Gelatin-specific humoral and cellular immune responses in children with immediate- and nonimmediate-type reactions to live measles, mumps, rubella, and varicella vaccines,☆☆,

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Abstract

Background: This study was designed to investigate the development of both cellular and humoral immune responses to gelatin in patients with vaccine-related immediate and nonimmediate reactions. Our purpose was to define the nature of the responses in the different clinical states. Methods: Six patients with immediate reactions and 21 patients with nonimmediate reactions after inoculation of various live vaccines were studied. Measurement of gelatin-specific IgE was performed in all subjects. Gelatin-specific T-cell responses detected by an in vitro lymphocyte proliferation assay and by an assay for IL-2 responsiveness were investigated to compare the immune response in patients with the two types of reaction. Results: All six patients with immediate reactions had IgE responses to gelatin, whereas none of the 21 patients with nonimmediate reactions had any anti-gelatin IgE. All of the six patients with immediate reactions and 17 of the 21 patients with nonimmediate reactions exhibited positive T-lymphocyte responses specific to gelatin. Conclusions: Immediate and nonimmediate reactions are caused by different types of allergy to gelatin, and cell-mediated immunity to gelatin may play an important role in the pathogenesis of nonimmediate reactions. (J Allergy Clin Immunol 1997;100:130-4.)

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Patients

Six patients with immediate reactions and 21 patients with nonimmediate reactions after inoculation of various live vaccines were studied. All six patients with immediate reactions showed anaphylactic symptoms characterized by cough, wheezing, and dyspnea occurring within 15 minutes after vaccine inoculation. Nonimmediate reactions consisted of erythema and swelling at the injection site and mild systemic cutaneous reactions, which occurred several to 48 hours after vaccination. Patients with

IgE antibody specific to gelatin

The positive/negative cutoff level value was set at 0.35 Ua/ml for IgE. All patients with immediate reactions showed positive IgE responses specific to gelatin, which ranged from 1.15 to 30.7 Ua/ml (Table I). The levels of IgE did not seem to correlate with the severity of the clinical reactions. In contrast to the patients with immediate-type reactions, none of the patients with nonimmediate reactions had positive IgE responses.

Gelatin-specific cell-mediated immunity

Lymphoproliferation assays specific to gelatin were performed in

Discussion

There has been an increasing number of reports regarding anaphylactic reactions to measles or measles-mumps-rubella vaccines in children without allergy to eggs,8, 9, 10, 11, 12, 13 and components of the vaccine other than egg protein have been implicated as the cause.14 In 1986, Miyake et al.15 found specific IgE antibody to measles vaccine by means of radioimmunoassay in the sera of patients who had episodes of immediate local allergic reactions. Subsequently, the actual antigen was

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From aPediatric Allergy and Infectious Diseases Society of Sapporo, Sapporo; bSapporo Medical University School of Medicine, Sapporo; cThe Jikei University School of Medicine, Tokyo; dMitsubishi Kagaku Bio-Clinical Laboratories, Inc., Tokyo; and eNational Institute of Health, Tokyo.

☆☆

Reprint requests: Takuji Kumagai, MD, Kumagai Pediatric Clinic, W-6, Momijidai, Atsubetsu-ku, Sapporo 004, Japan.

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