Managing a child with possible allergy to vaccine

Abstract

Similarly to other medications, vaccines may be responsible for allergic reactions. Although IgE-mediated allergies to vaccine are extremely rare, they are clearly overdiagnosed. Indeed, accurate diagnosis of vaccine allergy is important not only to prevent serious or even life-threatening reactions, but also to avoid unnecessary vaccine restriction. Systematic approaches have been proposed and, if implemented, will likely reduce the number of children being inappropriately labeled as allergic to vaccine. In diagnosis of vaccine allergy, the patient's history is central although not sufficient. In case of suspicion of an allergy, the child should be referred to an allergist in order to perform a complete allergy workup, based primarily on skin tests and/or specific IgE. Highlighting the most recent literature, this article will address the management of children with a possible allergy to vaccine.

Diagnosis and management of drug‐induced anaphylaxis in children: An EAACI position paper

“…Regarding vaccine hypersensitivity, specific guidelines including testing with the different vaccines components as well as vaccine itself have been recently published …”

“…For children with positive allergic workup after suspicion of anaphylaxis to vaccine, the vaccine can still be administered in graded dose according to the protocol proposed by the American Academy of Pediatrics …”

Vacinação antisarampo, parotidite e rubéola em crianças com suspeita de alergia ao ovo

“…Verificou-se atraso na primo vacinação em 54/69 doentes, o que vem confirmar que a referenciação hospitalar de todos os doentes que relatem uma história de alergia ao ovo ou que apresentem IgE ou TC positivos para o mesmo, poderá determinar atrasos no cumprimento do calendário vacinal, aumentando o risco de contrair as doenças cobertas pela vacina. 17 Não está recomendado que se proceda, de forma sistematizada, a qualquer investigação alergológica antes da administração da vacina, nomeadamente realização de TC com ovo ou com a vacina ou o doseamento de IgE, em doentes que refiram queixas com a ingestão de ovo ou que ainda não o tenham introduzido na dieta. 18 Nesta casuística, a maioria das crianças realizou TC com o extrato comercial de ovo por decisão médica individual, devido ao fácil acesso ao procedimento que permite uma avaliação rápida dos resultados.…”

Yellow fever vaccination in egg-allergic patients

“…[29,30] Diagnosis of vaccine allergy is important not only to prevent serious or even life-threatening reactions, but also to avoid unnecessary vaccine restriction. [31] In our egg-allergic patients, YFV was not avoided, but difficulties appeared when it was necessary to contact different Units (Allergy Unit and International Vaccination Centre) in order to deal with potential adverse reactions and certify correct vaccination. We adopted a short protocol used by Muñoz-Cano et al, which is tolerated without problems.…”