Yumurta allerjisi olan çocuklarda kızamık-kızamıkçık-kabakulak aşılaması sonrası reaksiyon durumunun değerlendirilmesi

Year 2020, , 687 - 693, 18.09.2020

Şennur Keleş , Serkan Filiz

https://doi.org/10.31362/patd.707081

Abstract

Amaç: Yumurta alerjisi olan çocuklara içerisinde yumurta proteini bulunan
kızamık-kızamıkçık-kabakulak (KKK) aşısının doğrudan uygulanması önerilmesine
rağmen hekimler genellikle çekince yaşamakta, bu durum hekim ve ailelerde
sıkıntılara yol açmaktadır. Bu çalışmamızda, kliniğimizde yumurta alerjisi
nedeniyle izlenen hastalarda, KKK aşısı sonrası aşı reaksiyon sıklığının
değerlendirilmesi amaçlanmıştır.

Yöntem: Kliniğimizde yumurta alerjisi tanısı ile izlenen hastaların Ocak 2019-Ocak
2020 tarihleri arasında KKK aşı kayıtları incelendi. KKK aşısı yapılan
hastaların demografik ve klinik özellikleri, laboratuvar bulguları
değerlendirildi.

Bulgular: Tanı anında yaş ortalaması 6,1±2,7 ay olan 80 hastanın %62,5’i (n=50)
erkek idi. Hastaların %68,8’inde (n=55) atopik dermatit, %18,8’inde (n=15)
ürtiker- anjioödem, %25’inde (n=20) reaktif hava yolu hastalığı, %15’inde
(n=12) anafilaksi, %16,3’ünde (n=13) proktokolit mevcuttu. Tüm hastalara KKK
aşısı aşı ile test yapılmadan, tek dozda uygulandı. Bir hastada aşıdan 30
dakika sonra aşırı ağlama, huzursuzluk ve yüzde kızarıklık şeklinde reaksiyon
gözlenirken antihistaminik sonrası 1 saat içinde şikayetleri geriledi. Diğer
hastalarda izlemlerinde sorun yaşanmadı.

Sonuç: Yumurta alerjili hastalarda KKK aşısı sonrası herhangi bir ciddi
reaksiyon gözlenmemiştir. Bağışıklama ve yapılma zamanı önemli olması nedeniyle
yumurta alerjisi olan hastalarda KKK aşısının güvenle yapılabileceğini düşünüyoruz.
Ancak aşı yapılan merkezlerde olası reaksiyonlara müdahale edilebilir uygun
koşullar sağlanmalı ve aşı sonrası hastalar uygun süre gözlem altında
bulundurulmalıdır.

Keywords

çocuk, yumurta alllerjisi, kızamık-kızamıkçık-kabakulak aşılama

The evaluation of allergic reaction in children with egg allergy after measles-mumps-rubella vaccination

Abstract

Objective: Although direct administration of the measles -mumps -rubella (MMR)
vaccine which contains egg protein is recommended to children with egg allergy,
physicians often have reservations, this situation leads to problems in
physicians and families. In this study, we aimed to evaluate the frequency of
reaction after the MMR vaccine in patients who were monitored for egg allergy
in our clinic.

Methods: MMR vaccination records were examined between January 2019 and January
2020 of patients diagnosed with egg allergy in our clinic. Demographic and
clinical characteristics, laboratory findings were evaluated in patients
vaccinated with MMR

Results: The average age was 6.1±2.7 months, and 62.5% (n=50) of the cases were
male. According to their diagnostic distribution, the patients had atopic
dermatitis (n=55; 68.8%), urticaria (n=15; 18.8%), reactive airway disease
(n=20; 25%), proctocolitis (n=13; 16.3%) and anaphylaxis (n=12; 15%). A whole
dose of vaccine was administered to all cases. Flushing and crying was observed
in one patient 30 minutes after vaccination, while her complaints resolved
1hour after antihistamine. No problems were observed in the follow-up of other
patients. There was no severe side effect in any of the cases.

Conclusion: No serious reactions have been observed in patients with egg allergy
after the MMR vaccine. We believe that the MMR vaccine can be safely
administered in patients with egg allergy in vaccinated centers, as
immunization and delivery time are important. However, appropriate conditions
can be intervened in possible reactions and patients should be kept under
observation for the appropriate period after vaccination.

Keywords

children, egg allergy, measles-mumps-rubella vaccination

References

• KAYNAKLAR
• 1) Chafen JJS, Newberry SJ, Riedl MA et al. Diagnosing and managing common food allergies:A systematic review. JAMA 2010;303:1848-1856.
• 2) Burks A.W, Tang M, Sicherer S et al. ICON:Food allergy. J. Allergy Clin. Immunol 2012;129,906–920. PMID: 22365653.
• 3) EAACI Food allergy and Anaphylaxis Guidelines Group. Allergy 2014;69:1008-1025.
• 4) Boyce JA, Assa’ad A, Burks AW et al. Guide¬lines for the diagnosis and management of food allergy in the United States: re¬port of the NIAID-sponsored expert panel. J Allergy Clin Immunol 2010;126:S1-58. PMID: 21134568.
• 5) Rona RJ, Keil T, Summers C et al. The prevalence of food allergy: a meta-analysis. J Allergy Clin İmmunology 2007;120:638-646. https://doi.org/10.1016/j.jaci.2007.05.026.
• 6) Dreskin SC, Halsey NA, Kelso JM et al. International Consensus (ICON): Allergic reactions to vaccines. World Allergy Organization Journal 2016;9:32. PMID: 27679682.
• 7) Chow WC, Eyw K, Lau YL. Measles-mumps-rubella vaccination and egg allergy. HKJ Pediatr 2003;8:35-39.
• 8) Dumortier B, Nosbaum A, Ponvert C, Nicolas JF, Bérard F. Measles-Mumps-Rubella vaccination of an egg-allergic child sensitized to gelatin. Arch Pediatr 2013;20:867-870. https://doi.org/10.1016/j.arcped.2013.05.006
• 9) Freitas DR, Moura E, Araújo G et al. Investigation of an outbreak of hypersensitivity-type reactions during the 2004 national measles-mumps-rubella vaccination campaign in Brazil. Vaccine 2013;31:950-954.
• 10) Nakayama T, Aizawa C, Kuno-Sakai H. A clinical analysis of gelatin allergy and determination of its causal relationship to the previous administration of gelatin-containing acellular pertussis vaccine combined with diphtheria and tetanus toxoids. J Allergy Clin Immunol 1999;103:321–325.
• 11) Carapetis JR, Curtis N, Royle J. MMR immunisation. True anaphylaxis to MMR vaccine is extremely rare. BMJ. 2001;323(7317):869.
• 12) Kuno-Sakai H, Kimura M. Removal of gelatin from live vaccines and DTaP-an ultimate solution for vaccine-related gelatin allergy. Biologicals 2003;31:245–249.
• 13) Patja A, Davidkin I, Kurki T, Kallio MJ, Valle M, Peltola H.Serious adverse events after measles-mumps-rubella vaccination during a fourteen-year prospective follow-up. Pediatr Infect Dis J 2000;19:1127-1134. https://doi.org/10.1097/00006454-200012000-00002
• 14) Nicoline A. T. van der Maas, T. Woudenberg, S. J. M. Hahné, and H. E. de Melker. Tolerability of Early Measles-Mumps-Rubella Vaccination in Infants Aged 6–14 Months During a Measles Outbreak in The Netherlands in 2013–2014. J Infect Dis 2016;213:1466-1471.https://doi.org/10.1093/infdis/jiv756
• 15) Bruno G, Giampietro PG, Grandolfo ME, Milita O, Businco L. Safety of measles immunisation in children with IgE-mediated egg allergy. Lancet. 1990;335(8691):739.
• 16) Khakoo GA, Lack G. Recommendations for using MMR vaccine in children allergic to eggs. BMJ. 2000;320(7239):929–932.
• 17) Esteghamati A, Keshtkar A, Heshmat R et al. Adverse reactions following immunization with MMR vaccine in children at selected provinces of Iran. Arch Iran Med. 2011;14:91–95.doi:011142/AIM.005.
• 18) Andersen DV, Jorgensen IM. MMR vaccination of children with egg allergy is safe. Dan Med J. 2013;60:A4573. 19) Final Aviles F, Campins Marti M, Martinez Gomez X et al. MMR vaccine and egg allergy.Experience in a hospital immunization unit. An Pediatr (Barc) 2007;67:362–367.
• 20) Bahceci S, Nacaroğlu HT, Arı HF et al. Measles-Rubella-Mumps vaccination in cases with egg allergy: Is skin prick test necessary? Can vaccination be done safely? İzmir Dr. Behçet Uz Çocuk Hast. Dergisi 2017; 7:129-132. doi:10.5222/buchd.2017.129.
• 21) Sayar EH. Yumurta Alerjisi Olan Süt Çocuklarında Kızamık Kızamıkçık Kabakulak Aşılama Deneyimi. Acta Med. Alanya 2019;3:283-286. Turkish doi:10.30565/ medalanya.562772.
• 22) Çöğürlü MT, Şimşek IE. Is skin prik test necessery before Measles-Mumps-Rubella vaccination in children with egg allergy? How safe is the vaccine? Kocaeli Med J 2019;8;1:220-225. DOI: 10.5505/ktd.2019.03411.
• 23) Çapanoğlu M, Giniş T, Büyüktiryaki AB et al. The evaluation of allergic reaction in patients with egg allergy after measles mumps-rubella vaccination. Asthma Allergy Immunol 2015;13:71-75. Doi:10.5578/aai.9215.
• 24) Elitok GK, Çelikboya E, Bulbul L et al. Does food allergy require any change in Measles-Mumps-Rubella vaccination? Indian J Pedi¬atr 2019;86:915-920. doi: 10.1007/s12098-019-02981-w.
• 25) Yavuz ST, Sahiner UM, Sekerel BE, Tuncer A, Kalayci O, Sackesen C. Anaphylactic reactions to measles-mumps rubella vaccine in three children with allergies to hen’s egg and cow’s milk. Acta Paediatr 2011;100:94-96.