Allergic Reactions to DTaP Vaccines Among Children with Milk Allergy

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Allergic Reactions to Diphtheria, Tetanus,

and Acellular Pertussis Vaccines Among Children with Milk

Allergy

J. D. Kattan, A. L. , A. Nowak-Wegrzyn, G. Gimenez, L.

Bardina,

H. A. Sampson, S. H. Sicherer;

Mt. Sinai School of Medicine, New York, NY.

RATIONALE: Vaccines containing diphtheria, tetanus, and acellular

pertussis

are processed in medium containing casamino acids derived from

cow’s milk; several milk allergic children have reported allergic

reactions

following administration of these vaccines.

METHODS: This was a chart review of patients seen in our practice

who

had reported allergic reactions after receiving tetanus vaccines (primary

or

booster doses) from September 2007 to March 2010. An

inhibition-ELISA

was performed to determine the presence of milk protein in the

vaccines.

RESULTS:We identified seven patients (5 male, 2 female; median age

11

years; range: 5-17), who reported convincing allergic reactions to

tetanus

vaccines. Six patients had prior allergic reactions to cow’s milk,

including

severe reactions (5) and or reactions to trace exposures (4); one was

diagnosed

with milk allergy based on serologic testing. All patients had

elevated

milk specific IgE levels documented within 2 years of their

reactions to the vaccine: 59, 96, and 5 patients >100 kUA/L. Each

reported

symptoms consistent with a diagnosis of anaphylaxis promptly after

receiving

the vaccine. Symptoms included: wheezing (5/7), urticaria (5/7),

sneezing/nasal congestion (3/7), angioedema (3/7), and repetitive

cough

(2/7). Treatments included antihistamines (5/7), epinephrine (3/7),

inhaled

beta-agonists (3/7), and corticosteroids (2/7). Assays were performed on

2

different lots of the tetanus, diphtheria, and acellular pertussis

vaccine,

confirming the presence of milk protein in one lot (30 ng/mL).

CONCLUSIONS: Vaccines containing tetanus, diphtheria, and acellular

pertussis derived from broths containing casamino acids may present

a

risk to persons with severe milk allergy.

..

..

[Guest guest]

http://ainotes.wikispaces.com/file/view/Allergic+Reactions+to+DTaP+-+AAAAI+2011.pdf

Allergic Reactions to Diphtheria, Tetanus,

and Acellular Pertussis Vaccines Among Children with Milk

Allergy

J. D. Kattan, A. L. , A. Nowak-Wegrzyn, G. Gimenez, L.

Bardina,

H. A. Sampson, S. H. Sicherer;

Mt. Sinai School of Medicine, New York, NY.

RATIONALE: Vaccines containing diphtheria, tetanus, and acellular

pertussis

are processed in medium containing casamino acids derived from

cow’s milk; several milk allergic children have reported allergic

reactions

following administration of these vaccines.

METHODS: This was a chart review of patients seen in our practice

who

had reported allergic reactions after receiving tetanus vaccines (primary

or

booster doses) from September 2007 to March 2010. An

inhibition-ELISA

was performed to determine the presence of milk protein in the

vaccines.

RESULTS:We identified seven patients (5 male, 2 female; median age

11

years; range: 5-17), who reported convincing allergic reactions to

tetanus

vaccines. Six patients had prior allergic reactions to cow’s milk,

including

severe reactions (5) and or reactions to trace exposures (4); one was

diagnosed

with milk allergy based on serologic testing. All patients had

elevated

milk specific IgE levels documented within 2 years of their

reactions to the vaccine: 59, 96, and 5 patients >100 kUA/L. Each

reported

symptoms consistent with a diagnosis of anaphylaxis promptly after

receiving

the vaccine. Symptoms included: wheezing (5/7), urticaria (5/7),

sneezing/nasal congestion (3/7), angioedema (3/7), and repetitive

cough

(2/7). Treatments included antihistamines (5/7), epinephrine (3/7),

inhaled

beta-agonists (3/7), and corticosteroids (2/7). Assays were performed on

2

different lots of the tetanus, diphtheria, and acellular pertussis

vaccine,

confirming the presence of milk protein in one lot (30 ng/mL).

CONCLUSIONS: Vaccines containing tetanus, diphtheria, and acellular

pertussis derived from broths containing casamino acids may present

a

risk to persons with severe milk allergy.

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