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MMR vaccine and allergy
  1. R LAKSHMAN, Clinical Research Fellow
  1. Sheffield Institute for Vaccine Studies
  2. University of Sheffield and Sheffield Children's Hospital
  3. Sheffield S10 2TH, UK
  4. email: R.Lakshman@shef.ac.uk
  5. Sheffield Institute for Vaccine Studies
    1. ADAM FINN, Senior Lecturer in Paediatric Immunology and Infectious Diseases
    1. Sheffield Institute for Vaccine Studies
    2. University of Sheffield and Sheffield Children's Hospital
    3. Sheffield S10 2TH, UK
    4. email: R.Lakshman@shef.ac.uk
    5. Sheffield Institute for Vaccine Studies

      https://doi.org/10.1136/adc.82.2.93

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        Live measles and mumps vaccine viruses are cultured in chick embryo fibroblasts and may contain minute amounts of egg related antigens.1-3 In view of this, there has been a longstanding debate on the safety of these vaccines in children with severe allergic reactions to egg. Initially it was believed that such children could safely receive the vaccine; Kamin et al in 19654 reported the safe administration of measles vaccine to 22 children with egg allergy confirmed by food challenges.

        Key messages

        • Anaphylaxis is an extremely rare but potentially fatal complication after any vaccination

        • It is difficult to predict which children are likely to have a severe allergic reaction

        • Many of the allergic reactions that occur after administration of gelatin containing vaccines in Japan appear to be due to IgE mediated or cell mediated immune responses to gelatin

        • MMR vaccine is not advised in children with known severe systemic allergic reactions to gelatin or neomycin

        • Children allergic to eggs (including those who have had anaphylactic reactions to egg) do not appear to be at greater risk for anaphylaxis to MMR vaccine than other children

        • All vaccination must be carried out in settings with equipment to deal with anaphylaxis and by personnel trained in its recognition and management. Assuming these criteria are met, vaccinations do not have to take place in the presence of a doctor or on medical premises

        The concern was again raised in 1983 by Herman et al when they reported two children with allergy to egg white protein who had generalised urticaria, angio-oedema, and respiratory difficulty following immunisation with measles vaccine.3Serum IgE reactive with ovalbumin related antigens in the vaccine was demonstrated in both children. They also showed the presence of ovalbumin reacting protein in the vaccine.

        They subsequently evaluated 24 children with egg …

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        Footnotes

        • ↵* Information published by the Department of Health on 2 December 1999 indicates that diphtheria tetanus acellular pertussis combined vaccines will shortly be introduced into the UK primary schedule. It may prove that some of these vaccines contain gelatin.

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          Archives of Disease in Childhood 2000; 82 0-0 Published Online First: 01 Feb 2000. doi: 10.1136/adc.82.2.0