Urticaria vaccines

The most frequent adverse effects are local reactions at the injection site (pain, tenderness, erythema, swelling, and pruritus), fevers (greater than 37.5°C or 99.5°F), headaches, dizziness, and irritability. Anaphylaxis and hypersensitivity reactions have been reported rarely and occur within a few hours after vaccine administration. In rare instances, a serum sickness-like apparent hypersensitivity syndrome (arthralgia, urticaria, ecchymoses, erythema multiforme, and erythema nodosum) has been... 

While exercising in mild weather the patient collapsed 75 minutes after vaccination. He presented with asystole, with a core temperature of 42.2 C, and there was no evidence of urticaria or angioedema. 

Alopecia (54), anetoderma (a disorder characterized by loss of dermal substance clinically and loss of elastic substance histologically) (55), lichen planus (56), urticaria (57), and white dot syndrome (58) have been attributed to hepatitis B vaccine. 

Hypersensitivity reactions (generalized urticaria or angio-edema) after the use of Japanese encephahtis vaccine have been reported from some countries (see Table 1) the vaccine constituents responsible for these events have not been identified (12). There has been a detailed report of the adverse effects, mainly allergic mucocutaneous reactions, of Biken vaccine in Danish travellers and US Marine Corps personnel (SEDA-22, 351). 

An association between reactions to Japanese encephalitis vaccine and a history of urticaria or allergic rhinitis has been identified (14). 

In 135 children with suspected or documented systemic allergy (atopic eczema, asthma, cow milk s allergy, severe systemic reactions after previous doses of different vaccines), who were prick-tested with undiluted MMR vaccine before immunization, 122 of 126 prick-test-negative children received the MMR vaccine. No untoward reactions developed, except for mild generalized urticaria or fever in two vaccinees. The author concluded that allergic diseases should not be considered as contraindications to MMR immunization (132). 

Serious allergic reactions were reported in 18 patients after the use of a Japanese encephalitis vaccine containing thiomersal (51). Reactions in 15 patients were thought to be related to the product 13 had urticaria affecting the whole body, one had erythema multiforme, and one had a rash. Fourteen reactions arose after the second... 

Lohiya G. Asthma and urticaria after hepatitis B vaccination. West J Med 1987 147(3) 341. 

Eight children developed urticaria within 30 minutes after administration of a diphtheria -I- tetanus -I- acellular pertussis (DTaP) vaccine that contained gelatin as a stabilizer (38). None of the children had anti-gelatin IgE, and only two had detectable concentrations of antitoxoid IgE to diphtheria and pertussis toxoids. No methods to measure anti-thiomersal and anti-alum IgE were available. The authors recommended the development of such methods, which could improve research into the causality of adverse effects of this sort. 

General malaise, headache, fever, mild lymphadenopathy, or erythema and induration at the injection site have been reported following the administration of plague vaccine (10% of vaccinees) these effects are more common with repeated injections. Sterile abscesses and hypersensitivity reactions (urticaria, asthma) occur rarely (2). 

Any rabies vaccine can apparently cause mild local discomfort and swelling, and either of the animal preparations can result in hypersensitivity reactions, for example pyrexia, serum sickness, or urticaria sensitization can occur. 

Abnormal hair growth (54), herpes virus infections (55), and malignant changes in smallpox vaccination scars have also been observed (56,57). Allergic skin reactions sometimes occur, for example urticaria and purpura (58) and possibly photosensitivity reactions. 

A pentavalent botulinum toxoid (botulinum toxin in different antigenic types) has been used for more than 30 years in some countries to prevent the disease in laboratory workers and to protect troops against attack. Pre-exposure immunization for the general population is neither feasible nor desirable the vaccine is ineffective for postexposure prophylaxis. Treatment of botulism consists of passive immunization and supportive care. Most licensed antitoxins contain antibodies against the most common toxin types A, B, and E. About 9% of recipients of equine antitoxin developed urticaria, serum sickness, or other hypersensitivity reactions. In 2% of recipients anaphylaxis occurred within 10 minutes of antitoxin... 

Adverse effects of the rubella virus vaccine tend to increase with the age of the recipient. Symptoms are similar to wild-virus infection and include lymphadenopathy, rash, urticaria, fever, malaise, sore throat, headache, myalgias, and paresthesias of the extremities. These occur 7 to 12 days after vaccination and last 1 to 5 days. Joint symptoms occur more often in susceptible postpubertal females. Arthralgia occurs in 25% of such vaccinees, and 10% will have arthritislike symptoms. These symptoms usually begin 1 to 3 weeks after vaccination and persist for 1 day to 3 weeks. A very small excess risk of chronic arthropathy exists. The vaccine may cause suppression of tuberculin skin tests for up to 6 weeks after vaccination. While the vaccine virus may be excreted in nose and throat secretions, it is not contagious. 

Adverse reactions include pain and tenderness at the injection site (20%) and systemic side effects such as fever, headache, malaise, rash, chills, dizziness, myalgia, nausea, vomiting, and abdominal pain in 10%. In addition, there are sporadic reports of hypersensitivity reactions to the vaccine. The manifestations of this type of reaction include urticaria, angioedema, and respiratory distress. These reactions have generally occurred after a median of 12 hours after the first dose of vaccine, with 88% of reactions occurring within 3 days. After a second dose, these hypersensitivity reactions may occur 3 to 14 days after injection. 

The course of drug-induced urticaria is acute. In the vast majority of cases the lesions heal within 1-3 days without leaving any residual changes. However, the condition can assume a chronic form and the lesions can recur repeatedly over many weeks. Such events are most commonly observed in penicillin allergy. Small amounts of penicillins can be detected in foodstuffs, especially dairy products, in vaccines, secretions (saliva, semen), and furthermore they are produced by various molds (Hyphomycetes) which are found everywhere in our environment and hence gain entry to our bodies every day (Cole and Robinson 1961 McGovern et al. 1970 JiLLSON and Porter 1965 Stewart 1965 Un and Valu 1963), However, it is only in a small proportion of patients that the manifestations persist and it may be doubted whether the widespread occurrence of traces of penicillin is enough to explain why some cases of acute penicillin urticaria become chronic. 

Other routes of administration have been assessed. An interviewer analysis of a cohort of children from a paediatric walk-in clinic (with a respiratory focus) in Germany who had received a nasal, live attenuated influenza vaccine was undertaken. The children were matched to unvaccinated controls in order to assess safety and tolerability. Out of 146 children who received the vaccine, 48% had mild to moderate asthma, 11% reported nasal congestion following administrahon of the vaccine and there was one episode of bronchitis with urticaria [26 ]. 

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