The Journal of Allergy and Clinical Immunology: In Practice
Original ArticleVaccine Allergy? Skin Testing and Challenge at a Tertiary Pediatric Hospital in Melbourne, Australia
Section snippets
Methods
A retrospective review of all children, under the age of 18 years, who underwent in-hospital vaccine skin testing and/or challenge over a 5-year period (from May 1, 2011, to April 30, 2016) is presented. The Royal Children's Hospital is a major tertiary care referral allergy center located in Melbourne, Australia. The study was approved by the Human Research Ethics Committee of the Royal Children's Hospital, Melbourne, Australia (DA013-2017-16).
Study population and vaccines challenged
There were a total of 95 allergy testing episodes in 73 children. Eighteen children had both SPT and IDT. There were 59 children with 73 separate vaccine challenges (without preceding skin testing). Children with IDT to 1 vaccine were also included in the challenge group if they underwent challenge to a separate vaccine without preceding IDT. These results are shown in Figure 1.
The number of each vaccine challenged is demonstrated in Table I. The ages of children included in this study range
Discussion
Potential hypersensitivity AEFI are commonly reported, but the incidence of true vaccine allergy is likely to be much lower, with the rate of anaphylaxis reported to be 0.65 cases per million vaccine doses in children and adolescents10 and vaccine-specific anaphylaxis rates ranging from 0 to 5.14 per million vaccine doses.11 We found a rate of 8% of true vaccine allergy in our cohort; however, it must be noted that this is in patients already deemed suspicious of a previous IgE-mediated vaccine
Conclusions
In conclusion, we find that the vast majority of children presenting with a possible IgE-mediated adverse event after vaccination are tolerant to a suspect vaccine or antigen on rechallenge. We identified that all children with positive testing either had index reaction within the first 15 minutes after vaccination or history consistent with anaphylaxis.
Given our findings, we present our investigation protocol. We hope that this proposed protocol will assist in the appropriate investigation
References (18)
- et al.
Adverse reaction to vaccines practice parameter 2012 update
J Allergy Clin Immunol
(2012) - et al.
Vaccine allergy
Immunol Allergy Clin North Am
(2014) - et al.
Irritant skin test reactions to common vaccines
J Allergy Clin Immunol August
(2007) - et al.
Dermal testing of vaccines for children at high risk of allergies
Vaccine
(2007) - et al.
Risk of anaphylaxis after vaccination in children and adults
J Allergy Clin Immunol
(2016) - et al.
Syncope after immunization
Arch Pediatr Adolesc Med
(1997) - et al.
Pediatric anaphylactic adverse events following immunization in Victoria, Australia from 2007 to 2013
Vaccine
(2005) - et al.
Clinical approach used in medical consultations for allergic-like events following immunization: case series report in relation to practice guidelines
J Allergy Clin Immunol Pract
(2017) Skin prick testing for the diagnosis of allergic disease: a manual for practitioners
Cited by (11)
Revaccination and Adverse Event Recurrence in Patients with Adverse Events following Immunization
2022, Journal of PediatricsCitation Excerpt :However, the number of revaccinated participants was small, and the recurrence risk was not significantly different between those who did and did not meet skin test criteria. These findings are consistent with 2 retrospective studies of pediatric and adult patients assessed for suspected vaccine allergy that found positive skin tests and adverse event recurrence occurred most commonly in patients with a history of clinically confirmed anaphylaxis and/or symptom onset <1 hour postvaccination.19,20 Participants were revaccinated with a full dose or in 2 steps; none was revaccinated using the 5-step graded dosing procedure recommended for patients with positive skin testing who require revaccination.9
The adverse reactions to vaccines practice parameter 10 years on—what have we learned?
2022, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :We must provide advice based on available evidence regarding the likelihood of a vaccine reaction in a patient allergic to a constituent or the likelihood of a reaction to a subsequent vaccine dose in a patient who may have had an allergic reaction to a previous dose. In almost all circumstances, the data are very reassuring that the vaccines will be well-tolerated.5,6 Withholding vaccination in patients where there is concern about a reaction to the vaccine may seem prudent or conservative; however, not vaccinating also carries real risk.
The Journal of Allergy and Clinical Immunology: In Practice 2019 Highlights
2020, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Allergic reactions to vaccines are rare, and few studies have reported on evaluations of a large group of patients. Cheung et al101 reported their retrospective experience with evaluating 73 Australian children suspected of having vaccine allergy. Most had immediate reactions, with 69% reporting reactions within 15 minutes.
Global burden of vaccine-associated anaphylaxis and their related vaccines, 1967–2023: A comprehensive analysis of the international pharmacovigilance database
2024, Allergy: European Journal of Allergy and Clinical ImmunologyAnaphylaxis caused by vaccines
2022, Revista Alergia Mexico
No funding was received for this work.
Conflicts of interest: K. P. Perrett is supported by a Melbourne Children's Clinician-Scientist Fellowship and her institution, Murdoch Children's Research Institute, has received research grants from DBV, GlaxoSmithKline, MedImmune, Novartis, Novavax, and Pfizer.