Department of Allergy and Immunology, Women's and Children's Hospital, Adelaide, Australia.
Department of Allergy and Immunology, Royal Children's Hospital, Melbourne, Australia; Laboratory Services, Immunology Laboratory, The Royal Children's Hospital, Melbourne, Australia.
J Allergy Clin Immunol Pract. 2019 May-Jun;7(5):1541-1549. doi: 10.1016/j.jaip.2019.01.025. Epub 2019 Jan 23.
The rate of true vaccine allergy is unknown. Children with potential IgE-mediated adverse events following immunization (AEFI) should undergo allergy investigation that may include skin testing or challenge. Previous protocols tend to be highly conservative and often suggest invasive testing for all, a practice not evidence based, technically difficult, and unpleasant in children. It has more recently been suggested that skin testing may be restricted to those with allergic-like events within the first hour and those with a history of anaphylaxis.
We aimed to describe the outcome of vaccine skin testing and challenge in children referred to a tertiary pediatric hospital with a potential IgE-mediated AEFI. The secondary aim was to identify any significant risk factors for vaccine allergy.
A retrospective review of all children (<18 years) who underwent vaccine skin testing (skin prick testing or intradermal testing [IDT]) or challenge over a 5-year period (May 1, 2011, to April 30, 2016) at the Royal Children's Hospital Melbourne is presented.
There were 95 admissions in 73 children. Eight percent (6 of 73) of children had confirmed vaccine allergy (positive skin testing or challenge to the index vaccination). Two had positive IDT to a suspect vaccine but challenge negative to an alternative brand vaccine. Two had negative IDT but subsequent positive challenge and two had immediate urticaria on challenge without prior skin testing. All children in the positive group either had index reaction within 15 minutes of vaccination or had history consistent with anaphylaxis.
The vast majority of children (92%) presenting with a potential IgE-mediated AEFI are able to tolerate challenge to a suspect vaccine without reaction. We present our investigation protocol recommending skin testing in all children with anaphylaxis and challenge with a suspect vaccine if negative testing or previous nonanaphylactic potential IgE-mediated AEFI.
真正的疫苗过敏发生率尚不清楚。疑似存在免疫接种后即刻发生的 IgE 介导的不良反应（AEFI）的儿童应进行过敏评估，包括皮肤测试或激发试验。既往的方案往往非常保守，通常建议对所有疑似过敏的儿童进行有创性检查，这种做法没有证据支持，技术上有难度，且儿童不易接受。最近有人建议，仅对接种后 1 小时内出现过敏样反应的儿童，或有过敏反应史的儿童进行皮肤测试。
本研究旨在描述疑似 IgE 介导的 AEFI 患儿转诊至三级儿科医院后，进行疫苗皮肤测试和激发试验的结果。次要目的是确定任何疫苗过敏的显著危险因素。
对 2011 年 5 月 1 日至 2016 年 4 月 30 日期间在墨尔本皇家儿童医院接受疫苗皮肤测试（皮试或皮内试验）或激发试验的所有（＜18 岁）患儿进行回顾性研究。
73 例患儿中共有 95 例次就诊。8%（6/73）的患儿确诊存在疫苗过敏（疫苗皮试或激发试验阳性）。2 例患儿对可疑疫苗的皮内试验阳性，但对另一种品牌疫苗的激发试验阴性；2 例患儿皮内试验阴性，但随后激发试验阳性；2 例患儿在未行皮试的情况下激发试验时即刻出现荨麻疹。阳性组所有患儿的反应均发生在接种后 15 分钟内，或有过敏反应史。
大多数（92%）疑似存在 IgE 介导的 AEFI 的儿童在接受可疑疫苗激发试验时均无不良反应。我们提出了一种调查方案，建议对所有有过敏反应的儿童进行皮试，对皮试阴性或之前无过敏反应的疑似 IgE 介导的 AEFI 儿童进行可疑疫苗激发试验。
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