Administration of Yellow Fever Vaccine in Patients with Egg Allergy

Abstract

Background: The population of large parts of Africa, South America and travellers to these areas are at risk of yellow fever (YF) with a 50% mortality risk. Yellow fever vaccine (YFV) propagated in hens' eggs confers protection in 95% of the vaccinated. The rate of anaphylaxis for YFV ranges from 0.42 to 1.8/100,000 doses with most cases considered to be due to egg allergy. Egg allergy is a contraindication for the YFV. Nevertheless, the potential fatal sequelae from YF give the incentive to protect everyone at risk irrespective of their allergic status. Methods: Six subjects who had had a recent reaction to egg and who were travelling to endemic areas (3 adults and 3 children) underwent skin prick tests (SPT) with undiluted YFV and egg extract. Intradermal tests for YFV were undertaken at a 1:10 dilution. In 4 egg-allergic patients with a positive SPT to YFV, a 7-step desensitization protocol was used. A 2-step (10 + 90%) protocol was used in the 2 subjects with a negative YFV SPT. Premedication was not administered. Results: All 6 patients were successfully vaccinated. Four patients completed desensitization: 1 developed mild local erythema at the injection site, 1 had fleeting generalized urticaria with local erythema/angioedema and 2 did not experience any adverse reactions. Patients who received YFV in 2 steps developed no adverse reactions. Conclusions: We describe the successful administration of YFV in 6 egg-allergic patients. The Cambridge Allergy 7-step protocol allows for its safe administration in patients with positive SPT to YFV. A 2-step protocol can be used in patients with negative YFV SPT.

Vaccination and allergy: EAACI position paper, practical aspects

“…59 The YF vaccine Stamaril (UK) contains 0.13-0.61 ug/mL of egg protein, 60 and YF-VAX contains 2.43-4.42 ug/mL of egg protein, 59 used in USA. Compared to the recommendations for egg protein in TIV, egg protein in Stamaril is not high.…”

“…60 With the low ovalbumin content in the present YF vaccine, desensitization will probably not be necessary henceforth. However, egg-allergic persons should be evaluated by an allergist before YF vaccination (see 5.3).…”

Plasmid DNA initiates replication of yellow fever vaccine in vitro and elicits virus-specific immune response in mice

“…Some adverse events appear to be associated with host factors rather than with the vaccine (Barban et al, 2007). Because the vaccine is still manufactured using chicken embryos, egg allergy is a contraindication for vaccination (Rutkowski et al, 2013). Thus, alternative strategies are still needed to improve YF vaccination.…”

Yellow Fever Vaccination in Egg‐allergic Children

“…Ketaki Sharma 1 , Dr Kirsten Perrett 2 , Associate Professor Nicholas Wood 3 1 The Children's Hospital at Westmead, Sydney, New South Wales, Australia; 2 The Royal Children's Hospital, Melbourne, Victoria, Australia; 3 The Children's Hospital at Westmead, Sydney, New South Wales, Australia Background: Yellow fever vaccine (YFV) contains ovalbumin, in a higher quantity than is found in influenza vaccines 1 , and was previously contraindicated in egg-allergic individuals. Vaccination of egg-allergic individuals has been described in the literature, using a variety of skin testing and desensitisation protocols.…”

“…Vaccination of egg-allergic individuals has been described in the literature, using a variety of skin testing and desensitisation protocols. There is very little data to support the safety of yellow fever vaccine in egg-allergic children, particularly those with severe egg allergy [2][3][4] .…”