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Anaphylaxis to the 23-valent pneumococcal vaccine in child: a case-control study based on immediate responses in skin
C Ponvert1, D Ardelean-Jaby, A M Colin-Gorski
1Department of Medicine, Paris VI University, Paediatric Pulmonology & Allergy Service, Sick Children Hospital, 149 rue de Sèvres, 75015, Paris, France. pneumo.allergo@nck.ap-hop-paris.fr
Insights
Skin tests and specific IgE tests accurately diagnose IgE-dependent hypersensitivity to pneumococcal vaccine in children reporting severe reactions. These diagnostic methods are valuable for identifying vaccine allergies.
Area of Science:
- Immunology
- Allergy and Clinical Immunology
- Vaccinology
Background:
- The 23-valent pneumococcal vaccine is generally safe, but severe hypersensitivity reactions can occur.
- Accurate diagnosis of vaccine hypersensitivity is crucial for patient management and future vaccination strategies.
Observation:
- A child experiencing severe anaphylaxis post-pneumococcal vaccination underwent skin testing (prick and intradermal) and a radioallergosorbent test (RAST) using pneumococcal vaccine and phenol.
- Ten control children (one with uneventful vaccination, nine unvaccinated) were also tested.
- Skin tests and RAST with the vaccine were positive in the anaphylactic child and negative in most controls.
Findings:
- Positive skin tests and RAST with pneumococcal vaccine in the patient suggest IgE-mediated hypersensitivity.
- A non-vaccinated child showed a weakly positive intradermal test with the vaccine but a negative RAST.
- All subjects had negative skin tests and RAST with phenol, ruling out phenol as a sensitizer.
Implications:
- Immediate hypersensitivity reactions to pneumococcal vaccine can be diagnosed using skin tests and specific IgE determination.
- These diagnostic tools demonstrate good value in identifying children with suspected IgE-dependent hypersensitivity to pneumococcal vaccines.
- Findings support the utility of allergy testing in evaluating severe adverse events following pneumococcal vaccination.
Abstract:
Injections of the 23-valent pneumococcal vaccine are usually well tolerated. Skin tests (prick and intradermal) and a self-made RAST with pneumococcal vaccine and phenol were performed in a child reporting a severe anaphylactic reaction induced by a 23-valent pneumococcal vaccine, and in ten control children, including one child with a well-tolerated vaccination, and nine non-vaccinated children. Skin tests and RAST with the vaccine were positive in the child reporting anaphylaxis, and negative in nine of the control children. Intradermal test with the vaccine was slightly positive in a non-vaccinated child with negative RAST. Skin tests and RAST with phenol were negative in all the children. These results suggest that immediate responses in skin tests and specific IgE determination have a good diagnostic value in children reporting severe reactions suggestive of IgE-dependent hypersensitivity to pneumococcal vaccine.