Safe vaccination of patients with egg allergy with an adjuvanted pandemic H1N1 vaccine
Safe vaccination of patients with egg allergy with an adjuvanted pandemic H1N1 vaccine
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DOI：
10.1016/j.jaci.2010.05.037
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发表时间：
2010-08-01
影响因子：
14.2
通讯作者：
De Serres, Gaston
中科院分区：
文献类型：
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作者：
Gagnon, Remi;Primeau, Marie Noel;De Serres, Gaston
工作背景：由于流感疫苗中含有部分残留的鸡蛋蛋白，理论上对鸡蛋过敏的患者接种疫苗时存在过敏反应的风险。本研究的目的是评估鸡蛋过敏儿童接种2009年甲型H1N1流感疫苗后发生过敏反应的风险（Arepanrix; GlaxoSmithKline，密西索加，安大略，加拿大）。经证实对鸡蛋过敏、且有鸡蛋摄入后呼吸道或心血管反应史的患者分2次接种疫苗（10%和90%）每隔30分钟接种一次，而患有其他类型鸡蛋引起的过敏反应的儿童接种单剂疫苗。所有患者在接种疫苗后继续观察60分钟。进行24小时电话随访，以检测任何延迟反应。主要结果是过敏反应的发生，根据指定的标准由Brighton Collaboration.Results：在830例确诊的鸡蛋过敏，只有9%的患者需要接种疫苗分剂量管理。无患者发生过敏反应。9例患者有轻微过敏症状，接受抗组胺药治疗（1例在接种后60分钟内，8例在随后23小时内），另外3例接受沙丁胺醇治疗（1例在接种后前60分钟内）。根据布莱顿协作组的标准，对3600多名报告鸡蛋过敏的其他儿童进行进一步疫苗接种后没有引起过敏反应，尽管2名患者因过敏症状接受了肾上腺素治疗。尽管流感免疫后的过敏反应在理论上是一种风险，用含佐剂的单价pH 1 N1流感疫苗对鸡蛋过敏的患者进行疫苗接种没有导致过敏反应，并且在此基础上看起来是安全的。（J Allergy Clin Immunol 2010;126：317-23.）
Background: Because influenza vaccine contains some residual egg protein, there is a theoretic risk of anaphylaxis when vaccinating patients with egg allergy. The objective of this study was to estimate the risk of anaphylaxis in children with egg allergy administered an adjuvanted monovalent 2009 pandemic influenza A/H1N1 influenza vaccine (Arepanrix; GlaxoSmithKline, Mississauga, Ontario, Canada).Methods: Patients with confirmed egg allergy with a history of respiratory or cardiovascular reactions after egg ingestion were vaccinated in 2 divided doses (10% and 90%) administered at a 30-minute interval, whereas children with other types of egg-induced allergic reactions were vaccinated with a single dose. All patients remained under observation for 60 minutes after vaccination. A 24-hour follow-up telephone call was made to detect any delayed reaction. The main outcome was the occurrence of an anaphylactic reaction according to criteria specified by the Brighton Collaboration.Results: Among the 830 patients with confirmed egg allergy, only 9% required the vaccine to be administered in divided doses. No patient had an anaphylactic reaction. Nine patients had minor allergic symptoms treated with an antihistamine (1 in the 60 minutes after vaccination and 8 in the following 23 hours), and 3 others received salbutamol (1 in the first 60 minutes after vaccination). Further vaccination of more than 3600 other children with reported egg allergy caused no anaphylaxis based on the criteria of the Brighton Collaboration, although 2 patients received epinephrine for symptoms compatible with allergy.Conclusion: Although anaphylaxis after influenza immunization is a theoretic risk, vaccination of patients with egg allergy with an adjuvanted monovalent pH1N1 influenza vaccine resulted in no cases of anaphylaxis and on that basis appears safe. (J Allergy Clin Immunol 2010;126:317-23.)