This document discusses vaccine allergies, including IgE-mediated and non-IgE mediated reactions. Specific vaccine components like gelatin, egg, latex and yeast can cause allergic reactions. While reactions are rare, certain vaccines like MMR, influenza and yellow fever may pose higher risks for individuals with allergies to these components. Skin testing is recommended to determine safe vaccination for those with suspected allergies.

1. Vaccine Allergy
BY
DR. Magdy Shafik
Senior Pediatric Consultant
Diploma, M.S ,Ph.D of Pediatric

2. .
Outline
• •Vaccine allergy (IgE mediated vs Non-IgE
mediated)
• Reactions to specific vaccines
• Vaccination Recommended

3. Introduction
• Vaccination is necessary (children receive 10
vaccines to protect against 16 disease)
• Protective effect extends to nonvaccinated
persons (herd immunity)
• Vaccine – associated hypersensitivity (IgE-
mediated or IgG, complement-mediated
anaphylactic, serious delayed-onset T cell
mediated systemic reaction) extremely rare
• Risk of anaphylaxis 1.31(95%Cl, 0.90-1.84)
per million vaccine dose

4. Type of vaccine components

5. Reactions
• IgE–Mediated Reactions to Vaccines
• IgE–Mediated Reactions to Vaccine
Constituents
• Non-IgE-Mediated Reactions to vaccine
Constituents
• Reactions to specific vaccines

7. Type of vaccine components
IgE Mediated

8. Incident of Anaphylaxis

9. Influenza vaccine

10. Immunoglobulin E-mediated reactions to
vaccine constituents other than the immunizing
agent
• Gelatin
• Egg
• Latex
• Yeast
• Milk

11. Gelatin
• A vaccine stabilizer of bovine or porcine origin
• Japan report anaphylaxis reaction after MMR
vaccination
• Anaphylaxis to some brands of MMR and
varicella vaccines, and also earlier in Japanese
encephalitis and influenza vaccines
• Japan and Germany removed gelatin or changed
to a less allergenic gelatin
• A new Japanese encephalitis vaccine does not
contain gelatin
• IgE for gelatin and skin test before give
vaccination

12. Gelatin with Alpha-gal allergy
• Alpha-gal sensitivity presents with delayed
anaphylaxis(3-6 hours) after consumption of red meat
with lesser degrees of reactivity to milk and gelatin
• 202 reported events 14 cases of adverse reactions to
zoster vaccine anaphylaxis
• Five (36%) of 14 cases of anaphylaxis had a known
associated beef, pork, gelatin, or alpha-gal allergy
• Both MMR and Zoster vaccine use bovine calf serum
during their production
• Global interest as the immunologic mechanism for
delayed anaphylaxis after ingestion of mammalian meat

14. Risk for reactions to gelatin-containing
vaccines
• Gelatin used in vaccines is of either bovine
or porcine origin (cross reaction)
• Some patients sensitized to beef or pork
meat are also sensitized to beef or pork
gelatin, which might place them at risk
for reactions to gelatin-containing vaccines
• • Strong association gelatin allergy and
human leukocyte antigen (HLA)-DR9 an
HLA type unique to Asians, suggesting a
genetic susceptibility to gelatin allergy

15. Egg

16. Egg with MMR
• Report in 1983 described two egg-allergic
children who suffered allergic reactions to
measles vaccine
• • Measles and mumps vaccines are grown in
chick embryo fibroblast culture
• • Measles or MMR vaccine was administered in
the normal manner to egg-allergic children
without adverse reaction
• • Recommendations that MMR vaccine can be
given routinely to children with egg allergy
without previous skin testing

17. Egg protein with influenza vaccine
• Safely to even severely egg-allergic recipients
• • Very low amount of egg protein (ovalbumin)
contained vaccine
• • History of only hives after egg ingestion can receive
TIV
• History of more severe reactions after egg ingestion
should be referred to an allergist to receive TIV
• • LAIV, the lowest amount of ovalbumin per dose, has
not been formally studied for safety in egg-allergic
individuals
• • LAIV also is contraindicated in any individual with
asthma
• • Skin testing (prick, intradermal) with the influenza
vaccine is not recommend

19. • Patients with egg allergy of any
severity should receive annual
influenza vaccinations
• • TIV, rather than the live
attenuated influenza vaccine(LAIV),
should be used for recipients with
egg allergy
• • All influenza vaccines available in
the United States contain low
amounts of ovalbumin

20. (Egg allergy with Influenza vaccine)

22. Egg with yellow fever
• Yellow fever vaccine is cultured in chicken
embryos and contains egg protein
• Anaphylactic reactions in egg-allergic persons
have been reported
• Chicken proteins other than those found in
chicken egg may be present in yellow fever
vaccine.
• A history of allergy after the ingestion of egg,
raw or cooked, should be sought before the
administration of yellow fever vaccine

23. Latex
• Vial stoppers and syringe plungers contain dry
natural rubber
• 167,223 reports in the VAERS database
through 2003 revealed 28 reports of
immediate-type allergic reactions to various
vaccines in Patients
• History of latex-precipitated anaphylaxis can
safely receive vaccines from vials with
nonlatex stoppers
• Risk of allergic reactions possibly due to latex
contamination of vaccines appears to be very
small

24. Latex in vaccine packing

25. Latex in vaccine packing

26. Yeast (Residual media)
• Hepatitis B vaccines are grown in Saccharomyces
cerevisiae (baker’s yeast or brewer’s yeast)
• Adverse reactions 15 case in 180,895 reports (rare)
• Quadrivalent human papillomavirus vaccine
(HPV4)contain residual yeast protein
• If history of immediate-type allergy to baker’s yeast and a
positive skin test response to S. cerevisiae, an
appropriate precaution is skin testing with
yeastcontaining vaccines before administration

27. Milk
• Described 8 children anaphylaxis within 1
hour of receiving DTaP or Tdap
• Anaphylactic reactions to DTaP or Tdap
vaccines are rare
• Patients with cow’s milk allergy tolerate
them without reaction
• Recommended that all patients and with
milk allergy, continue to receive these
vaccines on schedule

28. Recommended skin test

29. Skin test with Gelatin

30. Skin prick test

32. Reactions
• IgE–Mediated Reactions to Vaccines
• IgE–Mediated Reactions to Vaccine
Constituents
•
Non-IgE-Mediated Reactions to vaccine
Constituents
• Reactions to specific vaccines

33. Non-IgE Mediated Reactions to vaccine
• Minor, self-limited side effects
• Local (injection site) reactions such as pain,
warmth, tenderness, swelling, and erythema
• Mild systemic reactions such as fever
• No contraindications to further doses of any
vaccine
• Constituents (Neomycin, Thimerosal,
Aluminum) – delayed type hypersensitivity

34. Antimicrobials
• Gentamycin, tetracycline, neomycin,
streptomycin and polymyxin B are used
during the production to prevent bacterial
or fungal growth.
• Removed during the purification process
• Neomycin is contained in several
vaccines.
• Delayed-type hypersensitivity contact
dermatitis to neomycin

35. Preservations
• Thimerosal, 2-phenoxyethanol, and phenol
are used in multidose vials of vaccines to
prevent bacterial growth.
• MP rash to thimerosal in an influenza
vaccine (case report).
• Immediate-type reaction that may have
been caused by thimerosal in a vaccine
(case report)

36. • Removed thimerosal in vaccines used in
young children cause mercury toxicity
(neurologic disorders).
• Local or delayed-onset hypersensitivity to
thimerosal is not a contraindication to
vaccines.

37. Adjuvants
• Adjuvants are incorporated in to enhance or
direct the immune response of the vaccinated.
• Aluminum hydroxide and aluminum phosphate
are the most common adjuvants used in
vaccines
• No immediate hypersensitivity reactions
• Small granulomas or nodules with persistent
urticaria at the site can occur after aluminum-
containing vaccine

38. Management of patients with suspected
hypersensitivity to a vaccine

40. Pre-immunization testing and immunization

41. Graded doses

42. Reactions
• IgE–Mediated Reactions to Vaccines
• IgE–Mediated Reactions to Vaccine
Constituents
•
Non-IgE-Mediated Reactions to vaccine
Constituents
• Reactions to specific vaccines

43. REACTIONS TO SPECIFIC VACCINES
• Diphtheria vaccine: Local reaction >
generalized reaction.
• Hemophilus influenzae type b (Hib)
vaccine : Generalized urticaria after
vaccine by conjugate protein CRM 197(a
mutant diphtheria protein ).
• HBV :Relationship between HBV and
anaphylaxis in yeast sensitive individuals
(1:600,000)

44. • Human Papillomavirus Vaccine:
Anaphylaxis from 1 per 1 million76 to 2.6
per 100,000 doses.
• Influenza vaccine: VAERS reports from
1990 to 2005, during which 747 million
doses revealed 4 reports of death
occurring shortly after influenza
vaccination.
• JE vaccine : most affected patients have
anti-gelatin IgE, new vaccine does not
contain gelatin

45. • MMR: no relationship has been found
between anaphylactic reactions to MMR
vaccine and egg allergy.
:15% late onset of fever 5-12 days ,
increased risk of febrile seizure in
children, thrombocytopenia 1 in
1,000,000.
• Rabies vaccine : Two of the reported
patients had anaphylaxis to both
PCEC(purified chicken embryo cell) and
HDCV(Human diploid cell virus cell),
suggesting contains gelatin

46. • Varicella : Anaphylaxis 1 to 3 per 1 million
doses and gelatin allergy as the cause of
some of these reactions, 4% varicella like
lesion at the injection site, safety in
children with atopic dermatitis.
• Yellow fever : Anaphylaxis 7 per 1 million
doses and associated egg allergy
• : Encephalitis, infant < 9 months of age
• : YEL-AVD (vaccine-associated
viscerotrophic disease)

47. • Pertussis : Febrile seizure
• Polio : paralytic poliomyelitis in year 2000
after OPV(8-9 vaccine). In US, OPV
discontinued, favor of IPV.
• Tetanus : injected site reaction, Arthurs
reaction.
• Rotavirus: intussusception in infants by
oral rotavirus in 1998, now new live oral
rotavirus no increased risk
• .

48. Long-Term Consequences of Vaccination
• Atopy - infant vaccines do not increase the
risk of allergic disease.
• Autism - case series 12 children related MMR
• Autism - Many studies no association
between MMR and autism.
• Autoimmune - Guillain-Barré syndrome,
multiple sclerosis, DM type I, optic neuritis,
and transverse myelitis, has been reported.
• Autoimmune - evidence is inadequate to
accept or reject a causal relationship

49. Immunoglobulin preparations interfere live
viral vaccines

53. Conclusion
• Determine the culprit allergen ( Vaccine Vs
Constituents)
• Determine Immunoglobulin E or Non-
Immunoglobulin E
• Skin tests with the suspect vaccine and skin
tests or serum-specifc IgE antibody tests to
vaccine constituents (gelatin, egg, latex, or
yeast)