International Consensus (ICON): allergic reactions to vaccines.
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.
Division of Allergy and Clinical Immunology, Department of Medicine, University of Colorado Denver School of Medicine, Aurora, CO USA.
Stephen C
SC
Dreskin
Institute for Vaccine Safety, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA.
Neal A
NA
Halsey
Division of Allergy, Asthma, and Immunology, Scripps Clinic, San Diego, CA USA.
John M
JM
Kelso
The Division of Pediatric Allergy and Immunology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD USA.
Robert A
RA
Wood
Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN USA.
Donna S
DS
Hummell
Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN USA.
Kathryn M
KM
Edwards
Department of Pediatrics, University Hospitals of Geneva and Medical School, University of Geneva, Geneva, Switzerland.
Jean-Christoph
JC
Caubet
Department of Medicine and Pediatrics, Uniformed Services University of the Health Sciences, Allergy-Immunology-Immunization, Walter Reed National Military Medical Center, Bethesda, MD USA.
Renata J M
RJ
Engler
Disipline of Paediatrics, School of Medicine, University of Adelaide, Adelaide, South Australia Australia.
Michael S
MS
Gold
Department Paediatrics, Pulmonology and Allergy service, Necker-Enfants Malades Hospital, 149 rue de Sèvres, 75015 Paris, France.
Claude
C
Ponvert
Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve - University Hospital of Montpellier, 34295 Montpellier cedex 05 - FRANCE and Sorbonne Universités, UPMC Paris 06, UMR-S 1136 INSERM, IPLESP, Equipe EPAR, 75013 Paris, France.
Pascal
P
Demoly
Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Caracas, Venezuela.
Mario
M
Sanchez-Borges
Food Allergy Referral Centre Department of Women and Child health, University of Padua, Padua, Italy.
Antonella
A
Muraro
Division of Allergic Diseases, Mayo Clinic, Rochester, MN USA.
James T
JT
Li
Allergy Asthma and Immunology, Emek Medical Center, Afula, and the Rappaport Faculty of Medicine, Technion- Israel Institute of Technology, Haifa, Israel.
Menachem
M
Rottem
Allergy-Immunology Division, Children's Mercy Hospital and the University of Missouri-Kansas City School of Medicine, Kansas City, MO USA.
Lanny J
LJ
Rosenwasser
Allergic reactions; Allergy; Anaphylaxis; Causality; Components; Consensus; International; Vaccine
Eur J Pediatr. 2014 Oct;173(10):1297-307
24752308
MMWR Morb Mortal Wkly Rep. 2014 Aug 15;63(32):691-7
25121712
Can J Public Health. 2011 May-Jun;102(3):196-9
21714318
J Allergy Clin Immunol. 2009 Nov;124(5):1108-10
19665767
Arch Pediatr. 2009 Apr;16(4):391-5
19250809
J Allergy Clin Immunol. 1997 Jul;100(1):130-4
9257797
J Allergy Clin Immunol. 1997 Feb;99(2):263-4
9042057
Int Arch Allergy Immunol. 2013;161(3):274-8
23548550
Vaccine. 2014 May 30;32(26):3147-54
24726249
Vaccine. 1999 Jan 28;17(4):327-9
9987170
Swiss Med Wkly. 2010 May 1;140(17-18):238-46
20349363
Expert Rev Vaccines. 2014 Aug;13(8):1049-57
24962036
J Pediatr. 1983 Feb;102(2):196-9
6822922
Pediatr Dermatol. 2012 Jan-Feb;29(1):68-72
21854416
Vaccine. 2004 Dec 16;23(5):664-7
15542187
World Allergy Organ J. 2012 Mar;5(3):39-40
23268470
J Allergy Clin Immunol. 2007 Aug;120(2):478-81
17544094
Ann Allergy Asthma Immunol. 2012 Apr;108(4):215-6
22469437
Clin Exp Allergy. 2000 Aug;30(8):1144-50
10931122
Vaccine. 2013 Dec 9;31(51):6107-12
24120547
Vaccine. 2010 Jun 17;28(28):4487-98
20434547
Pediatr Allergy Immunol. 2016 Jun;27(4):433-7
26844407
Clin Exp Vaccine Res. 2014 Jan;3(1):50-7
24427763
Vaccine. 1997 Feb;15(2):121-2
9066026
J Allergy Clin Immunol. 2015 May;135(5):1125-31
25441636
Pediatrics. 2002 Dec;110(6):e71
12456938
Histopathology. 2006 Jan;48(2):182-8
16405667
J Allergy Clin Immunol. 2011 Aug;128(2):434; author reply 435
21807255
Vaccine. 2005 Jan 26;23(10):1205-8
15652662
BMJ. 2000 Apr 1;320(7239):929-32
10787255
J Allergy Clin Immunol. 1998 Dec;102(6 Pt 1):984-97
9847440
Allergy. 2014 Aug;69(8):1026-45
24909803
MMWR Recomm Rep. 2011 Jan 28;60(2):1-64
21293327
Ann Allergy Asthma Immunol. 2013 Jun;110(6):397-401
23706707
Dermatitis. 2012 May-Jun;23(3):102-9
22653170
Biologicals. 2003 Dec;31(4):245-9
14624794
Ticks Tick Borne Dis. 2011 Mar;2(1):2-15
21771531
Biol Pharm Bull. 1998 Apr;21(4):330-4
9586567
Clin Infect Dis. 2003 Mar 15;36(6):705-13
12627354
Ther Adv Respir Dis. 2008 Aug;2(4):193-8
19124371
Vaccine. 2015 Mar 3;33(10):1231-2
25620248
Vaccine. 2016 Feb 3;34(6):714-22
26740250
Curr Opin Allergy Clin Immunol. 2012 Aug;12(4):383-8
22766619
MMWR Recomm Rep. 2013 Jun 14;62(RR-04):1-34
23760231
Ann Allergy Asthma Immunol. 2013 Oct;111(4):301-2
24054370
J Allergy Clin Immunol. 1996 Dec;98(6 Pt 1):1058-61
8977505
Am J Prev Med. 2011 Aug;41(2):121-8
21767718
Am J Health Syst Pharm. 2005 Sep 1;62(17):1822-7
16120743
J Allergy Clin Immunol. 2012 Apr;129(4):904-5
22365583
J Allergy Clin Immunol. 2010 Aug;126(2):317-23
20579720
Ann Allergy. 1994 Sep;73(3):232-4
8092557
Pharmacoepidemiol Drug Saf. 2014 May;23(5):548-53
24497128
Vaccine. 2009 Nov 5;27(47):6589-94
19716456
J Allergy Clin Immunol. 2000 Sep;106(3):591-2
10984383
Vaccine. 1996 Feb;14(2):131-4
8852409
Can Commun Dis Rep. 2002 Sep 1;28(ACS-6):1
12219587
An Pediatr (Barc). 2007 Oct;67(4):362-7
17949646
Pediatr Infect Dis J. 2002 Aug;21(8):781-6
12192169
JAMA. 2000 Sep 13;284(10):1271-9
10979114
Vaccine. 2007 May 22;25(21):4244-51
17382435
BMJ. 2001 Aug 11;323(7308):334-6
11498496
Vaccine. 2013 Oct 17;31(44):5041-6
24021304
Eur J Pediatr. 2013 Feb;172(2):171-7
23052615
J Allergy Clin Immunol. 1993 Apr;91(4):867-72
8473675
Allergy Asthma Immunol Res. 2013 Nov;5(6):348-56
24179680
Lancet. 1990 Mar 24;335(8691):739
1969103
Allergy. 2010 Apr;65(4):533-4
19839970
Vaccine. 2006 Jun 12;24(24):5256-63
16624457
Vaccine. 2015 Mar 24;33(13):1602-7
25698493
EMBO Mol Med. 2014 May 06;6(6):708-20
24803000
Semin Pediatr Infect Dis. 2002 Jul;13(3):205-14
12199617
Pediatr Allergy Immunol. 2013 Sep;24(6):521-6
23902374
Eur J Pediatr. 2002 Jan;161(1):21-5
11808876
Acta Paediatr. 2012 Sep;101(9):941-5
22612789
Przegl Epidemiol. 1989;43(3):259-62
2616798
J Allergy Clin Immunol. 1999 Aug;104(2 Pt 1):462-5
10452772
Ann Allergy Asthma Immunol. 2009 Oct;103(4 Suppl 2):S1-14
19886402
Am J Gastroenterol. 2003 Jun;98(6):1315-24
12818276
Travel Med Infect Dis. 2013 Sep-Oct;11(5):295-300
23916617
J Allergy Clin Immunol. 2015 Mar;135(3):589-96; quiz 597
25747720
N Engl J Med. 1995 May 11;332(19):1262-6
7708070
Acta Derm Venereol. 2000 May;80(3):232
10954232
Vaccine. 2014 Jun 12;32(28):3480-7
24793951
MMWR Recomm Rep. 2010 Aug 6;59(RR-8):1-62
20689501
Commun Dis Intell. 2000 Feb 17;24(2):27-33
10758692
MMWR Morb Mortal Wkly Rep. 2014 Apr 25;63(16):352-5
24759657
J Allergy Clin Immunol. 1999 Apr;103(4):698-701
10200022
J Allergy Clin Immunol. 2011 Jul;128(1):215-8
21624648
J Allergy Clin Immunol. 2015 Aug;136(2):376-81
25684279
Vaccine. 2012 Aug 24;30(39):5791-8
22507656
Vaccine. 2013 Dec 5;31(50):5989-96
24144473
Contact Dermatitis. 2013 May;68(5):286-92
23601064
Clin Exp Allergy. 2013 Feb;43(2):249-54
23331566
Vaccine. 2001 Sep 14;19(32):4588-91
11535304
Allergy. 2012 Apr;67(4):449-50
22414196
Vaccine. 2007 Aug 1;25(31):5675-84
17448577
Vaccine. 2015 Jan 29;33(5):708-12
25498208
Clin Vaccine Immunol. 2012 Mar;19(3):313-8
22219315
J Allergy Clin Immunol. 1999 Feb;103(2 Pt 1):321-5
9949325
J Allergy Clin Immunol. 2012 Jul;130(1):25-43
22608573
Clin Infect Dis. 2015 Mar 1;60(5):777-80
25428412
Dan Med J. 2013 Feb;60(2):A4573
23461988
J Allergy Clin Immunol Pract. 2015 Jan-Feb;3(1):138-9
25577640
Ann Allergy Asthma Immunol. 2005 Sep;95(3):217-26; quiz 226, 258
16200811
Vaccine. 2015 Jan 1;33(1):187-92
25444798
Pediatrics. 2011 Mar;127(3):e581-7
21300679
J Allergy Clin Immunol. 1999 Jul;104(1):202-4
10400862
Ann Allergy Asthma Immunol. 2005 Jan;94(1):90-4
15702823
Vaccine. 2000 Nov 22;19(7-8):916-23
11115716
Heart Lung. 1999 Nov-Dec;28(6):418-28
10580216
Jpn J Infect Dis. 2000 Oct;53(5):189-95
11135703
Vaccine. 2011 Aug 26;29(37):6402-7
21527305
BMJ. 2015 Dec 08;351:h6291
26645895
J Allergy Clin Immunol. 2012 Dec;130(6):1423-6
22958947
World Allergy Organ J. 2014 May 30;7(1):9
24920969
Klin Padiatr. 2006 Nov-Dec;218(6):379; discussion 379
17080341
Pediatrics. 2003 Oct;112(4):815-20
14523172
J Allergy Clin Immunol. 2008 Dec;122(6):1166-8
19084110
Immunol Allergy Clin North Am. 2014 Aug;34(3):597-613, ix
25017679
J Pediatr. 1992 Jun;120(6):878-81
1593346
Pediatrics. 2008 Sep;122(3):e771-7
18762513
Natl Med J India. 1995 Sep-Oct;8(5):208-10
7549850
J Allergy Clin Immunol. 2006 Feb;117(2):391-7
16461139
Lancet. 1995 May 13;345(8959):1249
7739341
Pediatrics. 2000 Oct;106(4):762-6
11015520
Vaccine. 2003 Jan 30;21(7-8):738-41
12531352
Vaccine. 2006 Feb 6;24(6):703-7
16154669
J Allergy Clin Immunol. 1995 Oct;96(4):563-5
7560672
Ann Allergy Asthma Immunol. 2007 Dec;99(6):574-5
18219843
Vaccine. 2005 May 25;23(28):3726-32
15882534
J Allergy Clin Immunol. 1994 May;93(5):836-42
8182224
Pediatrics. 2001 Feb;107(2):E27
11158501
J Allergy Clin Immunol. 2000 Nov;106(5):990
11080728
J Allergy Clin Immunol. 2010 Sep;126(3):477-80.e1-42
20692689
MMWR Morb Mortal Wkly Rep. 2008 May 2;57(17):457-60
18451756
J Allergy Clin Immunol. 1996 Jan;97(1 Pt 1):131-4
8568127
Arch Iran Med. 2011 Mar;14(2):91-5
21361714
J Allergy Clin Immunol. 2014 Jun;133(6):1509-18; quiz 1519-20
24878443
Appl Microbiol. 1971 Apr;21(4):780-2
4995854
Pediatr Allergy Immunol. 2014 Jun;25(4):394-403
24131271
Ann Allergy Asthma Immunol. 2006 Sep;97(3):294-7
17042133
Allergy. 2011 Jul;66 Suppl 95:31-4
21668849
BMJ. 2001 Oct 13;323(7317):869
11683165
Allergy. 2001 Sep;56(9):813-24
11551246
World J Clin Cases. 2015 May 16;3(5):430-41
25984517
Vaccine. 2007 Aug 1;25(31):5875-81
17537554
Pediatrics. 2014 Aug;134(2):325-37
25086160
Arch Dis Child. 2012 Jun;97(6):487-90
22275307