severe) were identified in the review, all the vaccines studied were generally well tolerated.
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Affiliation(s)
- Peter Yamoah
- School of Pharmacy, University of Health and Allied Sciences, Ghana
- College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Varsha Bangalee
- College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Frasia Oosthuizen
- College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
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Allergien und Impfungen. ALLERGO JOURNAL 2019. [DOI: 10.1007/s15007-019-1989-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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10
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Allergie und Impfen — ein Mythos entmystifiziert. ALLERGO JOURNAL 2018. [DOI: 10.1007/s15007-018-1707-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Swartz J, Aronsson B, Lindblad F, Järnbert-Pettersson H, Scheynius A, Pershagen G, Alm J. Vaccination and Allergic Sensitization in Early Childhood - The ALADDIN Birth Cohort. EClinicalMedicine 2018; 4-5:92-98. [PMID: 31193660 PMCID: PMC6537579 DOI: 10.1016/j.eclinm.2018.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/24/2018] [Accepted: 10/15/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The increasing incidence of allergic diseases highlights the importance of finding underlying mechanisms. Early vaccination has been suggested as one influential factor. However, it is difficult to find a study group with a large variation between subjects concerning compliance to the official vaccination program. The anthroposophic lifestyle is of interest in this context. Moreover, cohort studies show that children of families with this lifestyle run a lower risk of allergic sensitization and allergy-related disease. METHODS From the prospective birth cohort ALADDIN we included one group from the anthroposophic community, with restrictive attitudes concerning vaccinations, and two other groups of age-matched children with more conventional parental lifestyles. In all, 466 children were followed from birth to five years of age. Detailed vaccination data and blood samples were collected at six months, one, two, and five years. Information was also obtained on risk factors for allergy. The outcome variable, allergic sensitization was defined as allergen-specific serum IgE levels ≥ 0.35 kUA/L. FINDINGS In a logistic regression model adjusted for socio-demographics and established allergy risk factors, vaccination at later age or having a lower number of injections or vaccines were associated with low OR for allergic sensitization during the first year of life. However, after adjustment for anthroposophic lifestyle, no statistically significant associations remained. The adjusted OR for sensitization at five years of age in children not receiving any vaccinations (n = 54) was 0.98 [95% CI 0.38-2.57]. INTERPRETATION We found no support for an association between early childhood vaccination and subsequent allergic sensitization. Our findings do not support scepticism towards early childhood vaccination motivated by allergy risk.
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Key Words
- ALADDIN
- ALADDIN, Assessment of Lifestyle and Allergic Diseases During INfancy
- Allergic sensitization
- Anthroposophic lifestyle
- DPPT, Diphtheria, Pertussis, Polio, Tetanus
- DTP, Diphtheria, Tetanus, Pertussis
- DTaP, Diphtheria, Tetanus, acellular Pertussis
- Early childhood
- MCHC, Maternal and Child Healthcare Centres
- MMR, Measles, Mumps, Rubella
- NIP, the National Swedish Immunization Program
- OR, odds ratio
- Pentavac™, Diphtheria, Tetanus, Pertussis, Polio, Haemophilus influenzae type b
- Tetravac™, Diphtheria, Tetanus, Pertussis, Polio
- Vaccination
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Affiliation(s)
- Jackie Swartz
- Vidarkliniken, Järna, Sweden
- Corresponding author at: Child and Adolescent Psychiatrist, GP, Vidarkliniken, SE-15391 Järna, Sweden.
| | - Bernice Aronsson
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Frank Lindblad
- Department of Neuroscience, Child and Adolescent Psychiatry, Uppsala University, Uppsala, Sweden
| | - Hans Järnbert-Pettersson
- Karolinska Institutet, Department of Clinical Science and Education Södersjukhuset, Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Annika Scheynius
- Karolinska Institutet, Department of Clinical Science and Education Södersjukhuset, Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
- Clinical Genomics, SciLifeLab, Stockholm, Sweden
| | - Göran Pershagen
- Karolinska Institutet, Institute of Environmental Medicine, Stockholm, Sweden
| | - Johan Alm
- Karolinska Institutet, Department of Clinical Science and Education Södersjukhuset, Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
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Nilsson LJ. No increased sensitization from early vaccination of infants: a prospective study of infant vaccination in anthroposophical families. EClinicalMedicine 2018; 4-5:8-9. [PMID: 31193625 PMCID: PMC6537531 DOI: 10.1016/j.eclinm.2018.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 11/26/2022] Open
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14
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Kaufman AJ. Atopic Dermatitis. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00072-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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15
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Nilsson L, Brockow K, Alm J, Cardona V, Caubet JC, Gomes E, Jenmalm MC, Lau S, Netterlid E, Schwarze J, Sheikh A, Storsaeter J, Skevaki C, Terreehorst I, Zanoni G. Vaccination and allergy: EAACI position paper, practical aspects. Pediatr Allergy Immunol 2017; 28:628-640. [PMID: 28779496 DOI: 10.1111/pai.12762] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 01/15/2023]
Abstract
Immunization is highly effective in preventing infectious diseases and therefore an indispensable public health measure. Allergic patients deserve access to the same publicly recommended immunizations as non-allergic patients unless risks associated with vaccination outweigh the gains. Whereas the number of reported possible allergic reactions to vaccines is high, confirmed vaccine-triggered allergic reactions are rare. Anaphylaxis following vaccination is rare, affecting <1/100 000, but can occur in any patient. Some patient groups, notably those with a previous allergic reaction to a vaccine or its components, are at heightened risk of allergic reaction and require special precautions. Allergic reactions, however, may occur in patients without known risk factors and cannot be predicted by currently available tools. Unwarranted fear and uncertainty can result in incomplete vaccination coverage for children and adults with or without allergy. In addition to concerns about an allergic reaction to the vaccine itself, there is fear that routine childhood immunization may promote the development of allergic sensitization and disease. Thus, although there is no evidence that routine childhood immunization increases the risk of allergy development, such risks need to be discussed.
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Affiliation(s)
| | - Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technical University Munich, Munich, Germany
| | - Johan Alm
- Sachs' Children and Youth Hospital and Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Maria C Jenmalm
- Unit of Autoimmunity and Immune Regulation, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Susanne Lau
- Pediatric Pneumology and Immunology, Charité Universitätsmedizin, Berlin, Germany
| | - Eva Netterlid
- Department of Occupational and Environmental Dermatology, Lund University, Malmö, Sweden.,The Public Health Agency of Sweden, Stockholm, Sweden
| | - Jürgen Schwarze
- Child Life & Health and MRC-Centre for Inflammation Research, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | | | - Chrysanthi Skevaki
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Philipps University Marburg, University Hospital Giessen and Marburg GmbH, Marburg, Germany
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Janjanam VD, Mukherjee N, Lockett GA, Rezwan FI, Kurukulaaratchy R, Mitchell F, Zhang H, Arshad H, Holloway JW, Karmaus W. Tetanus vaccination is associated with differential DNA-methylation: Reduces the risk of asthma in adolescence. Vaccine 2016; 34:6493-6501. [PMID: 27866770 DOI: 10.1016/j.vaccine.2016.10.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 08/19/2016] [Accepted: 10/26/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Vaccinations have been suggested to be associated with increased risk of allergic diseases. Tetanus vaccination is one of the most frequently administered vaccines as a part of wound management and was also found to be associated with increased serum IgE levels. We hypothesized that the vaccination modifies the risk of allergic diseases through epigenetic changes such as DNA methylation. METHOD Data on tetanus vaccination between 10 and 18years of age was collected from a birth cohort established on the Isle of Wight UK in 1989. DNA methylation data were collected from individuals at different ages (at birth [n=30], age 10 [n=34], age 18 [n=245] and during pregnancy [n=121]) using the Illumina Infinium HumanMethylation450K array. Firstly, we performed an epigenome-wide screening to identify cytosine-phosphate-guanine sites (CpGs) associated with tetanus vaccination in 18-year-olds. Secondly, we tested their association with asthma, allergic sensitization, eczema, serum IgE and pulmonary lung function (FVC, FEV1, FEV1/FVC, and FEF25-75%). We then described changes in the methylation of the selected CpG sites over age, and by vaccination status. RESULTS Tetanus vaccination was found to be associated with decreased methylation of cg14472551 (p value 0.5×10-5, FDR-adjusted p value 2.1×10-4) and increased methylation of cg01669161 (p value 0.0007, FDR-adjusted p value 0.014). Both CpGs, in turn, were associated with decreased risk of asthma at 18years of age. Cg14472551 is located in an intron of KIAA1549L, whose protein binds to a B-cell commitment transcription factor; cg01669161 is located between an antisense regulator of the proteasome assembly chaperone PSMG3, and TFAMP1, a pseudogene. Increased methylation of cg01669161 was also associated with decreased serum IgE levels. CONCLUSION DNA methylation changes following tetanus vaccination may offer a novel prospect to explain a differential occurrence of asthma in adolescence.
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Affiliation(s)
- Vimala Devi Janjanam
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, 236A Robison Hall, Memphis, TN 38152, USA.
| | - Nandini Mukherjee
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, 236A Robison Hall, Memphis, TN 38152, USA.
| | - Gabrielle A Lockett
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
| | - Faisal I Rezwan
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
| | - Ramesh Kurukulaaratchy
- The David Hide Asthma and Allergy Research Centre, St Mary's, Hospital, Parkhurst Road, Newport, Isle of Wight PO30 5TG, UK; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; NIHR Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton SO16 6YD, UK.
| | - Frances Mitchell
- The David Hide Asthma and Allergy Research Centre, St Mary's, Hospital, Parkhurst Road, Newport, Isle of Wight PO30 5TG, UK.
| | - Hongmei Zhang
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, 236A Robison Hall, Memphis, TN 38152, USA.
| | - Hasan Arshad
- The David Hide Asthma and Allergy Research Centre, St Mary's, Hospital, Parkhurst Road, Newport, Isle of Wight PO30 5TG, UK; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; NIHR Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton SO16 6YD, UK.
| | - John W Holloway
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
| | - Wilfried Karmaus
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, 236A Robison Hall, Memphis, TN 38152, USA.
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Abstract
BACKGROUND Recent studies reported that infection by varicella zoster virus (VZV) may lead to delayed onset of asthma in children/adolescents. This information will likely alter the cost-effectiveness of the US. VZV vaccination program. We created a decision analysis model to estimate the costs and health-related effects of VZV 2-dose vaccination, assuming VZV infection delays asthma onset. METHODS The Markov model considered a birth cohort of 3,957,577 individuals entering the population from a societal perspective. We predicted the number of asthma/VZV cases, asthma-/VZV-related mortality and costs associated with asthma/VZV. Comparison arms included (1) VZV vaccination program without delayed asthma onset, (2) VZV vaccination program with delayed asthma onset and (3) no VZV vaccination program with delayed asthma onset. We considered delayed onset ranging from 3 to 12 years. RESULTS The vaccination program proved cost-effective without an assumed delay in asthma onset. When the vaccination and no-vaccination arms were compared assuming delayed asthma onset, vaccination remained less costly despite increased savings related to asthma without vaccination. With delayed asthma onset of 9 years post VZV infection, cost savings due to vaccination were $914.09 million, with 9984 cases of asthma averted and 9 greater overall deaths with vaccination. CONCLUSION VZV vaccination program was less costly than the "no-vaccination" scenario, despite delayed onset of asthma post VZV infection. However, vaccination resulted in increased asthma morbidity and mortality. This adds to current evidence that VZV vaccination is cost-effective, and may alter asthma-related health-care outcomes. VZV's effect on asthma symptoms still needs further evaluation before firm conclusions can be reached.
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Kiraly N, Koplin JJ, Crawford NW, Bannister S, Flanagan KL, Holt PG, Gurrin LC, Lowe AJ, Tang MLK, Wake M, Ponsonby AL, Dharmage SC, Allen KJ. Timing of routine infant vaccinations and risk of food allergy and eczema at one year of age. Allergy 2016; 71:541-9. [PMID: 26707796 DOI: 10.1111/all.12830] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Epidemiological evidence suggests that routine vaccinations can have nontargeted effects on susceptibility to infections and allergic disease. Such effects may depend on age at vaccination, and a delay in pertussis vaccination has been linked to reduced risk of allergic disease. We aimed to test the hypothesis that delay in vaccines containing diphtheria-tetanus-acellular pertussis (DTaP) is associated with reduced risk of food allergy and other allergic diseases. METHODS HealthNuts is a population-based cohort in Melbourne, Australia. Twelve-month-old infants were skin prick-tested to common food allergens, and sensitized infants were offered oral food challenges to determine food allergy status. In this data linkage study, vaccination data for children in the HealthNuts cohort were obtained from the Australian Childhood Immunisation Register. Associations were examined between age at the first dose of DTaP and allergic disease. RESULTS Of 4433 children, 109 (2.5%) received the first dose of DTaP one month late (delayed DTaP). Overall, delayed DTaP was not associated with primary outcomes of food allergy (adjusted odds ratio (aOR) 0.77; 95% CI: 0.36-1.62, P = 0.49) or atopic sensitization (aOR: 0.66; 95% CI: 0.35-1.24, P = 0.19). Amongst secondary outcomes, delayed DTaP was associated with reduced eczema (aOR: 0.57; 95% CI: 0.34-0.97, P = 0.04) and reduced use of eczema medication (aOR: 0.45; 95% CI: 0.24-0.83, P = 0.01). CONCLUSIONS There was no overall association between delayed DTaP and food allergy; however, children with delayed DTaP had less eczema and less use of eczema medication. Timing of routine infant immunizations may affect susceptibility to allergic disease.
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Affiliation(s)
- N. Kiraly
- Gastro & Food Allergy; Murdoch Childrens Research Institute; Parkville VIC Australia
- Department of General Medicine; The Royal Children's Hospital; Parkville VIC Australia
| | - J. J. Koplin
- Gastro & Food Allergy; Murdoch Childrens Research Institute; Parkville VIC Australia
- Melbourne School of Population and Global Health; The University of Melbourne; Carlton VIC Australia
| | - N. W. Crawford
- Department of General Medicine; The Royal Children's Hospital; Parkville VIC Australia
- SAEFVIC; Murdoch Childrens Research Institute; Parkville VIC Australia
- Department of Paediatrics; The University of Melbourne; Parkville VIC Australia
| | - S. Bannister
- Department of General Medicine; The Royal Children's Hospital; Parkville VIC Australia
| | - K. L. Flanagan
- Department of Immunology; Monash University; Prahran VIC Australia
| | - P. G. Holt
- Telethon Institute for Child Health Research; University of Western Australia; Perth, WA Australia
- Queensland Children's Medical Research Institute; University of Queensland; Brisbane QLD Australia
| | - L. C. Gurrin
- Gastro & Food Allergy; Murdoch Childrens Research Institute; Parkville VIC Australia
- Melbourne School of Population and Global Health; The University of Melbourne; Carlton VIC Australia
| | - A. J. Lowe
- Gastro & Food Allergy; Murdoch Childrens Research Institute; Parkville VIC Australia
- Melbourne School of Population and Global Health; The University of Melbourne; Carlton VIC Australia
| | - M. L. K. Tang
- Department of Paediatrics; The University of Melbourne; Parkville VIC Australia
- Allergy & Immune Disorders; Murdoch Childrens Research Institute; Manchester UK
- Department of Allergy and Immunology; The Royal Children's Hospital; Manchester UK
| | - M. Wake
- Department of Paediatrics; The University of Melbourne; Parkville VIC Australia
- Community Health Services Research; Murdoch Childrens Research Institute; Manchester UK
- The Centre for Community Child Health; The Royal Children's Hospital; Manchester UK
| | - A.-L. Ponsonby
- Department of Paediatrics; The University of Melbourne; Parkville VIC Australia
- Environmental & Genetic Epidemiology Research; Murdoch Childrens Research Institute; Manchester UK
| | - S. C. Dharmage
- Gastro & Food Allergy; Murdoch Childrens Research Institute; Parkville VIC Australia
- Melbourne School of Population and Global Health; The University of Melbourne; Carlton VIC Australia
| | - K. J. Allen
- Gastro & Food Allergy; Murdoch Childrens Research Institute; Parkville VIC Australia
- Department of Paediatrics; The University of Melbourne; Parkville VIC Australia
- Department of Allergy and Immunology; The Royal Children's Hospital; Manchester UK
- Institute of Inflammation and Repair; University of Manchester; Manchester UK
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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; 33:1602-7. [PMID: 25698493 DOI: 10.1016/j.vaccine.2015.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 02/03/2015] [Accepted: 02/04/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anaphylaxis is a rare life-threatening adverse event following immunization (AEFI). Variability in presentation can make differentiation between anaphylaxis and other AEFI difficult. This study summarizes pediatric anaphylaxis AEFI reported to an Australian state-based passive surveillance system. METHODS All suspected and reported pediatric (<18 years) anaphylaxis AEFI notified to SAEFVIC (Surveillance of Adverse Events Following Vaccination In the Community) Melbourne, Australia, between May 2007 to May 2013 were analyzed. Clinical descriptions of the AEFI, using the internationally recognized Brighton Collaboration case definition (BCCD) and final outcome were documented. RESULTS 93% (25/27) of AEFI classified as anaphylaxis met BCCD criteria, with 36% (9/25), assessed as the highest level of diagnostic certainty (Level 1). Median age was 4.7 years (range 0.3-16.2); 48% of cases were male. The vaccine antigens administered included: diphtheria, tetanus, acellular pertussis (DTaP) alone or in combination vaccines containing other antigens in 11 of 25 cases (44%); and live attenuated measles mumps rubella (MMR) vaccine for six (five also had other vaccines concomitantly administered). The estimated incidence rate of anaphylaxis for DTaP vaccines was 0.36 cases per 100,000 doses, and 1.25 per 100,000 doses for MMR vaccines. The majority of cases had rapid onset, but in 24% (6/25) of cases, first symptoms of anaphylaxis developed ≥30 min after immunization. In 60% (15/25) of cases, symptoms resolved ≤60 min of presentation. Intramuscular adrenaline was administered in 90% (18/25) of cases. All cases made a full recovery with no sequelae identified. CONCLUSION This comprehensive case series of pediatric anaphylaxis as an AEFI identified that diagnostic criteria are useful when applied to a passive vaccine surveillance system when adequate clinical information is available. Anaphylaxis as an AEFI is rare and usually begins within 30 min of vaccination. However, healthcare professionals and vaccinees/parents should be aware that onset of anaphylaxis can be delayed beyond 30 min following immunization and that medical attention should be sought promptly if anaphylaxis is suspected.
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Affiliation(s)
- Daryl R Cheng
- Department of General Medicine, The Royal Children's Hospital, Melbourne, VIC, Australia; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Kirsten P Perrett
- Department of General Medicine, The Royal Children's Hospital, Melbourne, VIC, Australia; Vaccine and Immunisation Research Group (VIRGo), Murdoch Childrens Research Institute and Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Sharon Choo
- Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Margie Danchin
- Department of General Medicine, The Royal Children's Hospital, Melbourne, VIC, Australia; Vaccine and Immunisation Research Group (VIRGo), Murdoch Childrens Research Institute and Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia; Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Jim P Buttery
- SAEFVIC, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Nigel W Crawford
- Department of General Medicine, The Royal Children's Hospital, Melbourne, VIC, Australia; Department of Pediatrics, The University of Melbourne, Melbourne, VIC, Australia; SAEFVIC, Murdoch Children's Research Institute, Melbourne, VIC, Australia
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Broderick MP, Oberste MS, Moore D, Romero-Steiner S, Hansen CJ, Faix DJ. Effect of multiple, simultaneous vaccines on polio seroresponse and associated health outcomes. Vaccine 2014; 33:2842-8. [PMID: 25131729 DOI: 10.1016/j.vaccine.2014.07.088] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 07/03/2014] [Accepted: 07/30/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Administration of multiple simultaneous vaccines to infants, children, and military recruits is not uncommon. However, little research exists to examine associated serological and health effects, especially in adults. METHOD We retrospectively examined 416 paired serum specimens from U.S. military subjects who had received the inactivated polio vaccine (IPV) alone or in combination with either 1 other vaccine (<3 group) or 4 other vaccines (>4 group). Each of the 2 groups was subdivided into 2 subgroups in which Tdap was present or absent. RESULTS The >4 group was associated with a higher proportion of polio seroconversions than the <3 group (95% vs. 58%, respectively, p<0.01). Analysis of the <3 subgroup that excluded Tdap vs. the >4 subgroup that excluded Tdap showed no difference between them (p>0.1). However, the >4 subgroup that included Tdap had significantly more seroconversions than either the <3 subgroup that excluded Tdap or the >4 subgroup that excluded Tdap (p<0.01). Overall, at least 98% of subjects were at or above the putative level of seroprotection both pre- and post-vaccination, yet at least 81% of subjects seroconverted. In an analysis of 400 of the subjects in which clinic in- and outpatient encounters were counted over the course of 1 year following vaccinations, there was no significant difference between the 2 groups (p>0.1). CONCLUSION A combination of >4 vaccines including IPV appeared to have an immunopotentiation effect on polio seroconversion, and Tdap in particular was a strong candidate for an important role. The dose of IPV we studied in our subjects, who already had a high level of seroprotection, acted as a booster. In addition, there appear to be no negative health consequences from receiving few versus more multiple simultaneous vaccinations.
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Affiliation(s)
- Michael P Broderick
- Operational Infectious Diseases Department, Naval Health Research Center, McClelland & Patterson Roads, Gate 4 / Bldg 315, San Diego, CA 92106 USA.
| | - M Steven Oberste
- PPLB/DVD/NCIRD Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop G-17, Atlanta, GA 30333 USA
| | - Deborah Moore
- PPLB/DVD/NCIRD Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop G-17, Atlanta, GA 30333 USA
| | - Sandra Romero-Steiner
- PPLB/DVD/NCIRD Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop G-17, Atlanta, GA 30333 USA
| | - Christian J Hansen
- Operational Infectious Diseases Department, Naval Health Research Center, McClelland & Patterson Roads, Gate 4 / Bldg 315, San Diego, CA 92106 USA
| | - Dennis J Faix
- Operational Infectious Diseases Department, Naval Health Research Center, McClelland & Patterson Roads, Gate 4 / Bldg 315, San Diego, CA 92106 USA
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Maglione MA, Das L, Raaen L, Smith A, Chari R, Newberry S, Shanman R, Perry T, Goetz MB, Gidengil C. Safety of vaccines used for routine immunization of U.S. children: a systematic review. Pediatrics 2014; 134:325-37. [PMID: 25086160 DOI: 10.1542/peds.2014-1079] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Concerns about vaccine safety have led some parents to decline recommended vaccination of their children, leading to the resurgence of diseases. Reassurance of vaccine safety remains critical for population health. This study systematically reviewed the literature on the safety of routine vaccines recommended for children in the United States. METHODS Data sources included PubMed, Advisory Committee on Immunization Practices statements, package inserts, existing reviews, manufacturer information packets, and the 2011 Institute of Medicine consensus report on vaccine safety. We augmented the Institute of Medicine report with more recent studies and increased the scope to include more vaccines. Only studies that used active surveillance and had a control mechanism were included. Formulations not used in the United States were excluded. Adverse events and patient and vaccine characteristics were abstracted. Adverse event collection and reporting was evaluated by using the McHarm scale. We were unable to pool results. Strength of evidence was rated as high, moderate, low, or insufficient. RESULTS Of 20 478 titles identified, 67 were included. Strength of evidence was high for measles/mumps/rubella (MMR) vaccine and febrile seizures; the varicella vaccine was associated with complications in immunodeficient individuals. There is strong evidence that MMR vaccine is not associated with autism. There is moderate evidence that rotavirus vaccines are associated with intussusception. Limitations of the study include that the majority of studies did not investigate or identify risk factors for AEs; and the severity of AEs was inconsistently reported. CONCLUSIONS We found evidence that some vaccines are associated with serious AEs; however, these events are extremely rare and must be weighed against the protective benefits that vaccines provide.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Matthew Bidwell Goetz
- VA Greater Los Angeles Healthcare System and David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and
| | - Courtney Gidengil
- RAND Corporation, Santa Monica, California;Boston Children's Hospital, Boston, Massachusetts
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Batista-Duharte A, Portuondo D, Pérez O, Carlos IZ. Systemic immunotoxicity reactions induced by adjuvanted vaccines. Int Immunopharmacol 2014; 20:170-80. [DOI: 10.1016/j.intimp.2014.02.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 02/04/2014] [Accepted: 02/21/2014] [Indexed: 02/08/2023]
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Does BCG vaccination protect against childhood asthma? Final results from the Manchester Community Asthma Study retrospective cohort study and updated systematic review and meta-analysis. J Allergy Clin Immunol 2013; 133:688-95.e14. [PMID: 24084077 DOI: 10.1016/j.jaci.2013.08.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 08/13/2013] [Accepted: 08/15/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND The Manchester Community Asthma Study (MANCAS) found a protective effect against the risk of wheeze at age 6 to 11 years for children given neonatal BCG vaccination. Our subsequent systematic review and meta-analysis suggested that BCG vaccination did not protect against allergic sensitization but might have exerted a protective effect against nonatopic asthma. OBJECTIVES We sought to assess whether the protective effect of BCG vaccination on wheeze observed in the MANCAS cohort was maintained at age 13 to 17 years and to incorporate the findings from this final MANCAS analysis into an updated systematic review and meta-analysis. METHODS BCG vaccination status was determined from health records and respiratory outcomes from questionnaire responses. We updated the systematic review and used fixed-effects and random-effects modeling to undertake meta-analyses. RESULTS There were 1608 participants in the final MANCAS analysis. The 12-month prevalence of wheeze was 15.1%. There was no difference in prevalence between those who were and were not BCG vaccinated (15.8% vs 14.3%; relative risk, 1.05; 95% CI, 0.94-1.19). The updated meta-analysis incorporated 4 new studies: this showed that the protective effect of BCG vaccination against the development of asthma identified in our previous meta-analysis was attenuated (odds ratio, 0.95; 95% CI, 0.89-1.00). No protective effect of BCG was seen for sensitization, eczema/atopic dermatitis, rhinoconjunctivitis, or allergy in general. CONCLUSIONS Taken together, the final results of the MANCAS cohort and the updated systematic review and meta-analysis provide clearer evidence that any protective effect of BCG vaccination on childhood asthma is likely to be transient.
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Kiraly N, Benn CS, Biering-Sørensen S, Rodrigues A, Jensen KJ, Ravn H, Allen KJ, Aaby P. Vitamin A supplementation and BCG vaccination at birth may affect atopy in childhood: long-term follow-up of a randomized controlled trial. Allergy 2013; 68:1168-76. [PMID: 23991838 DOI: 10.1111/all.12216] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Recent evidence suggests that immunogenic interventions such as vaccines and micronutrients may affect atopic sensitization and atopic disease. We aimed to determine whether neonatal BCG vaccination, vitamin A supplementation and other vaccinations affect atopy in childhood. METHODS In Guinea-Bissau, low-birthweight infants were randomized to early (intervention) or delayed (usual policy) BCG. A subgroup was also randomly assigned vitamin A supplementation or placebo in a two-by-two factorial design. Participants were followed up at age 3-9 years. The main outcome was atopy defined as skin prick test reaction ≥3 mm. Secondary outcomes were symptoms of eczema, asthma and food allergy. RESULTS Two hundred eighty-one children had valid skin prick tests performed, and 14% (39/281) were atopic. There was no significant difference in atopy between the early and delayed BCG groups (OR, 0.71; 95% CI, 0.34-1.47). Atopy was significantly reduced in children who had responded to BCG with a scar (OR, 0.42; 0.19-0.94). Vitamin A supplementation was associated with increased atopy (OR, 2.88; 1.26-6.58), especially in those who received simultaneous BCG (5.99; 1.99-18.1, P = 0.09 for interaction between vitamin A supplementation and BCG). Early vs delayed BCG was not associated with symptoms of atopic disease, but vitamin A supplementation increased odds of wheeze within the past 12 months (OR, 2.45; 1.20-4.96). CONCLUSIONS There were no statistically significant effects of early vs delayed BCG on atopy or symptoms of atopic disease. Having a BCG scar was associated with reduced atopy, whereas neonatal vitamin A supplementation was associated with increased atopy. STUDY REGISTRATION Clinicaltrials.gov NCT 01420705.
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Affiliation(s)
| | | | | | - A. Rodrigues
- Bandim Health Project; Indepth Network; Bissau; Guinea-Bissau; Australia
| | - K. J. Jensen
- Bandim Health Project; Indepth Network; Bissau; Guinea-Bissau; Australia
| | - H. Ravn
- Research Center for Vitamins and Vaccines (CVIVA); Bandim Health Project; Statens Serum Institute; Copenhagen; Denmark
| | - K. J. Allen
- Murdoch Childrens Research Institute; Parkville; VIC; Australia
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Miraglia del Giudice M, Matera MG, Capristo C, Conte M, Santaniello F, Chinellato I, Leonardi S, Miraglia del Giudice MC, Perrone L. LABAs in asthmatic children: highlights and new inside. Pulm Pharmacol Ther 2013; 26:540-3. [PMID: 23583567 DOI: 10.1016/j.pupt.2013.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 03/29/2013] [Accepted: 04/02/2013] [Indexed: 11/30/2022]
Abstract
International asthma guidelines recommend increasing the dose of ICS or adding leukotriene modifiers or the use of long-acting inhaled beta2-agonists (LABAs) in combination with inhaled corticosteroids (ICS) when uncontrolled asthma occurs in adult and children in treatment with low-dose inhaled corticosteroids. However, in children, the effects of this last treatment option are unclear because there are few studies on the efficacy and safety of these drugs in pediatric age. Furthermore, salmeterol is licensed for use in children over 4 years and formoterol in children of more than 6 years. Finally, recent data provides evidence that repeated bronchoconstriction induces epithelial cell stress that may lead to remodeling and these findings may have potential implications for asthma management, particularly for LABAs treatment in the future.
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Nagel G, Weinmayr G, Flohr C, Kleiner A, Strachan DP. Association of pertussis and measles infections and immunizations with asthma and allergic sensitization in ISAAC Phase Two. Pediatr Allergy Immunol 2012; 23:737-46. [PMID: 23005697 DOI: 10.1111/pai.12007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pertussis and measles infection as well as vaccination have been suspected as possible mediating factors of allergic disease in childhood. METHODS Between 1995 and 2005 cross-sectional studies were performed in 29 centers in 21 countries. Parental questionnaires were used to collect information on allergic diseases and exposures. We analyzed data from 54,943 randomly selected schoolchildren aged 8-12 yr. A subgroup of 31,759 children was also skin prick tested (SPT) to common environmental allergens. Combined odds ratios were calculated by random effect models for meta-analysis. RESULTS Pertussis and measles vaccination were not significantly associated with any of the allergy outcomes or SPT positivity. However, pertussis infection was associated with wheeze (OR(ad) 1.68; 95% CI 1.44-1.97) and rhinoconjunctivitis (OR(ad) 1.63; 95% 1.33-2.00). Pertussis infection was also significantly associated with a higher prevalence of reported eczema during the past year in non-affluent countries. Measles infection was associated with a higher prevalence of wheeze (OR(ad) 1.26; 95% 1.10-1.43) and reported eczema (OR(ad) 1.22; 95% 1.08-1.39). No association with SPT positivity was found, suggesting that these associations are unlikely to be mediated by an allergic component. CONCLUSIONS Associations of pertussis and measles infection with symptoms of asthma, rhinoconjunctivitis and eczema were found in both affluent and non-affluent countries and are unlikely to be mediated by IgE.
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Affiliation(s)
- Gabriele Nagel
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
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Atopic Dermatitis. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00052-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Schmitz R, Poethko-Müller C, Reiter S, Schlaud M. Vaccination status and health in children and adolescents: findings of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:99-104. [PMID: 21412506 DOI: 10.3238/arztebl.2011.0099] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 06/10/2010] [Indexed: 01/03/2023]
Abstract
BACKGROUND Whether unvaccinated children and adolescents differ from those vaccinated in terms of health is subject to some discussion. METHOD We evaluated data on diseases that are preventable by vaccination, infectious and atopic diseases, and vaccinations received that had been collected between 2003 and 2006 in a representative sample of 17 641 subjects aged 0 to 17 years in the framework of the German Health Interview and Examination Survey for Children and Adolescents (Kinder- und Jugendgesundheitssurvey, KiGGS). RESULTS Evaluable data on vaccinations were available for 13 453 subjects aged 1-17 years from non-immigrant families. 0.7% of them (95% confidence interval: 0.5%-0.9%) were not vaccinated. The lifetime prevalence of diseases preventable by vaccination was markedly higher in unvaccinated than in vaccinated subjects. Unvaccinated children aged 1-5 years had a median number of 3.3 (2.1-4.6) infectious diseases in the past year, compared to 4.2 (4.1-4.4) in vaccinated children. Among 11- to 17-year-olds, the corresponding figures were 1.9 (1.0-2.8) (unvaccinated) versus 2.2 (2.1-2.3) (vaccinated). The lifetime prevalence of at least one atopic disease among 1- to 5-year-olds was 12.6% (5.0%-28.3%) in unvaccinated children and 15.0% (13.6%-16.4%) in vaccinated children. In older children, atopy was more common, but its prevalence was not found to depend on vaccination status: among 6- to 10-year-olds, the prevalence figures were 30.1% (12.9%-55.8%) for unvaccinated children versus 24.4% (22.8%-26.0%) for vaccinated children, and the corresponding figures for 11- to 17-year-olds were 20.3% (10.1%-36.6%) versus 29.9% (28.4%-31.5%). CONCLUSION The prevalence of allergic diseases and non-specific infections in children and adolescents was not found to depend on vaccination status.
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Affiliation(s)
- Roma Schmitz
- Abteilung für Epidemiologie und Gesundheitsberichterstattung, Robert Koch-Institut, Berlin
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Wollenberg A, Vogel S, Renner E. Impfungen bei Neurodermitis und anderen chronisch entzündlichen Hauterkrankungen. Hautarzt 2010; 61:985-93; quiz 994. [DOI: 10.1007/s00105-010-2019-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Food allergy seems to represent a new spectrum of disease that has elicited significant community concern and extended waiting lists for allergists and gastroenterologists alike. The apparent rise in prevalence of IgE-mediated food allergy (and associated risk of anaphylaxis) has been postulated to result from effects of a "modern lifestyle" but as yet clear environmental risk factors have not yet emerged. Family history seems to contribute to risk suggesting that gene-environment interactions will be important for identifying a subpopulation with increased susceptibility to any identified lifestyle effects. Non-IgE-mediated food allergy (including food-induced enteropathies and colitides, eosinophilic esophagitis, and Crohn's disease) with potentially similar environmental triggers resulting in diverse immune dysregulatory mechanisms. The evidence underpinning the putative rise in food allergy is discussed and potential mechanisms of disease explored. Clinical aspects of various food allergic conditions including non-IgE-mediated food allergy are outlined.
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Kavanagh H, Noone C, Cahill E, English K, Locht C, Mahon BP. Attenuated Bordetella pertussis vaccine strain BPZE1 modulates allergen-induced immunity and prevents allergic pulmonary pathology in a murine model. Clin Exp Allergy 2010; 40:933-41. [PMID: 20184606 DOI: 10.1111/j.1365-2222.2010.03459.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Virulent Bordetella pertussis, the causative agent of whooping cough, exacerbates allergic airway inflammation in a murine model of ovalbumin (OVA) sensitization. A live genetically attenuated B. pertussis mucosal vaccine, BPZE1, has been developed that evokes full protection against virulent challenge in mice but the effect of this attenuated strain on the development of allergic responses is unknown. OBJECTIVE To assess the influence of attenuated B. pertussis BPZE1 on OVA priming in a murine model of allergic airway inflammation. METHODS Mice were challenged with virulent or attenuated strains of B. pertussis, and sensitized to allergen (OVA) at the peak of bacterial carriage. Subsequently, airway pathology, local inflammation and OVA-specific immunity were examined. RESULTS In contrast to virulent B. pertussis, live BPZE1 did not exacerbate but reduced the airway pathology associated with allergen sensitization. BPZE1 immunization before allergen sensitization did not have an adjuvant effect on allergen specific IgE but resulted in a statistically significant decrease in airway inflammation in tissue and bronchoalveolar lavage fluid. BPZE1 significantly reduced the levels of OVA-driven IL-4, IL-5 and IL-13 but induced a significant increase in IFN-gamma in response to OVA re-stimulation. CONCLUSIONS These data demonstrate that, unlike virulent strains, the candidate attenuated B. pertussis vaccine BPZE1 does not exacerbate allergen-driven airway pathology. BPZE1 may represent an attractive T-helper type 1 promoting vaccine candidate for eradication of whooping cough that is unlikely to promote atopic disease.
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Affiliation(s)
- H Kavanagh
- Cellular Immunology Laboratory, Institute of Immunology, National University of Ireland Maynooth, Maynooth, County Kildare, Ireland
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