Continuing Medical Education
Vaccination in food allergic patients
Important potential food allergens in vaccines include egg and gelatin. Rare cases of reactions to yeast, lactose and casein have been reported.
It is strongly recommended that when vaccines are being administered resuscitation equipment must be available to manage potential anaphylactic reactions, and that all patients receiving a vaccine are observed for a sufficient period.
Children who are allergic to egg may safely receive the measles-mumps-rubella (MMR) vaccine; it may also be given routinely in primary healthcare settings. People with egg allergy may receive influenza vaccination routinely; however, some authorities still perform prior skin-prick testing and give two-stage dosing. The purified chick embryo cell culture rabies vaccine contains egg protein, and therefore the human diploid cell and purified verocell rabies vaccines are preferred in cases of egg allergy.
Yellow fever vaccine has the greatest likelihood of containing amounts of egg protein sufficient to cause an allergic reaction in allergic individuals. This vaccine should not be routinely administered in egg allergic patients and referral to an allergy specialist is recommended, as vaccination might be possible after careful evaluation, skin-testing and graded challenge or desensitisation.
S Karabus, Private Practice, Christiaan Barnard Memorial Hospital, Cape Town, and Division of Allergy, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
C L Gray, Private Practice, Vincent Pallotti Hospital, Pinelands, Cape Town, South Africa
E Goddard, Division of Paediatric Gastroenterology, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
M Kriel, Private Practice, Alberton, Johannesburg, South Africa
A C Lang, Wits Donald Gordon Medical Centre, Johannesburg, South Africa
A I Manjra, Private Practice, Westville, Durban, South Africa
S M Risenga, Department of Pulmonology and Allergy, Faculty of Health Sciences, Polokwane Campus, University of Limpopo, Polokwane, South Africa
A J Terblanche, Department of Paediatrics, Faculty of Health Sciences, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
D A van der Spuy, Private Practice, Cape Town, South Africa
M E Levin, Division of Allergy, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town and Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
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Date published: 2014-11-21
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