An Algorithm for Treatment of Patients With Hypersensitivity Reactions After Vaccines

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Published online September 1, 2008

PEDIATRICS Vol. 122 No. 3 September 2008, pp. e771-e777

(doi:10.1542/peds.2008-1002)

An Algorithm for Treatment of Patients With Hypersensitivity Reactions

After Vaccines

A. Wood, Melvin Berger, C. Dreskin, nna Setse,

Renata J.M. Engler, Cornelia L. Dekker, Neal A. Halsey the

Hypersensitivity Working Group of the Clinical Immunization Safety

Assessment (CISA) Network

Pediatrics. 2008; 122(3): p. e771-e777

http://pediatrics.aappublications.org/cgi/content/abstract/122/3/e771?ct

a Department of Pediatrics, s Hopkins University School of

Medicine, Baltimore, land

b Departments of Pediatrics and Medicine, University Hospitals of

Cleveland, Cleveland, Ohio

c Division of Allergy and Immunology, University of Colorado Health

Sciences Center, Denver, Colorado

d Department of International Health, s Hopkins University

Bloomberg School of Public Health, Baltimore, land

e Vaccine Healthcare Center Network, Walter Army Medical Center,

Washington, DC

f Division of Pediatric Infectious Diseases, Stanford University

School of Medicine, Stanford, California

Concerns about possible allergic reactions to immunizations are

raised frequently by both patients/parents and primary care

providers. Estimates of true allergic, or immediate hypersensitivity,

reactions to routine vaccines range from 1 per 50000 doses for

diphtheria-tetanus-pertussis to

~

1 per 500000 to 1000000 doses for most other vaccines. In a large

study from New Zealand, data were collected during a 5-year period on

15 marketed vaccines and revealed an estimated rate of 1 immediate

hypersensitivity reaction per 450000 doses of vaccine administered.

Another large study, conducted within the Vaccine Safety Datalink,

described a range of reaction rates to >7.5 million doses. Depending

on the study design and the time after the immunization event,

reaction rates varied from 0.65 cases per million doses to 1.53 cases

per million doses when additional allergy codes were included. For

some vaccines, particularly when allergens such as gelatin are part

of the formulation (eg, Japanese encephalitis), higher rates of

serious allergic reactions may occur. Although these per-dose

estimates suggest that true hypersensitivity reactions are quite

rare, the large number of doses that are administered, especially for

the commonly used vaccines, makes this a relatively common clinical

problem. In this review, we present background information on vaccine

hypersensitivity, followed by a detailed algorithm that provides a

rational and organized approach for the evaluation and treatment of

patients with suspected hypersensitivity. We then include 3 cases of

suspected allergic reactions to vaccines that have been referred to

the Clinical Immunization Safety Assessment network to demonstrate

the practical application of the algorithm.

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Sheri Nakken, former R.N., MA, Hahnemannian Homeopath

Vaccination Information & Choice Network, Nevada City CA & Wales UK

Vaccines - http://www.wellwithin1.com/vaccine.htm

Vaccine Dangers & Homeopathy Online/email courses - next classes Sept 10, 2008