Egg Hypersensitivity and Measles-Mumps-Rubella Vaccine Administration

PEDIATRICS ◽  
1991 ◽  
Vol 88 (5) ◽  
pp. 913-917
Author(s):  
Suzanne A. Beck ◽  
Larry W. Williams ◽  
M. Annette Shirrell ◽  
A. Wesley Burks
Keyword(s):  
Atopic Dermatitis ◽  
Skin Prick Testing ◽  
Skin Testing ◽  
Screening Method ◽  
Negative Control ◽  
Mmr Vaccine ◽  
Double Blind ◽  
Intradermal Testing ◽  
Vaccine Administration ◽  
History Of

Because reports have described egg-sensitive individuals in whom anaphylaxis developed after measles vaccination, current recommendations include delaying administration of egg-derived vaccines until skin testing can be performed. Specifically, the 1988 Red Book recommends skin testing via scratch, prick, or puncture with 1:10 dilution of the vaccine and, if the result is negative, intradermal testing is suggested. The purpose of this study was to evaluate the likelihood of reaction to measles-mumps-rubella (MMR) vaccine in patients with documented egg sensitivity and to delineate the efficacy of skin-prick testing (SPT) to MMR as a predictor of hypersensitivity to the vaccine. Egg sensitivity was documented by initial SPT to egg and then, if possible, double-blind placebo-controlled food challenge (DBPCFC). Patients with a positive DBPCFC to egg or a history of anaphylactic egg sensitivity had a SPT with the MMR vaccine and then were given the MMR vaccine. Additionally, children with atopic dermatitis who had been previously proven egg sensitive via DBPCFCs were evaluated retrospectively for sensitivity to the MMR vaccine. Sixteen children with a history of egg sensitivity underwent SPT to egg, with a positive result 3 mm greater than the negative control found in 12 patients. Eight of these children had a positive DBPCFC to egg. The SPT to MMR vaccine was negative in all 16 children; vaccine administration followed with no resultant systemic problems. Three children had a local reaction at the site of injection. Twelve additional children with atopic dermatitis and egg sensitivity were reviewed. Each child had a positive SPT and DBPCFC to egg. Ten of these children received the MMR vaccine prior to the time that their egg sensitivity was elucidated. Two other children were vaccinated elsewhere after they were documented egg sensitive. All 12 of these children tolerated the vaccine without incident. These results further substantiate the safety of MMR administration in egg-sensitive children and support routine vaccination of children who do not exhibit systemic allergic hypersensitivity to egg. It is suggested that SPT is an adequate screening method for children with anaphylactic egg sensitivity.

Systemic Reactions to Measles-Mumps-Rubella Vaccine Skin Testing

PEDIATRICS ◽  
1993 ◽  
Vol 91 (4) ◽  
pp. 835-836
Author(s):  
LAKSHMI PUVVADA ◽  
BERNARD SILVERMAN ◽  
CLIFFORD BASSETT ◽  
LAWRENCE T. CHIARAMONTE
Keyword(s):  
Skin Testing ◽  
Recent Experience ◽  
Egg Allergy ◽  
Mmr Vaccine ◽  
Rubella Vaccine ◽  
Intradermal Testing ◽  
Vaccine Administration ◽  
Systemic Reactions ◽  
History Of ◽  
Sensitive Individual

In this report, we describe our recent experience with measles-mumps-rubella (MMR) vaccine skin testing and desensitization, including the occurrence of systemic reactions to intradermal testing, which to our knowledge has not been reported previously. We also review the literature on MMR reactions and the controversies regarding testing and administration in the egg-sensitive individual, emphasizing the need for a cautious approach. Ten children with history of egg allergy, ranging in age from 6 to 18 months, were referred to us for further evaluation regarding MMR vaccine administration. Six of 10 had a history of mild to moderate egg sensitivity, which consisted of pruritis, eczema, localized urticaria, on immediate vomiting.

Characterization and Natural History of Skin Testing in Children with Persistent Atopic Dermatitis

2017 ◽  
Vol 139 (2) ◽  
pp. AB241
Author(s):  
Jonathan Somogyi ◽  
Stephanie L. Vakaljan ◽  
Shalini Thiru ◽  
Jason A. Ohayon ◽  
Carly Kenn ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Natural History ◽  
Skin Testing ◽  
History Of

scholarly journals The Rate of Epinephrine Administration Associated with Allergy Skin Testing in a Suburban Allergy Practice from 1997 to 2010

2012 ◽  
Vol 3 (2) ◽  
pp. ar.2012.3.0034 ◽  
Author(s):  
David A. Swender ◽  
Leah R. Chernin ◽  
Chris Mitchell ◽  
Theodore Sher ◽  
Robert Hostoffer ◽  
...  
Keyword(s):  
Skin Prick Testing ◽  
Skin Testing ◽  
Retrospective Chart Review ◽  
Safe Procedure ◽  
Intradermal Testing ◽  
Epinephrine Administration ◽  
Systemic Reactions ◽  
Time Period ◽  
Procedure Codes ◽  
Allergy Skin Testing

Allergy skin testing is considered a safe method for testing for IgE-mediated allergic responses although anaphylactic events can occur. Reported rates of anaphylaxis per patient are not consistent and range from 0.008 to 4%. The aim of this study was to determine the rate of epinephrine use associated with allergy skin-prick testing (SPT) and intradermal testing (IDT) in a suburban practice over 13 years. This retrospective chart review used billing and procedure coding records during the time period from January 1997 to June 2010 to identify encounters where epinephrine was administered after SPT or IDT. Patient encounters with procedure codes for skin testing plus either parenteral epinephrine, corticosteroid, antihistamine, or i.v. fluid administration were identified. These patient charts were reviewed to determine if epinephrine was administered, whether systemic reactions developed, and rates of epinephrine administration were calculated. There were 28,907 patient encounters for SPT and 18,212 for IDT. Epinephrine was administered in six patient encounters (0.02%) where SPT was performed; no IDT encounters led to epinephrine administration. There were no fatalities. Allergy skin testing to a variety of allergens, when administered by well-trained personnel, is a safe procedure. This study, involving the largest population to date, showed a rate of systemic reactions requiring epinephrine of 20 per 100,000 SPT visits. No epinephrine was given after IDT.

scholarly journals White paper on peanut allergy: treatment pathway

2021 ◽  
Author(s):  
Ludger Klimek ◽  
Lars Lange ◽  
Lea Alexandra Blum ◽  
Felix Klimek ◽  
Katja Nemat ◽  
...  
Keyword(s):  
Peanut Allergy ◽  
Care Pathway ◽  
Incidental Finding ◽  
Therapeutic Option ◽  
Skin Prick Testing ◽  
Treatment Algorithm ◽  
Specific Ige ◽  
White Paper ◽  
Double Blind ◽  
History Of

Summary Background Peanuts are a member of the legume family (botanical family Leguminosae) and peanut allergies are the most common cause of food anaphylaxis in many countries. The prevalence of peanut allergy is increasing. Methods Experts from Germany and Austria performed a standardized literature search and published their consensus recommendations in a White Paper on Peanut Allergy, which this care pathway is based upon, thus, providing a comprehensive diagnosis and treatment algorithm. Results The most important diagnostic key elements include a detailed clinical medical history, evidence of peanut-specific sensitization by means of skin prick testing and/or in vitro determination of the peanut (extract)-specific IgE and/or the molecular component diagnostics (most important Ara h 2-specific IgE, sometimes also Ara h1-, 3-, 6-, 8- and 9-specific IgE) as well as the gold standard, the double-blind, placebo-controlled food challenge. The diagnostic algorithms were created for the following constellations: Suspected primary peanut allergy with a clear history of systemic immediate-type reaction, suspected primary peanut allergy with questionable symptoms, suspected secondary (possibly pollen-associated) peanut allergy with a history of solely oropharyngeal symptoms and incidental finding of sensitization and no peanut ingestion so far. Conclusions After established diagnosis the standard of care is counseling to avoid peanut contact and prescription of emergency medications (oral antihistamines, oral steroids, inhaled β2-agonists, injectable intramuscular epinephrine) as needed. Instruction on the use of these emergency medications should be provided. A preparation for oral immunotherapy (OIT) for 4 to 17 years old peanut allergic children/ adolescents has been recently approved by the regulatory authorities. OIT for peanut allergy shows high efficacy and an acceptable safety profile, improves quality of life, and health economic aspects. Thus it offers a therapeutic option for peanut allergic children and adolescents.

scholarly journals Galactose-alpha-1,3-galactose syndrome

2020 ◽  
Vol 2 (1) ◽  
pp. 108-110
Author(s):  
Mary Nguyen ◽  
Jordan Heath
Keyword(s):  
Immunoglobulin E ◽  
Skin Prick Testing ◽  
Skin Testing ◽  
Specific Ige ◽  
Carbohydrate Antigen ◽  
Total Serum ◽  
Intradermal Testing ◽  
Total Ige ◽  
Lone Star Tick ◽  
Mammalian Meat

The galactose-alpha-1,3-galactose (alpha-Gal) syndrome is a newly recognized and unique form of food allergy, characterized by delayed reactions to mammalian meats. This form of allergy occurs in individuals who become sensitized to alpha-Gal, a carbohydrate that is present on most mammalian tissues. Sensitization occurs after exposure to multiple arthropod bites, most commonly the lone star tick. Cases of the alpha-Gal syndrome are primarily found in the southeastern United States, which overlaps with the known geographic distribution of the lone star tick. Patients present with a history of delayed symptom onset, ∼2‐6 hours after ingestion of mammalian meat. As with other immunoglobulin E (IgE) mediated food allergic reactions, alpha-Gal reaction symptoms may include skin, respiratory, gastrointestinal, or cardiovascular systems, and severity may range from mild reactions to severe anaphylaxis. The diagnosis is based on the detection of alpha-Gal specific IgE (sIgE) as well as the total IgE value because some cases include patients with low total IgE levels but a high percentage of alpha-Gal sIgE to total serum IgE levels. Percutaneous testing with commercial meat skin-prick testing extracts is not a reliable tool for diagnosis. Prick-prick skin testing to fresh cooked meat may be considered, whereas intradermal testing to fresh meat is primarily reserved for research purposes. The mainstay of treatment involves avoidance of mammalian meat and medications that express the same carbohydrate antigen. With a small portion of patients, other meat-containing products should also be avoided if symptoms persist with mammalian meat avoidance alone. Prolonged avoidance of mammalian meat as well as avoidance of further tick bites can decrease alpha-Gal sIgE over time, and some patients are able to reintroduce mammalian meat into their diet.

scholarly journals Genetic Analysis of a Cohort of 275 Patients with Hyper-IgE Syndromes and/or Chronic Mucocutaneous Candidiasis

2021 ◽  
Author(s):  
Natalie Frede ◽  
Jessica Rojas-Restrepo ◽  
Andrés Caballero Garcia de Oteyza ◽  
Mary Buchta ◽  
Katrin Hübscher ◽  
...  
Keyword(s):  
Screening Method ◽  
Cost Effective ◽  
Illumina Miseq ◽  
Clinical Findings ◽  
Genetic Defects ◽  
Chronic Mucocutaneous Candidiasis ◽  
Mucocutaneous Candidiasis ◽  
Serious Infections ◽  
History Of ◽  
Panel Sequencing

AbstractHyper-IgE syndromes and chronic mucocutaneous candidiasis constitute rare primary immunodeficiency syndromes with an overlapping clinical phenotype. In recent years, a growing number of underlying genetic defects have been identified. To characterize the underlying genetic defects in a large international cohort of 275 patients, of whom 211 had been clinically diagnosed with hyper-IgE syndrome and 64 with chronic mucocutaneous candidiasis, targeted panel sequencing was performed, relying on Agilent HaloPlex and Illumina MiSeq technologies. The targeted panel sequencing approach allowed us to identify 87 (32 novel and 55 previously described) mutations in 78 patients, which generated a diagnostic success rate of 28.4%. Specifically, mutations in DOCK8 (26 patients), STAT3 (21), STAT1 (15), CARD9 (6), AIRE (3), IL17RA (2), SPINK5 (3), ZNF341 (2), CARMIL2/RLTPR (1), IL12RB1 (1), and WAS (1) have been detected. The most common clinical findings in this cohort were elevated IgE (81.5%), eczema (71.7%), and eosinophilia (62.9%). Regarding infections, 54.7% of patients had a history of radiologically proven pneumonia, and 28.3% have had other serious infections. History of fungal infection was noted in 53% of cases and skin abscesses in 52.9%. Skeletal or dental abnormalities were observed in 46.2% of patients with a characteristic face being the most commonly reported feature (23.1%), followed by retained primary teeth in 18.9% of patients. Targeted panel sequencing provides a cost-effective first-line genetic screening method which allows for the identification of mutations also in patients with atypical clinical presentations and should be routinely implemented in referral centers.

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