Allergic Reactions to Vaccines: Diagnosis and Management

Abstract

Childhood vaccinations are the most cost-effective method to combat preventable diseases. Allergic reactions to vaccines are generally rare. However, all vaccines can potentially cause allergic reactions. These allergic reactions can develop against any of the components of the vaccine (adjuvant, microbial agent, stabilizer, residue antibiotic, cell culture, etc.). It is very important to correctly diagnose allergic reactions to vaccines because only 15% of suspected allergic reactions to vaccines are real allergic reactions and the continuation of immunization procedures is essential for public health. Allergic reactions to vaccines should be evaluated by an allergist-immunologist expert and a risk analysis should be performed. Vaccination of these children in a reliable way and guaranteed immunization procedure will also contribute to the protection of both children and public health. This study compiles the diagnosis of immediate and delayed reactions to vaccines or vaccine components and their management with current guidelines.

Keywords

• allergic reactions
• anaphylaxis
• hypersensitivity reactions
• vaccine components
• vaccines
• vaccine allergy

Aşılara Karşı Alerjik Reaksiyonlar: Tanı ve Yönetim

Abstract

Çocukluk çağı aşıları, önlenebilir hastalıklarla mücadelede en uygun maliyetli yöntemdir. Aşılara karşı alerjik reaksiyonlar genellikle nadirdir. Ancak tüm aşılar potansiyel olarak alerjik reaksiyonlara neden olabilir. Bu alerjik reaksiyonlar aşının herhangi bir bileşenine (adjuvan, mikrobiyal ajan, stabilizatör, kalıntı antibiyotik, hücre kültürü, vb) karşı gelişebilir. Aşılara karşı alerjik reaksiyonların doğru teşhis edilmesi çok önemlidir çünkü aşılara karşı şüpheli alerjik reaksiyonların sadece %15'i gerçek alerjik reaksiyonlardır ve bağışıklama prosedürlerinin devamı halk sağlığı için gereklidir. Aşılara karşı alerjik reaksiyonlar bir alerjist-immünolog uzman tarafından değerlendirilmeli ve risk analizi yapılmalıdır. Bu çocukların güvenilir bir şekilde ve garantili bağışıklama prosedürü ile aşılanması hem çocukların hem de toplum sağlığının korunmasına da katkı sağlayacaktır. Bu çalışmada aşılara veya aşı bileşenlerine karşı gelişen ani ve gecikmiş reaksiyonların tanısı ve yönetimi güncel kılavuzlar eşliğinde derlenmiştir.

Keywords

• alerjik reaksiyonlar
• anafilaksi
• aşırı duyarlılık reaksiyonları
• aşı bileşenleri
• aşılar
• aşı alerjisi

References

1. 1. Chung EH. Vaccine allergies. Clin Exp Vaccine Res. 2014;3(1). doi:10.7774/cevr.2014.3.1.50
2. 2. Stratton K, Ford A, Rusch E, Clayton EW. THE NATIONAL ACADEMIES PRESS Adverse Effects of Vaccines: Evidence and Causality. Adverse Effects of Vaccines: Evidence and Causality. Published online 2012.
3. 3. Nilsson L, Brockow K, Alm J, et al. Vaccination and allergy: EAACI position paper, practical aspects. Pediatric Allergy and Immunology. 2017;28(7). doi:10.1111/pai.12762
4. 4. Arcolaci A, Scarmozzino R, Zanoni G. A practical guide to address reactions to vaccines in children. Pediatric Allergy and Immunology. 2023;34(6). doi:10.1111/pai.13967
5. 5. Halsey NA, Griffioen M, Dreskin SC, et al. Immediate hypersensitivity reactions following monovalent 2009 pandemic influenza A (H1N1) vaccines: Reports to VAERS. Vaccine. 2013;31(51). doi:10.1016/j.vaccine.2013.09.066
6. 6. McNeil MM, Weintraub ES, Duffy J, et al. Risk of anaphylaxis after vaccination in children and adults. Journal of Allergy and Clinical Immunology. 2016;137(3). doi:10.1016/j.jaci.2015.07.048
7. 7. Chiang V, Mok SWS, Chan JKC, et al. Experience of the first 1127 COVID-19 Vaccine Allergy Safety patients in Hong Kong – Clinical outcomes, barriers to vaccination, and urgency for reform. World Allergy Organization Journal. 2022;15(1). doi:10.1016/j.waojou.2021.100622
8. 8. Echeverría-Zudaire LA, Ortigosa-del Castillo L, Alonso-Lebrero E, et al. Consensus document on the approach to children with allergic reactions after vaccination or allergy to vaccine components. Allergol Immunopathol (Madr). 2015;43(3). doi:10.1016/j.aller.2015.01.004

9. 9. Aquino MR, Bingemann TA, Nanda A, Maples KM. Delayed allergic skin reactions to vaccines. Allergy Asthma Proc. 2022;43(1). doi:10.2500/aap.2022.43.210105
10. 10. Burks WA, Holgate ST, Bacharier LB, et al. Middleton’s Allergy 2-Volume Set_ Principles and Practice-. Elsevier. 2020;2(9).
11. 11. Golden DBK, Golden DBK, Golden DBK, et al. Anaphylaxis: A 2023 practice parameter update. Annals of Allergy, Asthma and Immunology. 2024;132(2). doi:10.1016/j.anai.2023.09.015
12. 12. Cardona V, Ansotegui IJ, Ebisawa M, et al. World allergy organization anaphylaxis guidance 2020. World Allergy Organization Journal. 2020;13(10). doi:10.1016/j.waojou.2020.100472
13. 13. Sun J, Fu LB, Xu JS, Han XF, Wei L. Confused subcutaneous nodules in children: Differential diagnosis of pilomatricoma in children. J Cosmet Dermatol. 2023;22(12). doi:10.1111/jocd.15868
14. 14. Collinson AC, Moore L, Cheung A, Gold MS, Goh DW. Subcutaneous nodules following vaccination. J Paediatr Child Health. 2022;58(3). doi:10.1111/jpc.15900
15. 15. Kelso JM. Drug and Vaccine Allergy. Immunol Allergy Clin North Am. 2015;35(1). doi:10.1016/j.iac.2014.09.013
16. 16. Wood RA, Berger M, Dreskin SC, et al. An algorithm for treatment of patients with hypersensitivity reactions after vaccines. Pediatrics. 2008;122(3). doi:10.1542/peds.2008-1002
17. 17. Kelso JM, Greenhawt MJ, Li JT, et al. Adverse reactions to vaccines practice parameter 2012 update. Journal of Allergy and Clinical Immunology. 2012;130(1). doi:10.1016/j.jaci.2012.04.003
18. 18. Wood RA, Setse R, Halsey N. Irritant skin test reactions to common vaccines. Journal of Allergy and Clinical Immunology. 2007;120(2). doi:10.1016/j.jaci.2007.04.035
19. 19. Muraro A, Worm M, Alviani C, et al. EAACI guidelines: Anaphylaxis (2021 update). Allergy: European Journal of Allergy and Clinical Immunology. 2022;77(2). doi:10.1111/all.15032
20. 20. Lagos M, Carolina Díaz C, Hernández P. Immune response and allergies to vaccines. Revista Medica Clinica Las Condes. 2020;31(3). doi:10.1016/j.rmclc.2020.04.003
21. 21. Aytekin ES, Şekerel BE, Şahiner ÜM. Allergic reactions during childhood vaccination and management. Turkish Journal of Pediatrics. 2021;63(6). doi:10.24953/turkjped.2021.06.001
22. 22. Sarti L, Lezmi G, Mori F, Giovannini M, Caubet JC. Diagnosis and management of hypersensitivity reactions to vaccines. Expert Rev Clin Immunol. 2020;16(9). doi:10.1080/1744666X.2020.1814745
23. 23. Leventhal JS, Berger EM, Brauer JA, Cohen DE. Hypersensitivity reactions to vaccine constituents: A case series and review of the literature. Dermatitis. 2012;23(3). doi:10.1097/DER.0b013e31825228cf
24. 24. Zanoni G, Migliorini M, Gallo T, Guidolin L, Schena D. Recurrent injection site reactions to vaccines: Two clinical patterns of presentation. Vaccine. 2020;38(45). doi:10.1016/j.vaccine.2020.08.073
25. 25. Bergfors E, Inerot A, Falk L, Nyström U, Trollfors B. Patch testing children with aluminium chloride hexahydrate in petrolatum: A review and a recommendation. Contact Dermatitis. 2019;81(2). doi:10.1111/cod.13303
26. 26. Bergfors E, Trollfors B. Sixty-four children with persistent itching nodules and contact allergy to aluminium after vaccination with aluminium-adsorbed vaccines - Prognosis and outcome after booster vaccination. Eur J Pediatr. 2013;172(2). doi:10.1007/s00431-012-1841-2
27. 27. Bindslev-Jensen U, Mortz CG, Andersen KE, Bindslev-Jensen C. Patients with positive patch test to formaldehyde can be safely vaccinated with formaldehyde-containing vaccines. Contact Dermatitis. 2023;89(2). doi:10.1111/cod.14350
28. 28. Dreskin SC, Halsey NA, Kelso JM, et al. International Consensus (ICON): Allergic reactions to vaccines. World Allergy Organization Journal. 2016;9(1). doi:10.1186/s40413-016-0120-5
29. 29. Echeverría Zudaire L, Ortigosa Del Castillo L, Alonso Lebrero E, et al. Consensus position document on the child with an allergic reaction after vaccination or an allergy to vaccine components. An Pediatr (Engl Ed). 2015;83(1). doi:10.1016/j.anpedi.2014.11.002
30. 30. McNeil MM, DeStefano F. Vaccine-associated hypersensitivity. Journal of Allergy and Clinical Immunology. 2018;141(2). doi:10.1016/j.jaci.2017.12.971