title: Hypersensitivity reactions to human papillomavirus vaccine in Australian schoolgirls: retrospective cohort study.
abstract: 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.
authors.affiliation: Department of Allergy and Immunology, Royal Children's Hospital, Flemington Road, Parkville, Victoria 3052, Australia.
authors.forename: Liew Woei
authors.initials: LW
authors.lastname: Kang
authors.forename: Nigel
authors.initials: N
authors.lastname: Crawford
authors.forename: Mimi L K
authors.initials: ML
authors.lastname: Tang
authors.forename: Jim
authors.initials: J
authors.lastname: Buttery
authors.forename: Jenny
authors.initials: J
authors.lastname: Royle
authors.forename: Michael
authors.initials: M
authors.lastname: Gold
authors.forename: Christine
authors.initials: C
authors.lastname: Ziegler
authors.forename: Patrick
authors.initials: P
authors.lastname: Quinn
authors.forename: Sonja
authors.initials: S
authors.lastname: Elia
authors.forename: Sharon
authors.initials: S
authors.lastname: Choo
mesh_terms: 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
chemical_list: D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; D053918:Papillomavirus Vaccines