Vaccine Allergy? Skin Testing and Challenge at a Tertiary Pediatric Hospital in Melbourne, Australia
Vaccine Allergy? Skin Testing and Challenge at a Tertiary Pediatric Hospital in Melbourne, Australia
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DOI：
10.1016/j.jaip.2019.01.025
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发表时间：
2019-05-01
影响因子：
9.4
通讯作者：
Perrett, Kirsten P.
中科院分区：
文献类型：
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作者：
Cheung, Abigail;Choo, Sharon;Perrett, Kirsten P.
背景：真正的疫苗过敏率是未知的。在免疫接种后发生潜在IgE介导的不良事件的儿童应接受过敏调查，可能包括皮肤试验或挑战。以前的协议往往是高度保守的，往往建议侵入性测试的所有，实践没有证据为基础，技术上困难，不愉快的儿童。最近有人建议，皮肤测试可能会被限制在第一个小时内的过敏样事件和那些有过敏史的过敏反应。目的：我们的目的是描述结果的疫苗皮肤测试和挑战的儿童转介到一个三级儿科医院与潜在的IgE介导的过敏性紫癜。第二个目的是确定疫苗过敏的任何重要危险因素。（< 18岁）接受疫苗皮肤试验（皮肤点刺试验或皮内试验[IDT]）或5年内攻毒（2011年5月1日至2016年4月30日）在皇家儿童医院墨尔本presented.Results：有95在73名儿童入院。8%的儿童（73人中有6人）证实对疫苗过敏（皮肤试验阳性或对索引疫苗接种提出挑战）。2例对可疑疫苗IDT阳性，但对替代品牌疫苗攻毒阴性。2例IDT阴性，但随后激发阳性，2例激发后立即出现荨麻疹，但未进行皮肤试验。阳性组中的所有儿童要么在接种疫苗后15分钟内有指数反应，要么有与过敏性反应一致的病史。结论：绝大多数儿童（92%）表现出潜在的IgE介导的免疫缺陷，能够耐受对可疑疫苗的挑战而无反应。我们提出我们的研究方案，建议在所有过敏反应儿童中进行皮肤试验，如果试验阴性或既往存在非过敏性潜在IgE介导的过敏反应，则使用可疑疫苗进行激发。皇冠版权所有（C）2019由Elsevier Inc.美国过敏、哮喘和免疫学会（American Academy of Allergy，Asthma & Immunology）
BACKGROUND: The rate of true vaccine allergy is unknown. Children with potential IgE-mediated adverse events following immunization (AEFI) should undergo allergy investigation that may include skin testing or challenge. Previous protocols tend to be highly conservative and often suggest invasive testing for all, a practice not evidence based, technically difficult, and unpleasant in children. It has more recently been suggested that skin testing may be restricted to those with allergic-like events within the first hour and those with a history of anaphylaxis.OBJECTIVE: We aimed to describe the outcome of vaccine skin testing and challenge in children referred to a tertiary pediatric hospital with a potential IgE-mediated AEFI. The secondary aim was to identify any significant risk factors for vaccine allergy.METHODS: A retrospective review of all children (< 18 years) who underwent vaccine skin testing (skin prick testing or intradermal testing [IDT]) or challenge over a 5-year period (May 1, 2011, to April 30, 2016) at the Royal Children's Hospital Melbourne is presented.RESULTS: There were 95 admissions in 73 children. Eight percent (6 of 73) of children had confirmed vaccine allergy (positive skin testing or challenge to the index vaccination). Two had positive IDT to a suspect vaccine but challenge negative to an alternative brand vaccine. Two had negative IDT but subsequent positive challenge and two had immediate urticaria on challenge without prior skin testing. All children in the positive group either had index reaction within 15 minutes of vaccination or had history consistent with anaphylaxis.CONCLUSIONS: The vast majority of children (92%) presenting with a potential IgE-mediated AEFI are able to tolerate challenge to a suspect vaccine without reaction. We present our investigation protocol recommending skin testing in all children with anaphylaxis and challenge with a suspect vaccine if negative testing or previous nonanaphylactic potential IgE-mediated AEFI. Crown Copyright (C) 2019 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology