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Administration of yellow fever vaccine in patients with egg allergy.
Int Arch Allergy Immunol. 2013; 161(3):274-8.IA

Abstract

BACKGROUND

The population of large parts of Africa, South America and travellers to these areas are at risk of yellow fever (YF) with a 50% mortality risk. Yellow fever vaccine (YFV) propagated in hens' eggs confers protection in 95% of the vaccinated. The rate of anaphylaxis for YFV ranges from 0.42 to 1.8/100,000 doses with most cases considered to be due to egg allergy. Egg allergy is a contraindication for the YFV. Nevertheless, the potential fatal sequelae from YF give the incentive to protect everyone at risk irrespective of their allergic status.

METHODS

Six subjects who had had a recent reaction to egg and who were travelling to endemic areas (3 adults and 3 children) underwent skin prick tests (SPT) with undiluted YFV and egg extract. Intradermal tests for YFV were undertaken at a 1:10 dilution. In 4 egg-allergic patients with a positive SPT to YFV, a 7-step desensitization protocol was used. A 2-step (10 + 90%) protocol was used in the 2 subjects with a negative YFV SPT. Premedication was not administered.

RESULTS

All 6 patients were successfully vaccinated. Four patients completed desensitization: 1 developed mild local erythema at the injection site, 1 had fleeting generalized urticaria with local erythema/angioedema and 2 did not experience any adverse reactions. Patients who received YFV in 2 steps developed no adverse reactions.

CONCLUSIONS

We describe the successful administration of YFV in 6 egg-allergic patients. The Cambridge Allergy 7-step protocol allows for its safe administration in patients with positive SPT to YFV. A 2-step protocol can be used in patients with negative YFV SPT.

Authors+Show Affiliations

Allergy Department, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK. krzysztof.rutkowski @ addenbrookes.nhs.ukNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

23548550

Citation

Rutkowski, K, et al. "Administration of Yellow Fever Vaccine in Patients With Egg Allergy." International Archives of Allergy and Immunology, vol. 161, no. 3, 2013, pp. 274-8.
Rutkowski K, Ewan PW, Nasser SM. Administration of yellow fever vaccine in patients with egg allergy. Int Arch Allergy Immunol. 2013;161(3):274-8.
Rutkowski, K., Ewan, P. W., & Nasser, S. M. (2013). Administration of yellow fever vaccine in patients with egg allergy. International Archives of Allergy and Immunology, 161(3), 274-8. https://doi.org/10.1159/000346350
Rutkowski K, Ewan PW, Nasser SM. Administration of Yellow Fever Vaccine in Patients With Egg Allergy. Int Arch Allergy Immunol. 2013;161(3):274-8. PubMed PMID: 23548550.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Administration of yellow fever vaccine in patients with egg allergy. AU - Rutkowski,K, AU - Ewan,P W, AU - Nasser,S M, Y1 - 2013/03/15/ PY - 2012/08/21/received PY - 2012/12/06/accepted PY - 2013/4/4/entrez PY - 2013/4/4/pubmed PY - 2013/9/14/medline SP - 274 EP - 8 JF - International archives of allergy and immunology JO - Int Arch Allergy Immunol VL - 161 IS - 3 N2 - BACKGROUND: The population of large parts of Africa, South America and travellers to these areas are at risk of yellow fever (YF) with a 50% mortality risk. Yellow fever vaccine (YFV) propagated in hens' eggs confers protection in 95% of the vaccinated. The rate of anaphylaxis for YFV ranges from 0.42 to 1.8/100,000 doses with most cases considered to be due to egg allergy. Egg allergy is a contraindication for the YFV. Nevertheless, the potential fatal sequelae from YF give the incentive to protect everyone at risk irrespective of their allergic status. METHODS: Six subjects who had had a recent reaction to egg and who were travelling to endemic areas (3 adults and 3 children) underwent skin prick tests (SPT) with undiluted YFV and egg extract. Intradermal tests for YFV were undertaken at a 1:10 dilution. In 4 egg-allergic patients with a positive SPT to YFV, a 7-step desensitization protocol was used. A 2-step (10 + 90%) protocol was used in the 2 subjects with a negative YFV SPT. Premedication was not administered. RESULTS: All 6 patients were successfully vaccinated. Four patients completed desensitization: 1 developed mild local erythema at the injection site, 1 had fleeting generalized urticaria with local erythema/angioedema and 2 did not experience any adverse reactions. Patients who received YFV in 2 steps developed no adverse reactions. CONCLUSIONS: We describe the successful administration of YFV in 6 egg-allergic patients. The Cambridge Allergy 7-step protocol allows for its safe administration in patients with positive SPT to YFV. A 2-step protocol can be used in patients with negative YFV SPT. SN - 1423-0097 UR - https://www.unboundmedicine.com/medline/citation/23548550/Administration_of_yellow_fever_vaccine_in_patients_with_egg_allergy_ L2 - https://www.karger.com?DOI=10.1159/000346350 DB - PRIME DP - Unbound Medicine ER -