Pediatric Pulmonology & Allergy Service, Sick Children
Hospital, 149, rue de Sevres, 75015-Paris, France.
pneumo.allergo@nck.ap-hop-paris.fr
Allergic and pseudo-allergic
reactions to vaccines frequently involve the skin, and can be
generalized systemic symptoms (urticaria/angioedema, serum sickness,
flares of eczema) or localized at the sites of vaccination (persistent
nodules, abcesses, granulomas). Diagnosis of Arthus-type reactions is
based on clinical history and specific IgM/IgG anti-toxoid
determination. For other local reactions, diagnostic value of
non-immediate responses in skin tests varies with clinical symptoms and
substances involved. Immediate responses in skin tests and specific IgE
determination have good diagnostic and/or predictive value in
anaphylaxis and immediate/accelerated urticaria/angioedema to toxoid-,
pneumococcus-, and egg- and gelatin-containing vaccines. Diagnosis of
reactions to dextran in BCG is based on specific IgM/IgG determination.
Most non-immediate generalized reactions result from non-specific
inflammation, except for gelatin-containing vaccines, but the diagnostic
value of immuno-allergological tests with the vaccines and gelatin are
controversial. Withholding booster injections is advised if specific
IgM/IgG levels are high. If the levels are low, sequential injections of
vaccines containing a single vaccinating agent are usually tolerated.
However, injections of the vaccine should be performed using a "
desensitization " procedure in patients reporting anaphylaxis and
immediate/accelerated urticaria/angioedema.