Safety of measles, mumps, and rubella vaccine in egg allergy: in vivo and in vitro management
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linical and Molecular Allergy Open Access
CASE REPORT
Safety of measles, mumps, and rubella vaccine in egg allergy: in vivo and in vitro management Stefania Magistà1, Marcello Albanesi1,2, Nada Chaoul1, Danilo Di Bona1, Elisabetta Di Leo1, Eustachio Nettis1, Maria Filomena Caiaffa2 and Luigi Macchia1*
Abstract Background: Egg allergy is the second most prevalent form of food allergy in childhood. In spite of the evidence accumulated, inoculating egg allergy children with attenuated vaccines grown on chick embryo cell cultures, such as the measles, mumps, and rubella (MMR) vaccine, is regarded (erroneously) as potentially dangerous or even anaphylactogenic, by many. An issue perceived as particularly conflicting also by Health Professionals. Case presentation: A 15-year-old boy, with a history of severe egg allergy in early infancy, who was still sensitized to egg allergens, including baked egg, had never received MMR vaccination, in fear of possible anaphylaxis, in spite of the fact that this vaccination is mandatory in the first year of life, in Italy. Because of that, he was not allowed to attend school, longer, and was referred to us in order to assess the potential risk of MMR vaccination. Upon thorough allergologic workup, sensitization to MMR vaccine components was excluded by an in vivo approach, consisting in skin prick tests, intradermal tests, and subcutaneous injection test, corroborated by vaccine-specific B-lymphocyte proliferation assay, ex vivo. T-cell proliferation in response to MMR vaccine was also excluded. Eventually, the boy was inoculated with MMR vaccine and was readmitted to school. Conclusions: The diagnostic strategy adopted appears feasible and easy-to-perform and may be adopted in controversial cases (as the one reported), characterized by previous severe allergic reactions to egg. The B-lymphocyte proliferation assay we developed may represent a useful and reliable tool not only in research but also in clinical practice. Keywords: Vaccine adverse reaction, Food allergy, Drug allergy, Anaphylaxis, B-cell proliferation assay, Flow cytometry Background Egg allergy may be defined as an adverse immune reaction induced by egg proteins. Egg allergy is the most common food allergy in children aged from 5 months to 15 years, following only cow milk allergy [1]. It occurs most often in early infancy, after the first egg ingestion, *Correspondence: [email protected] 1 Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari-Aldo Moro, Piazza Giulio Cesare, Policlinico, 70124 Bari, Italy Full list of author information is available at the end of the article
whereas the prevalence in adults is around 0.2% [1]. Clinical traits include urticaria, respiratory symptoms, such as change in voice pitch, cough, and wheeze, cry, pallor, gastrointestinal symptoms, such as vomit and diarrhoea, and anaphylaxis. Twenty-four allergenic egg proteins have been identified, most of them in the egg white. Of these, ovomucoid (OVM), ova
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