Anaphylaxis to diphtheria, tetanus, and pertussis vaccines among children with cow’s milk allergy

• Published in: Journal of allergy and clinical immunology Vol. 128; no. 1; pp. 215 - 218
• Main Authors: Kattan, Jacob D., MD, Konstantinou, George N., MD, PhD, MSc, Cox, Amanda L., MD, Nowak-Węgrzyn, Anna, MD, Gimenez, Gustavo, BA, Sampson, Hugh A., MD, Sicherer, Scott H., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.07.2011; Elsevier; Elsevier Limited
• Subjects: Adolescent; Allergic diseases; Allergies; Allergy and Immunology; Anaphylaxis - chemically induced; Anaphylaxis - immunology; Bacterial diseases; Biological and medical sciences; Caseins - adverse effects; Caseins - immunology; Child; Child, Preschool; Digestive allergic diseases; Diphtheria-Tetanus-Pertussis Vaccine - adverse effects; Diphtheria-Tetanus-Pertussis Vaccine - chemistry; Ent and stomatologic bacterial diseases; Female; Food allergies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Human bacterial diseases; Humans; Immunopathology; Infectious diseases; Male; Medical sciences; Milk; Milk Hypersensitivity - immunology; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Vaccines; Human; Food allergy; Immunopathology; Respiratory disease; Vaccine; Diphtheria; Whooping cough; Infection; Anaphylaxis; Immunology; Bacteriosis; Digestive diseases; Cow milk; Tetanus; Child
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2011.04.046

[...]our novel observation raises a concern regarding booster vaccination of children with high levels of milk allergy with Tdap and DTaP. Age at time of reaction (y) Sex Milk allergy history Asthma history Milk-specific IgE level (kIUA/L) Symptoms of reaction after vaccination Treatments given Vaccine administered Time to reaction after vaccine administration 4 Male Proctocolitis from cow's milk-based formula at 3 mo of age Yes 82.9 Diffuse hives, respiratory distress Diphenhydramine, oral steroid DTaP 10 min 5 Male Hives, lip angioedema, wheezing at 3 y of age after eating turkey with milk contamination Yes >100 Repetitive cough, sneezing, rhinorrhea Albuterol, diphenhydramine DTaP 10 min 5 Male Urticaria, edema of the face, and wheezing after contact with milk-based formula at 2 y of age Yes >100 Generalized urticaria, facial swelling, wheezing, retractions, difficulty breathing Diphenhydramine, epinephrine DTaP Immediately 6 Male Milk was eliminated based on allergy testing as an infant after presenting with atopic dermatitis Yes >100 Cough, hives, facial swelling Levalbuterol, diphenhydramine DTaP Within 15 min 11 Male Urticaria and vomiting at 11 mo of age after eating yogurt; facial swelling and diffuse rash at 8 y of age after eating turkey with milk contamination Yes 58.9 Generalized urticaria, sneezing, congestion, wheezing Levalbuterol, diphenhydramine, oral steroid Tdap Within 10 min 11 Female Vomiting after milk-based formula as an infant; angioedema of hands after contact with spilled milk at 1 y of age Yes 96.1 Throat tightness, wheezing, respiratory distress Epinephrine Tdap Driving home from pediatrician 16 Female Cough, wheezing, and vomiting after milk at 1 y of age; respiratory distress, vomiting, hypotension, and cardiac arrest after eating pasta sprinkled with cheese at 8 y of age No >100 Nasal congestion, watery eyes, hives, wheezing, chest tightness Diphenhydramine, oral steroid Tdap Within 1 h 17 Male Hives, lip, and tongue swelling; diarrhea; and abdominal pain at 4 y of age Yes >100 Wheezing, respiratory distress, flushing of face and neck Epinephrine Tdap Within 20 min Table I Clinical characteristics of the children who reacted to the tetanus vaccines Vaccine Brand name Lot numbers Casein (ng/mL) Tdap Adacel C3727BA 12.7 Tdap Adacel C3518AA 13.6 Tdap Adacel C3819AA 8.1 Tdap Adacel C3246BA 17.3 Tdap Adacel C3448AA 11.8 DTaP Daptacel C3192BA 10 DTaP Infanrix AC14B099BA 18.3 DTaP Infanrix AC14B121BB 12.2 Influenza Fluarix AFLUA531BA 0 Influenza Fluzone UT3667AA 0 Influenza Fluvirin 111814P1 0 Hepatitis B (recombinant) Recombivax 1023Y 0 Table II Mean casein concentrations in vaccine samples examined