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Vaccine-Associated Anaphylaxis

Abstract

Purpose of Review

Anaphylaxis is a rare, serious hypersensitivity reaction following vaccination, which is rapid in onset and characterized by multisystem involvement. Although anaphylaxis may occur after any vaccine, understanding the risk for this outcome, particularly following influenza vaccines, is important because of the large number of persons vaccinated annually.

Recent Findings

Two recent CDC safety studies confirmed the rarity of post-vaccination anaphylaxis. In a 25-year review of data from the Vaccine Adverse Event Reporting System (VAERS), reports in children were most common following childhood vaccinations and among adults more often followed influenza vaccine. In a Vaccine Safety Datalink (VSD) study, the estimated incidence of anaphylaxis was 1.3 per million vaccine doses administered for all vaccines and 1.6 per million doses for IIV3 (trivalent) influenza vaccine.

Summary

Despite its rarity, its rapid onset (usually within minutes) and potentially lethal nature require that all personnel and facilities providing vaccinations have procedures in place for anaphylaxis management.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Wood RA, Camargo CA, Lieberman P, Sampson HA, Schwartz LB, Zitt M, et al. Anaphylaxis in America: the prevalence and characteristics of anaphylaxis in the United States. J Allergy Clin Immunol. 2014;133:461–7.

    Article  Google Scholar 

  2. 2.

    Lee JK, Vadas P. Anaphylaxis mechanisms and management. Clin Exp Allergy. 2011;25:163–75.

    Google Scholar 

  3. 3.

    Castells M. Diagnosis and management of anaphylaxis. J Allergy Clin Immunol. 2017;140:321–33.

    Article  Google Scholar 

  4. 4.

    Reber L, Hernandez JD, Galli SJ. The pathophysiology of anaphylaxis. J Allergy Clin Immunol. 2017;140:335–48.

    CAS  Article  Google Scholar 

  5. 5.

    Jimenez-Rodriguez TW, Garcia-Neuer ALA, Castells M. Anaphylaxis in the 21st century: phenotypes, endotypes, and biomarkers. J Asthma Allergy. 2018;11:121–41.

    CAS  Article  Google Scholar 

  6. 6.

    Dreskin SC, Halsey NA, Kelso JM, Wood RA, Hummell DS, Edwards KM, et al. International Consensus (ICON): allergic reactions to vaccines. World Allergy Organ J. 2016;9:32.

    Article  Google Scholar 

  7. 7.

    Wood RA. Allergic reactions to vaccines. Pediatr Allergy Immunol. 2013;24:521–6.

    Article  Google Scholar 

  8. 8.

    • Nilsson L, Brockow K, Alm J, Cardona V, Caubert JC, Gomes E, et al. Vaccination and allergy: EAACI position paper, practical aspects. Pediatr Allergy Immunol. 2017;28:628–40. Important current review.

    Article  Google Scholar 

  9. 9.

    • McNeil MM, DeStefano F. Vaccine-associated hypersensitivity. J Allergy Clin Immunol. 2018;141:463–72. Recent review paper.

    Article  Google Scholar 

  10. 10.

    Prevention and control of influenza with vaccines recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2010;59:1–62.

    Google Scholar 

  11. 11.

    •• Grohskopf LA, Sokolow LZ, Broder KR, Walter EB, Fry AM, Jerningan DB. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices-United States, 2018-19 influenza season. MMWR Recomm Rep. 2018;67:1–20 Recommendations on influenza vaccines in current season from ACIP.

    Article  Google Scholar 

  12. 12.

    Recommendations for Prevention and Control of Influenza in Children, 2018–2019. Pediatrics. 2018;142:e20182367.

  13. 13.

    Smith JC, Snider DE, Pickering LK. Advisory Committee on Immunization Practices. Immunization policy development in the United States: the role of the Advisory Committee on Immunization Practices. Ann Intern Med. 2009;150(1):45–9.

    Article  Google Scholar 

  14. 14.

    Shimabukuro TT, Nguyen M, Martin D, DeStefano F. Safety monitoring in the Vaccine Adverse Event Reporting System (VAERS). Vaccine. 2015;33:4398–405.

    Article  Google Scholar 

  15. 15.

    McNeil MM, Gee J, Weintraub ES, Belongia EA, Lee GM, Glanz JM, et al. The Vaccine Safety Datalink: successes and challenges monitoring vaccine safety. Vaccine. 2014;32:5390–8.

    Article  Google Scholar 

  16. 16.

    Williams SE, Klein NP, Halsey N, Dekker CL, Baxter RP, Marchant CD, et al. Overview of the clinical consult case review of adverse events following immunization: Clinical Immunization Safety Assessment (CISA) network 2004-2009. Vaccine. 2011;29:6920–7.

    Article  Google Scholar 

  17. 17.

    Wood RA, Berger M, Dreskin SC, Setse R, Engler RJ, Dekker CL, et al. An algorithm for treatment of patients with hypersensitivity reactions after vaccines. Pediatrics. 2008;122:e771–7.

    Article  Google Scholar 

  18. 18.

    Rüggeberg JU, Gold MS, Bayas JM, Blum MD, Bonhoeffer J, Friedlander S, et al. Anaphylaxis: case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine. 2007;25:5675–84.

    Article  Google Scholar 

  19. 19.

    Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, et al. Second symposium on the definition and management of anaphylaxis: summary report—Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006;117:391–7.

    Article  Google Scholar 

  20. 20.

    • Su JR, Moro PL, Ng CS, Lewis PW, Said MA, Cano MV. Anaphylaxis after vaccination reported to the Vaccine Adverse Event Reporting System, 1990–2016. J Allergy Clin Immunol. 2019;143:1465–73. Very recent VAERS report.

    Article  Google Scholar 

  21. 21.

    McNeil MM, Weintraub ES, Duffy J, Sukumaran L, Jacobsen SJ, Klein NP, et al. Risk of anaphylaxis after vaccination in children and adults. J Allergy Clin Immunol. 2016;137:868–78.

    Article  Google Scholar 

  22. 22.

    Woo EJ, Moro PL, Cano M, Jankosky C. Postmarketing safety surveillance of trivalent recombinant influenza vaccine: Reports to the Vaccine Adverse Event Reporting System. Vaccine. 2017;35:5618–21.

    Article  Google Scholar 

  23. 23.

    Haber P, Moro PL, Ng C, Dores GM, Lewis P, Cano M. Post-licensure surveillance of trivalent adjuvanted influenza vaccine (aIIV3; Fluad), Vaccine Adverse Event Reporting System (VAERS), United States, July 2016–June 2018. Vaccine. 2019;37:1516–20.

    Article  Google Scholar 

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Funding

This study was supported solely by the CDC, and no external funding was secured.

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Correspondence to Michael M. McNeil MD, MPH.

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Michael M. McNeil declares that he has no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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The findings and conclusions in this report are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC). Use of trade names and commercial sources is for identification only and does not imply endorsement by the Centers for Disease Control and Prevention or the US Department of Health and Human Services.

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This article is part of the Topical Collection on Anaphylaxis

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McNeil, M.M. Vaccine-Associated Anaphylaxis. Curr Treat Options Allergy 6, 297–308 (2019). https://doi.org/10.1007/s40521-019-00215-0

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Keywords

  • Anaphylaxis
  • Influenza vaccination
  • Surveillance
  • Vaccine safety