An approach to vaccine administration in a patient with known or possible immediate allergy to a vaccine constituent

This algorithm depicts an approach to patients with a history of possible or known allergy to a vaccine constituent. Patients who reacted in the past to a specific vaccine are evaluated differently (refer to UpToDate topic on allergic reactions to vaccines). Most allergens are present in such low amounts in vaccines that allergic patients can receive vaccines that contain them without any special precautions. The most common example is egg protein, which is present in some influenza and yellow fever vaccines but at sufficiently low levels that these vaccines can be administered normally to patients with even severe anaphylactic egg allergy. Gelatin is an important exception because it has been implicated in vaccine anaphylaxis.

MMR: measles, mumps, and rubella; PEG: polyethylene glycol.

* Immediate allergic reactions start within minutes to an hour of administration and include symptoms such as pruritus, urticaria, angioedema, rhinorrhea, bronchospasm, laryngeal edema, or hypotension.

¶ Gelatin is present in some vaccines for influenza, MMR and also the MMR with varicella, rabies, live oral typhoid, varicella, yellow fever, and zoster. In all cases, gelatin-free alternatives are available, although this may vary by country.

Δ Skin testing with vaccine: prick testing with undiluted vaccine. If negative, intradermal testing with vaccine diluted 1:100.

◊ Refer to UpToDate topic on allergic reactions to vaccines for a description of how to give a vaccine in a graded fashion.

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An approach to vaccine administration in a patient with known or possible immediate allergy to a vaccine constituent