Hypersensitivity reactions to human papillomavirus vaccine in Australian schoolgirls: retrospective cohort study.
OBJECTIVE
To describe the outcomes of clinical evaluation, skin testing, and vaccine challenge in adolescent schoolgirls with suspected hypersensitivity to the quadrivalent human papillomavirus vaccine introduced in Australian schools in 2007.


METHODS
Retrospective cohort study.


METHODS
Two tertiary paediatric allergy centres in Victoria and South Australia, Australia.


METHODS
35 schoolgirls aged 12 to 18.9 years with suspected hypersensitivity reactions to the quadrivalent human papillomavirus vaccine.


METHODS
Clinical review and skin prick and intradermal testing with the quadrivalent vaccine and subsequent challenge with the vaccine.


RESULTS
35 schoolgirls with suspected hypersensitivity to the quadrivalent human papillomavirus vaccine were notified to the specialised immunisation services in 2007, after more than 380 000 doses had been administered in schools. Of these 35 schoolgirls, 25 agreed to further evaluation. Twenty three (92%) experienced reactions after the first dose. Thirteen (52%) experienced urticaria or angio-oedema, and of these, two experienced anaphylaxis. Thirteen had generalised rash, one with angio-oedema. The median time to reaction was 90 minutes. Nineteen (76%) underwent skin testing with the quadrivalent vaccine: all were skin prick test negative and one was intradermal test positive. Eighteen (72%) were subsequently challenged with the quadrivalent vaccine and three (12%) elected to receive the bivalent vaccine. Seventeen tolerated the challenge and one reported limited urticaria four hours after the vaccine had been administered. Only three of the 25 schoolgirls were found to have probable hypersensitivity to the quadrivalent vaccine.


CONCLUSIONS
True hypersensitivity to the quadrivalent human papillomavirus vaccine in Australian schoolgirls was uncommon and most tolerated subsequent doses.
Kang
Liew Woei
LW
Department of Allergy and Immunology, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia.
Crawford
Nigel
N
Tang
Mimi L K
ML
Buttery
Jim
J
Royle
Jenny
J
Gold
Michael
M
Ziegler
Christine
C
Quinn
Patrick
P
Elia
Sonja
S
Choo
Sharon
S
D000293:Adolescent; D015331:Cohort Studies; D004342:Drug Hypersensitivity / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; D006801:Humans; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000009:adverse effects*; D012189:Retrospective Studies; D013021:South Australia / Q000453:epidemiology; D014739:Victoria / Q000453:epidemiology
D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; D053918:Papillomavirus Vaccines