Adverse Reactions to Vaccines for Infectious Disease

Adverse reactions to vaccines practice parameter 2012 update

“…If serologic evidence of immunity is documented, consideration can be given to withholding additional doses, although the magnitude and duration of immunity might be less than if all doses were received. 36,37 Even if the recommended number of doses has already been received or if protective antibody levels have already been achieved, evaluation of the reaction, including skin testing, if indicated, should be undertaken, as discussed herein. Summary Statement 5: All suspected anaphylactic reactions to vaccines should ideally be evaluated in an attempt to determine the culprit allergen.…”

“…74 Thus if the skin test results to the vaccine and its ingredients are negative, particularly at the intradermal level (with the vaccine diluted 1:100), then it is unlikely that the patient has IgE antibody to any component of the vaccine, and they can be given the vaccine in the usual manner but observed for at least 30 minutes afterward. 36,37 Summary Statement 9: In a patient with a history and skin test results consistent with an IgE-mediated reaction to a vaccine who requires additional doses of the suspect vaccine or other vaccines with common ingredients, consideration can be given to administering the vaccine in graded doses under observation. (C)…”

“…79 If the suspect vaccine contains egg (influenza and yellow fever), gelatin (Table II), latex (Table III), or Saccharomyces cerevisiae (baker's or brewer's) yeast (hepatitis B vaccine and quadrivalent human papillomavirus vaccine), the patient should also be skin tested for these allergens. 36,37 Egg and yeast extracts for skin testing are commercially available. Gelatin can be prepared by dissolving 1 teaspoon (5 g) of any sugared gelatin powder (for example Jell-O) in 5 mL of normal saline to create a skin prick test solution, recognizing that this is not a standardized, validated, US Intradermal skin tests are recommended for the evaluation of suspected anaphylaxis to a vaccine.…”

“…36,37 The vaccine should first be tested by using the prick method. If the past vaccine reaction was lifethreatening, it is appropriate to use dilute vaccine for the skin prick test; in all other cases, full-strength vaccine should be used for the skin prick test.…”

Consultancy and surveillance of post-immunisation adverse events in the Veneto region of Italy for 1992-2008

“…When indicated, in vivo/in vitro allergy or immunology testing was performed, in order to identify specific sensitizations to vaccine components, according to recommended procedures. 7,8 Finally, a conclusive report was released to the PHU physician, containing indications for subsequent vaccination, with standard procedure or individualized precautions such as premedication, temporally separated single injections, alternative brand, and/or administration in hospital with full strength or graded doses according to published protocols. In cases of serious AEFI or CI, indicating temporary suspension or exemption, vaccination was not recommended.…”