Anafilaxia causada por vacunas

Autores/as

  • Pablo Perea-Valle Secretaría de Salud, Hospital Infantil de México Federico Gómez, Departamento de Alergia e Inmunología Clínica, Ciudad de México https://orcid.org/0000-0003-0157-3321
  • Carlos Julio Delgado-Aguirre Secretaría de Salud, Hospital Infantil de México Federico Gómez, Departamento de Alergia e Inmunología Clínica, Ciudad de México https://orcid.org/0000-0001-6514-1371
  • Belkis Grindeli Villafuerte-Domínguez Secretaría de Salud, Hospital Infantil de México Federico Gómez, Departamento de Alergia e Inmunología Clínica, Ciudad de México https://orcid.org/0000-0001-5435-5278
  • Blanca Estela Del Río-Navarro Secretaría de Salud, Hospital Infantil de México Federico Gómez, Departamento de Alergia e Inmunología Clínica, Ciudad de México https://orcid.org/0000-0001-6441-8869

DOI:

https://doi.org/10.29262/ram.v69iSupl1.989

Palabras clave:

Hipersensibilidad, Anafilaxia, Vacunación

Resumen

A pesar de la difícil situación que se enfrenta con la actual pandemia de COVID-19, la ciencia ha tenido un desarrollo exponencial. Si bien la inmunización contra esa enfermedad ha sido posible gracias a ello, desafortunadamente se ha acompañado de desinformación y mitos en torno a su fabricación y reacciones adversas. Por tal razón, es importante revisar una de las reacciones adversas a vacunas más temidas para el personal de salud y la población general, la anafilaxia. La anafilaxia se define como una reacción alérgica aguda y sistémica que puede poner en riesgo la vida; se asocia con distintos mecanismos inmunológicos, factores desencadenantes y manifestaciones clínicas. Su diagnóstico puede ser confuso, por lo que se han establecido diferentes criterios. Todas las inmunizaciones tienen el potencial de desencadenar anafilaxia, aunque este evento es poco frecuente. Respecto de las vacunas contra el coronavirus SARS-CoV-2, en Estados Unidos se ha reportado una tasa de anafilaxia de 1:200 000 para la vacuna Pfizer-BioNTech, y de 1:360 000 para la vacuna de Moderna. Al igual que un fármaco, las vacunas pueden presentar efectos adversos mediados por mecanismos de hipersensibilidad, pero a diferencia de lo que sucede con los medicamentos, el principio activo rara vez es el responsable; es más frecuente que las reacciones indeseadas se deban a los excipientes. La sospecha de una anafilaxia secundaria a su aplicación obliga a una oportuna referencia y a un correcto diagnóstico, tanto para el beneficio del paciente como para mejorar el perfil de seguridad de la vacuna.

Citas

Dubé E, Laberge C, Guay M, Bramadat P, Roy R, Bettinger J. Vaccine hesitancy: an overview. Hum Vaccin Immunother. 2013;9(8):1763-73. DOI: 10.4161/hv.24657

Ruiter RA, Kessels LT, Peters GJ, Kok G. Sixty years of fear appeal research: current state of the evidence. Int J Psychol. 2014;49(2):63-70. DOI: 10.1002/ijop.12042

Turner PJ, Ansotegui IJ, Campbell DE, Cardona V, Ebisawa M, El-Gamal Y, et al. COVID-19 vaccine-associated anaphylaxis: a statement of the World Allergy Organization Anaphylaxis Committee. World Allergy Organ J. 2021;14(2):100517. DOI: 10.1016/j.waojou.2021.100517

Shaker MS, Wallace DV, Golden DBK, Oppenheimer J, Bernstein JA, Campbell RL, et al. Anaphylaxis-a 2020 practice parameter update, systematic review, and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) analysis. J Allergy Clin Immunol. 2020;145(4):1082-123. DOI: 10.1016/j.jaci.2020.01.017

Kohl KS, Gidudu J, Bonhoeffer J, Braun MM, Buettcher M, Chen RT, et al. The development of standardized case definitions and guidelines for adverse events following immunization. Vaccine. 2007;25(31):5671-4. DOI: 10.1016/j.vaccine.2007.02.063

Vanlander A, Hoppenbrouwers K. Anaphylaxis after vaccination of children: review of literature and recommendations for vaccination in child and school health services in Belgium. Vaccine. 2014;32(26):3147-54. DOI: 10.1016/j.vaccine.2014.03.096.

McNeil MM. Vaccine-Associated Anaphylaxis. Curr Treat Options Allergy. 2019;6(3):297-308. DOI: 10.1007/s40521-019-00215-0

Bohlke K, Davis RL, Marcy ; SM, Braun ; MM, Destefano F, Black SB, et al. Risk of anaphylaxis after vaccination of children and adolescents. Pediatrics. 2003;112(4):815-20. DOI: 10.1542/peds.112.4.815

McNeil MM, Weintraub ES, Duffy J, Sukumaran L, Jacobsen SJ, Klein NP, et al. Risk of anaphylaxis after vaccination in children and adults. J Allergy Clin Immunol. 2016;137(3):868-78. DOI: 10.1016/j.jaci.2015.07.048

Dreskin SC, Halsey NA, Kelso JM, Wood RA, Hummell DS, Edwards KM, et al. International Consensus (ICON): allergic reactions to vaccines. World Allergy Organ J. 2016 Sep 16;9(1):32. DOI: 10.1186/s40413-016-0120-5

Ceballos-Liceaga S, Carbajal-Sandoval G, Sánchez-Novoa P, León-Álvarez G, Romualdo-Tello NM, González-Caballero A. Manual de procedimientos estandarizados para la vigilancia epidemiológica de eventos supuestamente atribuibles a la vacunación o inmunización (ESAVI). Dirección General de Epidemiología; 2021. Disponible en: https://epidemiologia.salud.gob.mx/gobmx/salud/documentos/manuales/42_Manual_ESAVI.pdf

Kounis NG, Koniari I, de Gregorio C, Velissaris D, Petalas K, Brinia A, et al. Allergic reactions to current available COVID-19 vaccinations: Pathophysiology, Causality, and Therapeutic Considerations. Vaccines (Basel). 2021;9(3):221. DOI: 10.3390/vaccines9030221

Murphy K, Weaver C. Allergy and allergic diseases. En: Murphy K, Weaver C, editores. Janeway’s immunobiology. 9na ed. New York, USA: Garland Science; 2017. p. 80-103.

Stone CA, Rukasin CRF, Beachkofsky TM, Phillips EJ. Immune-mediated adverse reactions to vaccines. Br J Clin Pharmacol. 2019;85(12):2694-706. DOI: 10.1111/bcp.14112.

Zhang B, Li Q, Shi C, Zhang X. Drug-induced pseudoallergy: a review of the causes and mechanisms. Pharmacology. 2018;101(1-2):104-10. DOI: 10.1159/000479878

Szebeni J. Complement activation-related pseudoallergy: a stress reaction in blood triggered by nanomedicines and biologicals. Mol Immunol. 2014;61(2):163-73. DOI: 10.1016/j.molimm.2014.06.038

Wang H, Wang HS, Liu ZP. Agents that induce pseudo-allergic reaction. Drug Discov Ther. 2011;5(5):211-9. DOI: 10.5582/ddt.2011.v5.5.211

Navinés-Ferrer A, Serrano-Candelas E, Lafuente A, Muñoz-Cano R, Martín M, Gastaminza G. MRGPRX2-mediated mast cell response to drugs used in perioperative procedures and anaesthesia. Sci Rep. 2018;8(1):11628. DOI: 10.1038/s41598-018-29965-8

Caballero ML, Krantz MS, Quirce S, Phillips EJ, Stone CA. Hidden dangers: recognizing excipients as potential causes of drug and vaccine hypersensitivity reactions. J Allergy Clin Immunol Pract. 2021;9(8):2968-82. DOI: 10.1016/j.jaip.2021.03.002

Radice A, Carli G, Macchia D, Farsi A. Allergic reactions after vaccination: translating guidelines into clinical practice. Eur Ann Allergy Clin Immunol. 2019;51(2):51-61. DOI: 10.23822/EurAnnACI.1764-1489.86

Nilsson L, Brockow K, Alm J, Cardona V, Caubet JC, Gomes E, et al. Vaccination and allergy: EAACI position paper, practical aspects. Pediatr Allergy Immunol. 2017;28(7):628-40. DOI: 10.1111/pai.12762

Miller CK, Mendoza JC, Coop CA. Anaphylaxis to MMR vaccine mediated by IgE sensitivity to gelatin. Mil Med. 2020;185(9-10):e1869-71. DOI: 10.1093/milmed/usaa058

Sakai Y, Yamato R, Onuma M, Kikuta T, Watanabe M, Nakayama T. Non-antigenic and low allergic gelatin produced by specific digestion with an enzyme-coupled matrix. Biol Pharm Bull. 1998;21(4):330-4. DOI: 10.1248/bpb.21.330

Matricardi PM, Kleine-Tebbe J, Hoffmann HJ, Valenta R, Hilger C, Hofmaier S, et al. EAACI molecular allergology user’s guide. Pediatr Allergy Immunol. 2016;27(Suppl 23):1-250. DOI: 10.1111/pai.12563

Jiang Y, Yuan IH, Dutille EK, Bailey R, Shaker MS. Preventing iatrogenic gelatin anaphylaxis. Ann Allergy Asthma Immunol. 2019;123(4):366-74. DOI: 10.1016/j.anai.2019.07.017

Kelso JM. Safety of influenza vaccines. Curr Opin Allergy Clin Immunol. 2012;12(4):383-8. DOI: 10.1097/ACI.0b013e328354395d

Houchens N, Hartley S, Commins SP, Claar D, Saint S. Hunting for a Diagnosis. N Engl J Med. 2021;384(5):462-7. DOI: 10.1056/NEJMcps2017588

Uyttebroek A, Sabato V, Bridts CH, De Clerck LS, Ebo DG. Anaphylaxis to succinylated gelatin in a patient with a meat allergy: galactose-(1, 3)-galactose (-gal) as antigenic determinant. J Clin Anesth. 2014;26(7):574-6. DOI: 10.1016/j.jclinane.2014.04.014

Stone CA, Hemler JA, Commins SP, Schuyler AJ, Phillips EJ, Peebles RS, et al. Anaphylaxis after zoster vaccine: Implicating alpha-gal allergy as a possible mechanism. J Allergy Clin Immunol. 2017;139(5):1710-13.e2. DOI: 10.1016/j.jaci.2016.10.037

Caubet JC, Ponvert C. Vaccine Allergy. Immunology and Allergy Clinics of North America. 2014;34(3):597-613.

Zanoni G, Puccetti A, Dolcino M, Simone R, Peretti A, Ferro A, et al. Dextran-specific IgG response in hypersensitivity reactions to measles-mumps-rubella vaccine. J Allergy Clin Immunol. 2008;122(6):1233-5. DOI: 10.1016/j.jaci.2008.09.015

Rouleau I, De Serres G, Drolet JP, Skowronski DM, Ouakki M, Toth E, et al. Increased risk of anaphylaxis following administration of 2009 AS03-adjuvanted monovalent pandemic A/H1N1 (H1N1pdm09) vaccine. Vaccine. 2013;31(50):5989-96. DOI: 10.1016/j.vaccine.2013.10.033

Rouleau I, De Serres G, Skowronski DM, Drolet JP, Lemire C, Toth E, et al. Risk factors associated with anaphylaxis and other allergic-like events following receipt of 2009 monovalent AS03-adjuvanted pandemic influenza vaccine in Quebec, Canada. Vaccine. 2014;32(28):3480-7. DOI: 10.1016/j.vaccine.2014.04.059.

Bigham M, Copes R. Thiomersal in vaccines: balancing the risk of adverse effects with the risk of vaccine-preventable disease. Drug Saf. 2005;28(2):89-101. DOI: 10.2165/00002018-200528020-00001

Parker SK, Schwartz B, Todd J, Pickering LK. Thimerosal-containing vaccines and autistic spectrum disorder: a critical review of published original data. Pediatrics. 2004;114(3):793-804. DOI: 10.1542/peds.2004-0434

Zheng W, Dreskin SC. Thimerosal in influenza vaccine: an immediate hypersensitivity reaction. Ann Allergy Asthma Immunol. 2007;99(6):574-5. DOI: 10.1016/S1081-1206(10)60391-2

Kattan JD, Konstantinou GN, Cox AL, Nowak-Węgrzyn A, Gimenez G, Sampson HA, et al. Anaphylaxis to diphtheria, tetanus, and pertussis vaccines among children with cow’s milk allergy. J Allergy Clin Immunol. 2011;128(1):215-8. DOI: 10.1016/j.jaci.2011.04.046

Savage JH, Matsui EC, Skripak JM, Wood RA. The natural history of egg allergy. J Allergy Clin Immunol. 2007;120(6):1413-7. DOI: 10.1016/j.jaci.2007.09.040

Boyano-Martínez T, García-Ara C, Díaz-Pena JM, Martín-Esteban M. Prediction of tolerance on the basis of quantification of egg white-specific IgE antibodies in children with egg allergy. J Allergy Clin Immunol. 2002;110(2):304-9. DOI: 10.1067/mai.2002.126081

Merck. M-M-R II: highlights of prescribing information. Merck Sharp & Dohme Corp; 2020. p. 8. Disponible en: https://www.merck.com/product/usa/pi_circulars/m/mmr_ii/mmr_ii_pi.pdf

Kelso JM. Administering influenza vaccine to egg-allergic persons. Expert Rev Vaccines. 2014;13(8):1049-57. DOI: 10.1586/14760584.2014.933079

Baxter DN. Measles immunization in children with a history of egg allergy. Vaccine. 1996;14(2):131-4. DOI: 10.1016/0264-410x(95)00154-s

Committee on Infectious Diseases. Recommendations for Prevention and Control of Influenza in Children, 2020-2021. Pediatrics. 2020;146(4):e2020024588. DOI: 10.1542/peds.2020-024588

Australasian Society of Clinical Immunology and Allergy. ASCIA Guidelines – Vaccination of the egg-allergic individual. Australia: ASCIA; 2017. Disponible en: https://www.allergy.org.au/hp/papers/vaccination-of-the-egg-allergic-individual

Merck. GARDASIL: highlights of prescribing information. Merck Sharp & Dohme Corp; 2011. p. 28 Disponible en: https://www.fda.gov/files/vaccines,%20blood%20&%20biologics/published/Package-Insert---Gardasil.pdf

Merck. RECOMBIVAX HB: highlights of prescribing information. Merck Sharp & Dohme Corp; 2011. p. 10 Disponible en: https://www.merck.com/product/usa/pi_circulars/r/recombivax_hb/recombivax_pi.pdf

Franceschini F, Bottau P, Caimmi S, Crisafulli G, Lucia L, Peroni D, et al. Vaccination in children with allergy to non active vaccine components. Clin Transl Med. 2015;4:3. DOI: 10.1186/s40169-014-0043-0

Fritsche PJ, Helbling A, Ballmer-Weber BK. Vaccine hypersensitivity--update and overview. Swiss Med Wkly. 2010;140(17-18):238-46.

Cullinan P, Brown R, Field A, Hourihane J, Jones M, Kekwick R, et al. Latex allergy. A position paper of the British Society of Allergy and Clinical Immunology. Clin Exp Allergy. 2003;33(11):1484-99. DOI: 10.1046/j.1365-2222.2003.01818.x

Wenande E, Garvey LH. Immediate-type hypersensitivity to polyethylene glycols: a review. Clin Exp Allergy. 2016;46(7):907-22. DOI: 10.1111/cea.12760

Castells MC, Phillips EJ. Maintaining safety with SARS-CoV-2 Vaccines. N Engl J Med. 2021;384(7):643-9. DOI: 10.1056/NEJMra2035343

Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 Vaccine. N Engl J Med. 2021;384(5):403-16. DOI: 10.1056/NEJMoa2035389.

Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020;383(27):2603-15. DOI: 10.1056/NEJMoa2034577

Rutkowski K, Mirakian R, Till S, Rutkowski R, Wagner A. Adverse reactions to COVID-19 vaccines: A practical approach. Clin Exp Allergy. 2021;51(6):770-7. DOI: 10.1111/cea.13880

Kennard L, Rutkowski K, Mirakian R, Wagner A. Polyethylene glycol: not just a harmless excipient. J Allergy Clin Immunol Pract. 2018;6:2173. DOI: 10.1016/j.jaip.2018.08.033

Lu IN, Rutkowski K, Kennard L, Nakonechna A, Mirakian R, Wagner A. Polyethylene glycol may be the major allergen in depot medroxy-progesterone acetate. J Allergy Clin Immunol Pract. 2020;8(9):3194-7. DOI: 10.1016/j.jaip.2020.04.057

Stone CA, Liu Y, Relling MV, Krantz MS, Pratt AL, Abreo A, et al. Immediate hypersensitivity to polyethylene glycols and polysorbates: more common than we have recognized. J Allergy Clin Immunol Pract. 2019;7(5):1533-40.e8. DOI: 10.1016/j.jaip.2018.12.003

Wenande E, Kroigaard M, Mosbech H, Garvey LH. Polyethylene glycols (PEG) and related structures: overlooked allergens in the perioperative setting. A A Case Rep. 2015;4(5):61-4. DOI: 10.1213/XAA.0000000000000126

Bruusgaard-Mouritsen MA, Johansen JD, Garvey LH. Clinical manifestations and impact on daily life of allergy to polyethylene glycol (PEG) in ten patients. Clin Exp Allergy. 2021;51(3):463-70. DOI: 10.1111/cea.13822

Institute for Vaccine Safety. Vaccine information: components of vaccines. Johns Hopkins. Bloomberg School of Public Health; 2020. Disponible en: https://www.hopkinsvaccine.org/components.htm

De Serres G, Toth E, Ménard S, Grenier JL, Roussel R, Tremblay M, et al. Oculo-respiratory syndrome after influenza vaccination: trends over four influenza seasons. Vaccine. 2005;23(28):3726-32. DOI: 10.1016/j.vaccine.2005.01.154.

Centers for Disease Control and Prevention (CDC). Syncope after vaccination: United States, January 2005-July 2007. MMWR Morb Mortal Wkly Rep. 2008;57(17):457-46018451756

Buettcher M, Heininger U, Braun M, Bonhoeffer J, Halperin S, Heijbel H, et al. Hypotonic-hyporesponsive episode (HHE) as an adverse event following immunization in early childhood: case definition and guidelines for data collection, analysis, and presentation. Vaccine. 2007;25(31):5875-81. DOI: 10.1016/j.vaccine.2007.04.061

Cheung A, Choo S, Perrett KP. Vaccine allergy? skin testing and challenge at a tertiary pediatric hospital in Melbourne, Australia. J Allergy Clin Immunol Pract. 2019;7(5):1541-49. DOI: 10.1016/j.jaip.2019.01.025

Zafack JG, De Serres G, Rouleau I, Gariépy MC, Gagnon R, Drolet JP, et al. Clinical Approach Used in Medical Consultations for Allergic-Like Events Following Immunization: Case Series Report in Relation to Practice Guidelines. J Allergy Clin Immunol Pract. 2017;5(3):718-27.e1. DOI: 10.1016/j.jaip.2016.09.048

Wood RA, Setse R, Halsey N; Clinical Immunization Safety Assessment (CISA) Network Hypersensitivity Working Group. Irritant skin test reactions to common vaccines. J Allergy Clin Immunol. 2007;120(2):478-81. DOI: 10.1016/j.jaci.2007.04.035

Wood RA, Berger M, Dreskin SC, Setse R, Engler RJ, Dekker CL, et al. An algorithm for treatment of patients with hypersensitivity reactions after vaccines. Pediatrics. 2008;122(3):e771-7. DOI: 10.1542/peds.2008-1002

CDC COVID-19 Response Team; Food and Drug Administration. Allergic reactions including anaphylaxis after receipt of the first dose of Pfizer-BioNTech COVID-19 Vaccine - United States, December 14-23, 2020. MMWR Morb Mortal Wkly Rep. 2021;70(2):46-51. DOI: 10.15585/mmwr.mm7002e1

Shimabukuro T, Nair N. Allergic reactions including anaphylaxis after receipt of the first dose of Pfizer-BioNTech COVID-19 Vaccine. JAMA. 2021;325(8):780-1. DOI: 10.1001/jama.2021.0600

Shimabukuro TT, Cole M, Su JR. Reports of anaphylaxis after receipt of mRNA COVID-19 Vaccines in the US-December 14, 2020-January 18, 2021. JAMA. 2021;325(11):1101-2. DOI: 10.1001/jama.2021.1967

Sellaturay P, Nasser S, Islam S, Gurugama P, Ewan PW. Polyethylene glycol (PEG) is a cause of anaphylaxis to the Pfizer/BioNTech mRNA COVID-19 vaccine. Clin Exp Allergy. 2021;51(6):861-3. DOI: 10.1111/cea.13874

Rasmussen TH, Mortz CG, Georgsen TK, Rasmussen HM, Kjaer HF, Bindslev-Jensen C. Patients with suspected allergic reactions to COVID-19 vaccines can be safely revaccinated after diagnostic work-up. Clin Transl Allergy. 2021;11(5):e12044. DOI: 10.1002/clt2.12044

Paul-Ehrlich-Institut; Robert Koch Institute. How to proceed in case of positive allergy history prior to COVID-19 mRNA vaccination?. Paul-Ehrlich-Institut; 2021. Disponible en: https://www.pei.de/SharedDocs/Downloads/EN/newsroom-en/dossiers/flowchart-allergy-mrna-vaccination.pdf?__blob=publicationFile&v=3

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2022-01-08

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