A clinical approach to the investigation of suspected vaccine anaphylaxis

Abstract

Vaccine anaphylaxis is rare, despite the increased incidence of atopic disease and food allergies and an increase in the number of vaccines administered to young children. The mechanism of vaccine anaphylaxis is poorly understood and may be IgE- or non-IgE- mediated. The first step is to assess if the reported symptoms and signs are consistent with anaphylaxis, using the Brighton Collaboration case definition of anaphylaxis. Skin-prick and intradermal testing may support the diagnosis. If vaccine anaphylaxis is diagnosed, re-vaccination with the same vaccine antigens or other vaccines containing the same excipients is contraindicated, but the risk of anaphylaxis to other vaccines is not increased. The measles, mumps, rubella (MMR) and influenza vaccines are safe in egg-allergic children. Influenza vaccination in children with egg anaphylaxis may be given under specialist medical supervision. Misdiagnosis of vaccine anaphylaxis may prevent an individual from receiving vaccinations, possibly resulting in a vaccine-preventable illness. All healthcare providers must report suspected vaccine anaphylaxis and record in detail all symptoms and signs when they occur. Signs and symptoms suggestive of anaphylaxis following vaccination should be managed as anaphylaxis and the vaccinee treated with intramuscular adrenaline.