Joseline G Zafack1, Gaston De Serres2, Isabelle Rouleau3, Marie-Claude Gariépy4, Rémi Gagnon4, Jean-Philippe Drolet4, Danuta M Skowronski5. 1. Department of Social and Preventive Medicine, Laval University, Québec, QC, Canada. 2. Department of Social and Preventive Medicine, Laval University, Québec, QC, Canada; Immunity and Infectious Diseases, Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada; Biological and Occupational Health, Institut National de Santé Publique du Québec, Québec, Canada. Electronic address: gaston.deserres@inspq.qc.ca. 3. Direction de la Protection de la Santé Publique, Ministère de la Santé et des Services Sociaux du Québec, Montreal, QC, Canada. 4. Immunity and Infectious Diseases, Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada. 5. Influenza and Emerging Respiratory Pathogens, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.
Abstract
BACKGROUND: The Joint Task Force on Practice Parameters (JTFPP) guidelines for the investigation and reimmunization of patients who experienced allergic-like events (ALEs) after immunization are predicated on the likelihood of anaphylaxis, assessed through the time to symptom onset (≤ or >4 hours) and number of systems involved. OBJECTIVE: The objectives of this study were to compare the management of a series of patients with ALE in actual practice relative to JTFPP guidelines and to discuss key concepts and considerations in their use. METHODS: This retrospective study was based on a chart review of patients who consulted for suspected vaccine-associated ALEs at a large allergy department in Canada. RESULTS: Only 3 of the 135 patients who presented ALEs after immunization were referred for suspected anaphylaxis. There was no significant difference in the frequency of skin testing or reimmunization of patients whatever the time to symptom onset or number of systems involved in the ALE. Eight patients whose initial ALE occurred within 1 hour after immunization had a recurrence on reimmunization. Another patient whose initial ALE occurred 10 hours after influenza immunization had throat tightening and difficulty swallowing without objective signs. CONCLUSIONS: Most ALEs after immunization are not suggestive of anaphylaxis and should not be managed as such. The definition of anaphylaxis in the JTFPP guidelines is nonspecific and may need to be revisited. Restricting skin testing and graded dose reimmunization to patients whose ALE onset is ≤1 hour (compatible with IgE-mediated reaction) and to those meeting specific clinical criteria for anaphylaxis (whatever the timing) is likely a sufficiently sensitive and cautious approach.
BACKGROUND: The Joint Task Force on Practice Parameters (JTFPP) guidelines for the investigation and reimmunization of patients who experienced allergic-like events (ALEs) after immunization are predicated on the likelihood of anaphylaxis, assessed through the time to symptom onset (≤ or >4 hours) and number of systems involved. OBJECTIVE: The objectives of this study were to compare the management of a series of patients with ALE in actual practice relative to JTFPP guidelines and to discuss key concepts and considerations in their use. METHODS: This retrospective study was based on a chart review of patients who consulted for suspected vaccine-associated ALEs at a large allergy department in Canada. RESULTS: Only 3 of the 135 patients who presented ALEs after immunization were referred for suspected anaphylaxis. There was no significant difference in the frequency of skin testing or reimmunization of patients whatever the time to symptom onset or number of systems involved in the ALE. Eight patients whose initial ALE occurred within 1 hour after immunization had a recurrence on reimmunization. Another patient whose initial ALE occurred 10 hours after influenza immunization had throat tightening and difficulty swallowing without objective signs. CONCLUSIONS: Most ALEs after immunization are not suggestive of anaphylaxis and should not be managed as such. The definition of anaphylaxis in the JTFPP guidelines is nonspecific and may need to be revisited. Restricting skin testing and graded dose reimmunization to patients whose ALE onset is ≤1 hour (compatible with IgE-mediated reaction) and to those meeting specific clinical criteria for anaphylaxis (whatever the timing) is likely a sufficiently sensitive and cautious approach.
Authors: John R Su; Pedro L Moro; Carmen S Ng; Paige W Lewis; Maria A Said; Maria V Cano Journal: J Allergy Clin Immunol Date: 2019-01-14 Impact factor: 10.793
Authors: Min Jung Kim; Doo Hee Shim; Hye Ran Cha; Cheong Bi Kim; Soo Yeon Kim; Jeon Han Park; Myung Hyun Sohn; Jae Myun Lee; Kyung Won Kim Journal: Allergy Asthma Immunol Res Date: 2020-03 Impact factor: 5.764