Development of IgE antibody to gelatin in children with systemic immediate-type reactions to vaccines

doi:10.1016/S0091-6749(97)70038-1

Journal of Allergy and Clinical Immunology

Volume 99, Issue 5, May 1997, Pages 720-721

https://doi.org/10.1016/S0091-6749(97)70038-1 Get rights and content

Abstract

J Allergy Clin Immunol 1997;99:720-1.

Section snippets

Case 1

A girl, 1 year and 5 months old (child no. 1 in Table I), showed systemic immediate-type reactions (systemic urticaria, angioedema around eyes) to measles vaccine, which contained 1.5 mg of gelatin per injection. Serum samples were collected three times: the day after vaccination, 10 days after, and about 3 months later. She had received oral polio and diphtheria-tetanus-acellular pertussis (DTaP) vaccines (3 times) before but had no allergic reaction to these vaccines. The DTaP vaccine

Results and Discussion

We assayed serum IgE antibody to gelatin and egg white by the CAP method (Pharmacia, Uppsala, Sweden). Children nos. 1 and 2 had anti-gelatin IgE (14 and 11 Unit allergen (Ua)/ml, respectively) immediately after showing reactions to vaccine. After about 1 week, the antibody levels had markedly increased (Table I), but after several months, they decreased. To determine whether this rapid rise in antibody level was an anamnestic response or whether the low level at the time of allergy was due to

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Cited by (34)

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2019, Annals of Allergy, Asthma and Immunology
To assess the iatrogenic risks of gelatin allergy and identify resources for patient management.
A literature review was performed using PubMed and public databases provided by the National Library of Medicine.
Reports of iatrogenic gelatin allergy associated with vaccines, hemostatic agents, intravenous colloids, medicinal capsules, and intraoperative surgical supplies.
Gelatin ingredients may not be identified by electronic medical record safeguards, and an exhaustive listing of potential iatrogenic exposures is elusive. The National Library of Medicine AccessGUDID (https://accessgudid.nlm.nih.gov/) can be a useful resource in evaluating medical devices for gelatin content. Unexpected sources of iatrogenic gelatin exposure include hemostatic agents, vascular grafts, intravascular cannulas, bone replacement implants, and emergency resuscitation fluids.
Vigilance is important within medical systems to avoid inadvertent gelatin exposure when caring for patients with gelatin allergy. Additional safeguards are needed to remove latent health care system errors that fail to prevent gelatin administration in this at-risk population.
Childhood vaccination associated adverse events by sex: A literature review
2014, Travel Medicine and Infectious Disease
Citation Excerpt :
According to the authors' research, allergic adverse events have been reported in vaccinees not allergic to eggs. Hypersensitivity to other vaccine constituents, such as gelatin or neomycin, which are present in the vaccine in larger quantities than egg protein, have been proposed by other authors as causative agents [36,39–44]. In their prospective follow-up by case collection of allergic reactions to MMR immunization the authors could demonstrate that of the 36 participants, 10 were allergic to gelatin and 70% of these had persistent symptoms perhaps attributed to food containing gelatin or cross-reactive allergens.
Most approved medicines, including vaccines can be associated with adverse events. A vaccine adverse event is defined as any untoward medical occurrence which follows vaccination, but which does not necessarily have a causal relationship with the administration of the vaccine.
The objective of this structured literature review is to analyse the adverse events reported with vaccinations usually done during childhood and adolescence: human papilloma virus vaccine, hepatitis B vaccine and measles–mumps–rubella vaccine. We evaluated the vaccine literature on children and adolescents by sex. We searched the Cochrane Database, Medline (Pubmed) and Embase using predefined terms.
Of the 417 publications retrieved from searches in the 3 databases, 89 papers (21%) were identified as potentially relevant to the review. On further scrutiny 41 of these satisfied the criteria for inclusion in the analysis. Serious adverse events related to vaccinations were rare. We found some possible sex related vaccine adverse events. Few trials however reported adverse events by age and sex and very few analyses evaluated the observed differences.
Despite earlier calls for sex-specific analyses of clinical studies, we found that vaccine trials were rarely reported and published by sex. Prospectively collated vaccine safety data in children and adolescents should be analysed by age and sex, so that clinical trial results can form an evidence base for vaccine practice recommendations.
Vaccine Allergy
2014, Immunology and Allergy Clinics of North America
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Further studies are needed to evaluate the safety of yellow fever vaccine in these patients, particularly to determine the usefulness of skin tests and the optimal protocol to administer the vaccine (comparison of graded dose with full dose administration). Anaphylactic reactions have been reported in patients without egg allergy after injection of vaccines containing gelatin used as a stabilizer, including MMR, Japanese encephalitis, and chickenpox vaccines.17–22,132,133 Recently, gelatin hypersensitivity has been incriminated in a child allergic to egg who developed an anaphylactic reaction after receiving an influenza vaccine.134
Potential food allergens in medications
2014, Journal of Allergy and Clinical Immunology
Citation Excerpt :
A number of (mostly live viral) vaccines contain gelatin as a stabilizer (Table II).3 There are many well-documented cases of anaphylaxis to gelatin-containing vaccines in recipients subsequently determined to have serum specific anti-gelatin IgE.95,96,122-135 Most such reactions have occurred after injection of vaccines that contain milligram quantities of gelatin, namely measles-mumps-rubella,95,96,122,132,134 varicella,123,124,129 and Japanese encephalitis125,127,133 vaccines.
Excipients are substances in pharmaceuticals other than the active ingredients. Some excipients are foods or substances derived from foods, raising the possibility that these substances would pose a hazard to patients with food allergy. This review describes which food-derived substances are used as pharmaceutical excipients in which medications and reviews published data regarding the safety of the administration of these medications to recipients with food allergy. Such reactions are rare, usually because the amount of food protein is not present in a large enough quantity to elicit a reaction. When a food protein appears as an unintentional contaminant, the amount, if any, that is present might be variable and might elicit reactions only from some lots of medication or only in some patients. In most circumstances these medications should not be routinely withheld from patients who have particular food allergies because most will tolerate the medications uneventfully. However, if a particular patient has had an apparent allergic reaction to the medication, potential allergy to the food component should be investigated.
Safety of MMR immunization in egg-allergic children
2006, Anales de Pediatria
En España la alergia al huevo se ha considerado durante mucho tiempo una contraindicación de la administración de vacunas incubadas en células de embrión de pollo, como la triple vírica o la antigripal. Por ese motivo, en niños alérgicos al huevo, se ha indicado sistemáticamente una vacuna alternativa (Triviraten(r)) incubada en células diploides humanas, sin plantear si podrían tolerar la vacunación SaRuPa (Sarampión-Rubéola-Parotiditis) estándar.
Tras el cese de la producción de Triviraten(r) por parte del Laboratorio Biotech Berna se ha eliminado dicha alternativa para niños con alergia al huevo, que deben recibir la primovacunación a los 15 meses y una dosis de recuerdo a los 3 años, de acuerdo con el calendario vacunal vigente en la actualidad.
En este contexto, durante el período noviembre 2004-junio 2005 se realizó vacunación triple vírica convencional en 40 niños alérgicos al huevo, sin que ninguno de ellos presentase reacción adversa tras su administración, por lo que se puede concluir que esta es segura en el citado grupo de pacientes.
In Spain, for many years allergy to eggs was considered to contraindicate vaccines cultured in fibroblasts from chick embryos such as the measles, mumps, rubella (MMR) and influenza vaccines. Consequently, an alternative vaccine (Triviraten Berna^®) incubated in diploid human cells has been systematically administered to children who are allergic to eggs, without questioning tolerance to the standard MMR vaccine.
After Biotech Bern Laboratory discontinued the production of Triviraten^®, this alternative was no longer available for children with egg allergy, who should receive a first dose of the MMR vaccine at the age of 15 months and a second one (booster dose) at the age of 3 years.
In this context, from November 2004 to June 2005, a single dose of the MMR vaccine was administered to 40 children with allergy to eggs and none showed an adverse reaction. We conclude that this vaccine can be safely administered to this group of patients.
IgE reactivity to vaccine components in dogs that developed immediate-type allergic reactions after vaccination
2005, Veterinary Immunology and Immunopathology
Allergic reactions after vaccination are considered as an important practical problem in dogs; however, their immunological mechanism has not been well understood. The present study was designed to investigate the relationship between IgE reactivity to the vaccines and immediate-type allergic reactions after vaccination in dogs. Sera from 10 dogs that developed immediate-type allergic reactions such as circulatory collapse, cyanosis, dyspnea, facial edema, and vomiting within 1 h after vaccination with non-rabies monovalent or combined vaccines and sera from 50 dogs that did not develop allergic reactions after vaccination were collected. Serum IgE reactivity to the injected vaccines was measured by fluorometric ELISA using a mouse monoclonal anti-dog IgE antibody. Then, IgE reactivity to fetal calf serum (FCS) and stabilizer proteins (gelatin, casein, and peptone) included in the vaccines was measured in sera that had high levels of IgE to the vaccines. Levels of serum specific IgE to the vaccines in dogs with immediate-type allergic reactions (59–4173 fluorescence units [FU], mean ± S.D.: 992.5 ± 1181.9 FU) were significantly higher than those in control dogs (38–192 FU, 92.4 ± 43.3 FU) (P < 0.001). Of the eight dogs that developed immediate-type allergic reactions and had high levels of serum specific IgE to the vaccines, seven had specific IgE directed to FCS. The IgE reactivity to the vaccines in sera from these dogs was almost completely inhibited by FCS. The other one dog had serum IgE directed to gelatin and casein included in the vaccine as stabilizers. The results obtained in this study suggest that immediate-type allergic reactions after vaccination in dogs were induced by type I hypersensitivity mediated by IgE directed to vaccine components. In addition, FCS, gelatin, and casein included in vaccines could be the causative allergens that induced immediate-type allergic reactions after vaccination in dogs.

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^☆: From ^athe Department of Epidemiology, National Institute of Health, Tokyo: ^bShizuoka Children's Hospital: ^cFukuoka Children's Hospital and Medical Center for Infectious Diseases; and Miyanti Clinics, Chiryu.

^☆☆: Supported by the Ernest S. Bazley Asthma Grant to Northwestern University and Northwestern Memorial Hospital.

^★: Reprint requests: Masahiro Sakaguchi, PhD, Department of Epidemiology National Insitute of Health, Toyama 1-23-1, Shinjuku-ku, Tokyo 162, Japan.

^★★: 1/54/80339

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Development of IgE antibody to gelatin in children with systemic immediate-type reactions to vaccines☆,☆☆,★,★★

Abstract

Section snippets

Case 1

Results and Discussion

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol