Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Instagram
  • Listen to CMAJ podcasts
Practice

Vaccine allergy

Derek K. Chu and Zainab Abdurrahman
CMAJ April 08, 2019 191 (14) E395; DOI: https://doi.org/10.1503/cmaj.190208
Derek K. Chu
Departments of Medicine (Chu) and Pediatrics (Abdurrahman), Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Ont.
MD PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Zainab Abdurrahman
Departments of Medicine (Chu) and Pediatrics (Abdurrahman), Division of Clinical Immunology and Allergy, McMaster University, Hamilton, Ont.
MMath MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF
Loading

Immunoglobulin E (IgE)–mediated vaccine allergies are uncommon, manifesting within minutes as urticaria, angioedema, wheeze or anaphylaxis

Anaphylaxis to vaccines occurs in about 1 in 760 000 vaccinations.1 Parenteral exposure means that reactions mediated by IgE begin within minutes of an injection, are unlikely to begin after more than 30 to 60 minutes, and are highly unlikely after 4 hours.2

The most common adverse events of vaccines are fever, local pain or irritation, and local redness or swelling, which are not signs of allergy

With live vaccines, adverse effects can be delayed until 7 to 21 days after immunization; this includes vaccine-induced delayed-onset urticaria, which is commonly mistaken for allergy.

Patients with egg allergy can be safely vaccinated with several vaccines without any special precautions

The Public Health Agency of Canada and Canadian Paediatric Society state that certain vaccines (measles, mumps and rubella [MMR], influenza [all types — live or inactivated], varicella and rabies) contain such minuscule amounts of egg protein, which is also denatured, that they are safe for routine use in patients with egg allergy;2 no specialist evaluation or special precautions are required (Box 1).3,4

Box 1: Summary of common vaccine allergy–related considerations2–5*
Allergy to …Considerations for vaccination
Egg (common)
  • MMR, influenza (all types — live or attenuated), varicella and rabies are safe for routine vaccination without added precautions.

  • Refer to allergist to facilitate vaccination for yellow fever

Gelatin (e.g., gummy bears)Refer to allergist to facilitate vaccination for MMR, varicella or Japanese encephalitis
LatexAvoid puncturing latex-containing stoppers of multidose vials, or using preloaded syringes
Yeast (uncommon, questionable association)Clarify whether there is a history of immediate-onset allergic reaction to baker’s or brewer’s yeast (e.g., urticaria, angioedema, anaphylaxis in bakers or beer-makers), and if possible or probable reaction, refer to allergist to facilitate vaccination for hepatitis B or human papillomavirus
  • Note: MMR = measles, mumps and rubella.

  • * If allergic to 1 of the above, consult an allergist for administration via graded exposure, to facilitate vaccination. Report any serious vaccine-induced reaction, whether allergic or not, to public health (http://bit.ly/VaccineAEFI) and refer the patient to the most appropriate specialist (e.g., encephalopathy to neurology; anaphylaxis to allergy).

Vaccine allergies are typically unpredictable and specific to a single vaccine

Common exceptions to this are gelatin allergy (e.g., gummy bears, jelly dessert powder, marshmallows) that may trigger an allergic reaction to MMR, varicella or Japanese encephalitis vaccines; egg allergy and yellow fever vaccine; and latex allergy with exposure to rubber stoppers on multidose vials or in some preloaded syringes.5 Associations between yeast and and IgE-mediated reactions to hepatitis B or human papillomavirus vaccines are unlikely causal (Box 1).5

Even if patients are truly allergic to a vaccine, allergists can often safely vaccinate them

Allergists can facilitate immunization of patients with vaccine allergy through techniques such as graded administration.5 Possible allergies to vaccines should not be a source of vaccine hesitancy for patients and health care providers.

Footnotes

  • CMAJ Podcasts: author interview at https://soundcloud.com/cmajpodcasts/190208-five

  • Competing interests: Zainab Abdurrahman reports receiving personal fees from Pfizer, outside the submitted work. No other competing interests were declared.

  • This article has been peer reviewed.

References

  1. ↵
    1. McNeil MM,
    2. Weintraub ES,
    3. Duffy J,
    4. et al
    . Risk of anaphylaxis after vaccination in children and adults. J Allergy Clin Immunol 2016;137:868–78.
    OpenUrlCrossRefPubMed
  2. ↵
    1. James JM,
    2. Burks AW,
    3. Roberson PK,
    4. et al
    . Safe administration of the measles vaccine to children allergic to eggs. N Engl J Med 1995;332:1262–6.
    OpenUrlCrossRefPubMed
  3. ↵
    Addendum — LAIV use in egg allergic individuals Advisory Committee Statement (ACS) National Advisory Committee on Immunization (NACI). Canadian immunization guide chapter on influenza and statement on seasonal influenza vaccine for 2016–2017. Ottawa: Public Health Agency of Canada; 2016.
  4. ↵
    1. Moore DL
    . Vaccine recommendations for children and youth for the 2017/2018 influenza season. Paediatr Child Health 2018;23:e10–3.
    OpenUrl
  5. ↵
    1. Dreskin SC,
    2. Halsey NA,
    3. Kelso JM,
    4. et al
    . International Consensus (ICON): allergic reactions to vaccines. World Allergy Organ J 2016;9:32.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 191 (14)
CMAJ
Vol. 191, Issue 14
8 Apr 2019
  • Table of Contents
  • Index by author

Podcast

Subscribe to podcast
Download MP3

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Vaccine allergy
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Vaccine allergy
Derek K. Chu, Zainab Abdurrahman
CMAJ Apr 2019, 191 (14) E395; DOI: 10.1503/cmaj.190208

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Vaccine allergy
Derek K. Chu, Zainab Abdurrahman
CMAJ Apr 2019, 191 (14) E395; DOI: 10.1503/cmaj.190208
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • Immunoglobulin E (IgE)–mediated vaccine allergies are uncommon, manifesting within minutes as urticaria, angioedema, wheeze or anaphylaxis
    • The most common adverse events of vaccines are fever, local pain or irritation, and local redness or swelling, which are not signs of allergy
    • Patients with egg allergy can be safely vaccinated with several vaccines without any special precautions
    • Vaccine allergies are typically unpredictable and specific to a single vaccine
    • Even if patients are truly allergic to a vaccine, allergists can often safely vaccinate them
    • Footnotes
    • References
  • Figures & Tables
  • Related Content
  • Responses
  • Metrics
  • PDF

Related Articles

  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • SARS-CoV-2 vaccination in pregnancy
  • Infantile perianal pyramidal protrusion
  • Topical nonsteroidal anti-inflammatory drugs
Show more Practice

Similar Articles

Collections

  • Article Types
    • Five Things to Know About
  • Topics
    • Allergy
    • Infectious diseases
    • Public health
    • Vaccination

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: [email protected]

CMA Civility, Accessibility, Privacy

 

Powered by HighWire