International Consensus (ICON): allergic reactions to vaccines

Abstract

Background: Routine immunization, one of the most effective public health interventions, has effectively reduced death and morbidity due to a variety of infectious diseases. However, allergic reactions to vaccines occur very rarely and can be life threatening. Given the large numbers of vaccines administered worldwide, there is a need for an international consensus regarding the evaluation and management of allergic reactions to vaccines.

Methods: Following a review of the literature, and with the active participation of representatives from the World Allergy Organization (WAO), the European Academy of Allergy and Clinical Immunology (EAACI), the American Academy of Allergy, Asthma, and Immunology (AAAAI), and the American College of Allergy, Asthma, and Immunology (ACAAI), the final committee was formed with the purpose of having members who represented a wide-range of countries, had previously worked on vaccine safety, and included both allergist/immunologists as well as vaccinologists.

Results: Consensus was reached on a variety of topics, including: definition of immediate allergic reactions, including anaphylaxis, approaches to distinguish association from causality, approaches to patients with a history of an allergic reaction to a previous vaccine, and approaches to patients with a history of an allergic reaction to components of vaccines.

Conclusions: This document provides comprehensive and internationally accepted guidelines and access to on-line documents to help practitioners around the world identify allergic reactions following immunization. It also provides a framework for the evaluation and further management of patients who present either following an allergic reaction to a vaccine or with a history of allergy to a component of vaccines.

Keywords: Allergic reactions; Allergy; Anaphylaxis; Causality; Components; Consensus; International; Vaccine.

Fig. 1

Management of patients with suspected hypersensitivity to a vaccine and patients with known allergy to a vaccine component (modified from Caubet et al. 2014; Printed with permission of Wiley) [120]. *For egg allergic patients, see text (Approach to the patient with possible allergies to foods or other materials that may also be components of vaccines or vaccine packaging). **For patients with a positive skin test to a vaccine, consider risk benefit analysis based on serologic evidence of current immunity and level of risk for target disease. See Wood et al. [119]