Vaccine allergy and pseudo-allergy

Area of Science:

• Immunology
• Dermatology
• Vaccinology

Background:

• Allergic and pseudo-allergic reactions to vaccines commonly present with cutaneous manifestations.
• These reactions can be localized at vaccination sites (e.g., nodules, granulomas) or systemic (e.g., urticaria, angioedema, serum sickness).

Purpose of the Study:

• To review the diagnostic approaches for allergic and pseudo-allergic reactions to vaccines.
• To discuss the utility of various immuno-allergological tests in identifying causative agents and guiding clinical management.

Main Methods:

• Review of clinical history and diagnostic criteria for Arthus-type reactions.
• Evaluation of skin tests (immediate and non-immediate responses) and specific antibody determinations (IgE, IgM, IgG).
• Assessment of diagnostic value of immuno-allergological tests for various vaccine components.

Main Results:

• Specific IgM/IgG anti-toxoid determination aids in diagnosing Arthus-type reactions.
• Skin tests and specific IgE have diagnostic value for anaphylaxis and immediate/accelerated urticaria/angioedema.
• Diagnosis of BCG-related dextran reactions relies on specific IgM/IgG levels; management involves withholding boosters if levels are high.

Conclusions:

• Diagnostic strategies for vaccine-induced allergic reactions vary based on reaction type and causative agent.
• Immuno-allergological testing plays a crucial role in diagnosis and management, including desensitization protocols for severe reactions.
• Careful consideration of diagnostic test results guides decisions on booster injections and desensitization procedures.