Allergy and vaccination

Seek expert advice prior to administration of vaccination if concern about risk of possible allergic/anaphylactic reaction to vaccine or vaccine component

Check uptodate details in the The Green Book before prescribing/administering a vaccination.

Check the Summary of Product Characteristics (SPC) of the influenza vaccination before prescribing/administering a vaccine.

Vaccination providers should consider whether to avoid specific vaccinations in the following:

• individuals with a history of a confirmed anaphylactic reaction to a previous dose of the vaccine
• individuals with a history of a confirmed anaphylactic reaction to a component of the vaccine
• individuals with primary or acquired immunodeficiency
• individuals on current or recent immunosuppressive or immunosuppressive biological therapy
• infants born to a mother who received immunosuppressive biological therapy during pregnancy
• those in contact with an individual with immunodeficiency, current recent immunosuppressive including biological therapy
• pregnant women

While certain vaccines may be contraindicated in individuals falling into one of the categories mentioned above, this is not automatically the case

• in some instances, the benefit of that vaccination may outweigh the risk
• in some cases vaccination should be delayed rather than withheld, or alternative measures considered

Individuals who have had confirmed anaphylactic reaction to a previous dose of a vaccine containing the same antigens, or a confirmed anaphylactic reaction to another component contained in the relevant vaccine should not receive the vaccine concerned:

• other vaccines can and should be given where appropriate
• facilities for treating anaphylaxis should be available in all vaccination settings

Most common allergens and vaccines known to contain them are listed below - list is not exhaustive and anaphylactic reactions to other vaccine components are possible; if so, it may be necessary to check the summary of product characteristics and/or with the manufacturer to understand whether a specific vaccine contains the implicated component

Egg allergy

• Influenza
• Tick-borne encephalitis
• Yellow fever
• Hepatitis A

Recent data suggest that anaphylactic reactions to MMR vaccine are not associated with hypersensitivity to egg antigens. All children with egg allergy should receive the MMR vaccination as a routine procedure in primary care - children who have had documented anaphylaxis to the vaccine itself should however be assessed by an allergist (3)

Neomycin, streptomycin or polymyxin B allergies

• Pertussis
• Polio
• Tetanus
• Shingles
• Varicella
• Measles, Mumps and Rubella

Gelatine allergy

• Shingles
• Varicella
• Measles, Mumps and Rubella

Severe latex allergy

• some pre-filled syringes may contain latex proteins in the tip cap and/or rubber plunger of the syringe. Similarly, the stoppers of some vaccines supplied in vials may contain latex proteins
• as a precaution, if an individual has a history of severe (i.e. anaphylactic) allergy to latex, vaccines supplied in vials or syringes that contain latex should not be administered, unless the benefit of vaccination outweighs the risk of an allergic reaction to the vaccine. Where possible, an alternative latex-free vaccine that covers the same disease should be administered

Reference:

• Immunisation Against Infectious Disease, HMSO, 1996
• The Green Book Chapter 6. Contraindications and special considerations (August 2017)
• PHE. Contraindications and special considerations: the green book, chapter 6 (October 2017)