Frequency of allergic reactions in egg allergic patients after receiving the yellow fever vaccine
Main Article Content
Keywords
allergic reaction, anaphylaxis, egg allergy, vaccination, yellow fever
Abstract
Background: Immunization with live attenuated viral yellow fever vaccine (YFV) grants effective immunity in most cases, and is recommended and prioritized for residents and travelers of endemic countries. YFV is seldom administered to egg-allergic patients (EAP) since it is cultivated in embryonated chicken eggs and may contain residual egg proteins, being a problem for egg-allergic residents and travelers of endemic countries.
Objective: Describe the frequency of allergic reactions after YFV administration in confirmed EAP from an allergy outpatient center in Bogotá, Colombia.
Methods: An observational, retrospective, cross-sectional, and descriptive study was conducted from January 2017 to December 2019. EAP whose allergy was confirmed with a positive Skin Prick Test (SPT) and/or egg protein–specific IgE levels who hadn’t received the YFV were included. Every patient had an SPT, severe EAP, and an additional Intradermal Test (IDT) done with the vaccine. If the vaccine SPT and IDT were negative, the YFV was administered as a single dose; if either were positive, the YFV was administered in graded doses. Statistical analysis was done in Stata16MP.
Results: Seventy one patients were included, 24 (33.8%) of those had a history of egg anaphylaxis. All patients had negative YFV SPTs, and two of the five YVF IDTs were positive. Two patients, with previous egg-anaphylaxis, presented allergic reactions to the vaccine.
Conclusions: YFV did not trigger allergic reactions in EAP without history of egg-anaphylaxis. With further research, safe single-dose vaccination to this population could be considered; however, patients with previous egg-anaphylaxis should be evaluated by an allergist before vaccination.
References
2. Bédard MA, Graham F, Paradis L, Samaan K, Bégin P, Des Roches A. Single-dose yellow fever vaccination is well tolerated in egg-allergic children despite positive intradermal test to the vaccine. J Allergy Clin Immunol Pract. 2021;9(11):4170–4172.e1. 10.1016/j.jaip.2021.06.050
3. Gerhardt CMB, Castro APBM, Pastorino AC, Dorna MDB, Nunes-Santos CDJ, Aquilante BP, et al. Safety of yellow fever vaccine administration in confirmed egg-allergic patients. Vaccine. 2020;38(42):6539–6544. 10.1016/j.vaccine.2020.08.020
4. Ruíz G, Sanchis-Merino E, Monsalve B, Pérez I, Allue M, Berbel C. Yellow fever vaccination in egg-allergic patients. J Epidemiol Res. 2016;2(2):22–5. 10.5430/jer.v2n2p22
5. Rutkowski K, Ewan PW, Nasser SM. Administration of yellow fever vaccine in patients with egg allergy. Int Arch Allergy Immunol. 2013;161:274–278. 10.1159/000346350
6. Mosimann B, Stoll B, Francillon C, Pécoud A. Yellow fever vaccine and egg allergy. J Allergy Clin Immunol. 1995;95(5 Pt 1): 1064. 10.1016/S0091-6749(95)70118-4
7. Muñoz-Cano R, Sanchez-Lopez J, Bartra J, Valero A. Yellow fever vaccine and egg allergy: really a problem? Allergy Eur J Allergy Clin Immunol. 2010;65:533–534. 10.1111/j.1398-9995.2009.02205.x
8. Sharma K, Perrett KP, Wood N. Yellow fever vaccination in egg-allergic children. Pediatr Infect Dis J. 2020;39:E76–E78. 10.1097/INF.0000000000002625
9. Smith D, Wong P, Gomez R, White K. Ovalbumin content in the yellow fever vaccine. J Allergy Clin Immunol Pract. 2015;3:794–795. 10.1016/j.jaip.2015.03.011
10. Juliao GS, Barbosa PA, Silva PF, Cunha MA, Formigari CF, Pastorino AC, et al. Yellow fever vaccine in egg-allergic patients: safety of a vaccination protocol. J Allergy Clin Immunol. 2018;141:AB256. 10.1016/j.jaci.2017.12.813
11. Yellow Fever Vaccine YF-VAX® [package insert]. Swiftwater, PA, USA: Sanofi Pasteur Inc.; 2010.
12. STAMARIL vacuna contra la fiebre amarilla (viva) [package inster]. Lyon, France: Sanofi Pasteur SA.; 2011.
13. Vaccin amaril stabilise [package insert]. Dakar, Senegal: Institut pasteur de Dakar; [unknown date].
14. Yellow fever vaccine [package insert]. Brazil: Instituto de tecnologia em imunobiológicos Bio-Manguinhos; [unknown date].
15. Instruction on application of yellow fever vaccine, live -freeze-dried, lyophilizate for preparing the solution for intramuscular/subcutaneous injections [package insert]. Russia: Ministry of health and welfare of the russian federation; [unknown date].
16. Echeverría Zudaire L, Ortigosa del Castillo L, Alonso Lebrero E, Álvarez García FJ, Cortés Álvarez N, García Sánchez N, et al. Documento de consenso sobre la actitud ante un ni˜no con una reacción alérgica tras la vacunación o alergia a componentes vacunales. An Pediatría. 2015;83:63.e1–63.e10. 10.1016/j.anpedi.2014.11.002
17. Chung EH. Vaccine allergies. Clin Exp Vaccine Res. 2014;3: 50–57. 10.7774/cevr.2014.3.1.50
18. Wood RA. Allergic reactions to vaccines. Pediatr Allergy Immunol. 2013;24:521–526. 10.1111/pai.12102
19. Sánchez J, Ramírez R, Cardona R. Frecuencia de las reacciones alérgicas a la vacuna triple viral en pacientes con-alergia al huevo. Biomédica. 2018;38:514–520. 10.7705/biomedica.v38i4.3779
20. McNeil MM, DeStefano F. Vaccine-associated hypersensitivity Michael. J Allergy Clin Immunol. 2018;141:463–472. 10.1016/j.jaci.2017.12.971
21. Caubet JC, Rudzeviciene O, Gomes E, Terreehorst I, Brockow K, Eigenmann PA. Managing a child with possible allergy to vaccine. Pediatr Allergy Immunol. 2014;25:394–403. 10.1111/pai.12132
22. Kelso JM, Greenhawt MJ, Li JT, Nicklas RA, Bernstein DI, Blessing-Moore J, et al. Adverse reactions to vaccines practice parameter 2012 update. J Allergy Clin Immunol. 2012;130: 25–43. 10.1016/j.jaci.2012.04.003
23. Fritsche PJ, Helbling A, Ballmer-Weber BK. Vaccine hypersensitivity–update and overview. Swiss Med Wkly. 2010;140: 238–246. 10.4414/smw.2010.12980
24. Miller JR, Orgel HA, Meltzer EO. The safety of egg containing vaccines for egg-allergic patients. J Allergy Clin Immunol. 1983;71:568–573. 10.1016/0091-6749(83)90438-4
25. Nilsson L, Brockow K, Alm J, Cardona V, Caubet JC, Gomes E, et al. Vaccination and allergy: EAACI position paper, practical aspects. Pediatr Allergy Immunol. 2017;28:628–640. 10.1111/pai.12762
26. UNICEF. Yellow fever vaccine: current supply outlook. 2016, p. 6. Retrieved on November 16, 2021, Available at: https://www.unicef.org/supply/reports/yellow-fever-vaccine-supply-outlook
27. Ford M, Cohn J. Use of yellow fever vaccine in egg--allergic patients. Ann Allergy Asthma Immunol. 2016;117:S45. 10.1016/j.anai.2016.09.089
28. Roukens AH, Vossen AC, Van Dissel JT, Visser LG. Reduced intradermal test dose of yellow fever vaccine induces protective immunity in individuals with egg allergy. Vaccine. 2009;27:2408–2409. 10.1016/j.vaccine.2009.02.049
29. Porudominsky R, Gotuzzo EH. Yellow fever vaccine and risk of developing serious adverse events: a systematic review. Rev Panam Salud Publica/Pan Am J Public Health. 2018;42:1–9. 10.26633/RPSP.2018.75
30. Ministerio de salud y protección social. Plan nacional para la prevención y control de la fiebre amarilla en Colombia 2017–2022. Colombia. 2018. Retreived on November 12, 2020, Available from: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/PP/ET/plan-nal-prevencion-control-fiebre-amarilla-colombia-2017-2022.pdf
31. Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, Valenta R, Ollert M, Giovannini M, et al. B11 - Allergy to egg. In: Molecular allergology: User’s guide. Zurich: Published by the European academy of allergy and clinical immunology; 2016. pp. 297–302.
32. Leech SC, Ewan PW, Skypala IJ, Brathwaite N, Erlewyn-Lajeunesse M, Heath S, et al. BSACI 2021 guideline for the management of egg allergy. Clin Exp Allergy. 2021;51:1262–1278. 10.1111/cea.14009
33. Bird JA, Leonard S, Groetch M, Assa’ad A, Cianferoni A, Clark A, et al. Conducting an oral food challenge: an update to the 2009 Adverse Reactions to Foods Committee Work Group Report. J Allergy Clin Immunol Pract. 2020;8:75–90.e17. 10.1016/j.jaip.2019.09.029
34. Sampson HA. Anaphylaxis and emergency treatment. Pediatrics. 2003;111:1601–1608. 10.1542/peds.111.S3.1601
35. Cardona V, Ansotegui IJ, Ebisawa M, El-Gamald Y, Rivas MF, Fineman S, et al. World allergy organization anaphylaxis guidance 2020. World Allergy Organ J. 2020;13:211–221. 10.1016/j.waojou.2020.100472
36. Muraro A, Roberts G, Clark A, Eigenmann PA, Halken S, Lack G, et al. The management of anaphylaxis in childhood: position paper of the European academy of allergology and clinical immunology. Allergy Eur J Allergy Clin Immunol. 2007;62:857–871. 10.1111/j.1398-9995.2007.01421.x
37. Pérez-Herrera LC, Moreno-López S, Peñaranda D, García E, Chapman E, Peñaranda A. Frequency of self-reported allergies at a high-complexity referral hospital in Colombia, a tropical Latin American country. Allergol Immunopathol (Madr). 2021;49:100–105. 10.15586/aei.v49i5.449
38. Franceschini F, Bottau P, Caimmi S, Crisafulli G, Lucia L, Peroni D, et al. Vaccination in children with allergy to non active vaccine components. Clin Transl Med. 2015;4(1):1-8. 10.1186/s40169-014-0043-0
39. Cancado B, Aranda C, Mallozi M, Weckx L, Sole D. Yellow fever vaccine and egg allergy. Lancet Infect Dis. 2019;19:812. 10.1016/S1473-3099(19)30355-X
40. Instituto nacional de vigilancia de medicamentos y alimentos. Listado de vacunas con Registro Sanitario Vigente con corte al último día hábil de mes: Datos Abiertos Colombia [Internet]. Ministerio de salud y protección social; 2020. Retrieved on February 12, 2020, Available at: https://www.datos.gov.co/Salud-y-Protecci-n-Social/LISTADO-DE-VACUNAS-CON-REGISTRO-SANITARIO-VIGENTE-/ctct-gh6w
41. Cancado LB, Aranda CS, Souza AR, Weckx LY, Mallozi MC, Sole D. Yellow fever vaccine (YFV) for patients with egg allergy: protocol proposal. J Allergy Clin Immunol. 2019;143:AB228. 10.1016/j.jaci.2018.12.695
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.