Side effects due to allergic reactions to vaccine antigen or to additives such as chicken protein or gelatin have been known for some time. Recent findings regarding reactions mediated via the carbohydrate epitope galactose-alpha-1,3-galactose (alpha-gal), a constituent of animal gelatin, broaden the spectrum of gelatin-related allergies. This case series presents four patients who developed anaphylactic reactions following rabies vaccination using the vaccine Rabipur®. After appropriate allergy testing by skin prick testing and the determination of specific IgE to allergens in the vaccine, triggering by alpha-gal could be excluded and an allergy to gelatin was detected. The absence of allergic symptoms following the consumption of gelatin could potentially be explained through intestinal hydrolysis resulting in a loss of allergenic potency. Further implications related to the use of gelatin-containing infusions in emergency medicine are discussed.
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Method to determine the level of specific IgE antibodies
Kilounits of antigen per liter
Nokleby H. Vaccination and anaphylaxis. Curr Allergy Asthma Rep. 2006;6:9–13.
Franceschini F, Bottau P, Caimmi S, Crisafulli G, Lucia L, Peroni D, et al. Vaccination in children with allergy to non active vaccine components. Clin Transl Med. 2015;4:3.
Babel W. Gelatine – ein vielseitiges Biopolymer. Chem Zeit. 1996;30:86–95.
Mullins RJ, James H, Platts-Mills TA, Commins S. Relationship between red meat allergy and sensitization to gelatin and galactose-α-1,3-galactose. J Allergy Clin Immunol. 2012;129:1334–1342.e1.
Patja A, Mäkinen-Kiljunen S, Davidkin I, Paunio M, Peltola H. Allergic reactions to measles-mumps-rubella vaccination. Pediatr Electron Pages. 2001;107:E27.
Commins SP, Jerath MR, Platts-Mills T. The glycan did it: how the α‑gal story rescued carbohydrates for allergists – a US perspective. Allergo J Int. 2016;25:44–8.
Stone CA Jr, Hemler JA, Commins SP, Schuyler AJ, Phillips EJ, Peebles RS Jr, et al. Anaphylaxis after zoster vaccine: implicating alpha-gal allergy as a possible mechanism. J Allergy Clin Immunol. 2017;137:1710–1713.e2.
Fischer J, Yazdi AS, Biedermann T. Clinical spectrum of α‑Gal syndrome: from immediate-type to delayed immediate-type reactions to mammalian innards and meat. Allergo J Int. 2016;25:55–62.
Chung EH. Vaccine allergies. Clin Exp Vaccine Res. 2014;3:50–7.
Kelso JM. Potential food allergens in medications. J Allergy Clin Immunol. 2014;133:1509–18.
Giesen A, Gniel D, Malerczyk C. 30 years of rabies vaccination with Rabipur: a summary of clinical data and global experience. Expert Rev Vaccines. 2015;14:351–67.
Niclou N, Müller CS, Stanisz H, Vogt T, Pföhler C. Gelatin allergy as cause for repeated severe anaphylaxis after administration of a rabies vaccine. Austin J Allergy. 2014;1:3. http://austinpublishinggroup.com/allergy/fulltext/aja-v1-id1011.php.
Kelso JM, Jones RT, Yunginger JW. Anaphylaxis to measles, mumps, and rubella vaccine mediated by IgE to gelatin. J Allergy Clin Immunol. 1993;91:867–72.
Marrel J, Christ D, Spahn DR. Anaphylactic shock after sensitization to gelatin. Br J Anaesth. 2011;107:647–8.
Kelso JM. The gelatin story. J Allergy Clin Immunol. 1999;103:200–2.
Invited Commentary CSP. Alpha-Gal Allergy: Tip of the Iceberg to a Pivotal Immune Response. Curr Allergy Asthma Rep. 2016;16:61.
Conflict of interest
F. Bradfisch, M. Pietsch, S. Forchhammer, S. Strobl, H.M. Stege, R. Pietsch, S. Carstens, K. Schäkel, A. Yazdi and J. Saloga declare that they have no competing interests.
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Bradfisch, F., Pietsch, M., Forchhammer, S. et al. Case series of anaphylactic reactions after rabies vaccinations with gelatin sensitization. Allergo J Int 28, 103–106 (2019). https://doi.org/10.1007/s40629-019-0094-2