Allergic Reactions to DTaP Vaccines Among Children with Milk Allergy

April 25, 2011

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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.

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