Sex: F
Vaccine: HEPA
Symptoms: Anaphylactic reaction, Angioedema, Dyspnoea, Intensive care, Paraesthesia oral
Clinical narrative: This case was reported in a literature article and described the occurrence of anaphylaxis in a 57-year-old female patient who received Hepatitis A vaccine. On an unknown date, the patient received Hepatitis A vaccine at an unknown dose. On an unknown date, 2 days after receiving Hepatitis A vaccine, the patient experienced anaphylaxis (serious criteria hospitalization and GSK medically significant), dyspnea (serious criteria hospitalization), wheezing (serious criteria hospitalization), throat tightness (serious criteria hospitalization), face angioedema (serious criteria hospitalization and GSK medically significant), hives (serious criteria hospitalization) and paresthesia lips (serious criteria hospitalization). The patient was treated with famotidine, Cetirizine, Montelukast, Hydroxyzine, Antihistamines, methylprednisolone, epinephrine and diphenhydramine. On an unknown date, the outcome of the anaphylaxis, dyspnea, wheezing, throat tightness, face angioedema, hives and paresthesia lips were recovering/resolving. The reporter considered the anaphylaxis, dyspnea, wheezing, throat tightness, face angioedema, hives and paresthesia lips to be related to Hepatitis A vaccine. Additional information was provided. This case was reported in a literature article and described the occurrence of protracted and treatment resistant anaphylaxis in a 57-year-old female who was vaccinated with unspecified Hepatitis A vaccine (HAV)  (manufacturer unknown). The extensive review of patient's history did not reveal any suspicious ingestion or skin exposure. No information on patient's family history or concomitant medication or concurrent condition was provided. On an unspecified date, the patient received unspecified HAV vaccine (administration route and site unspecified; dosages unknown; batch number not provided). The age of vaccination was not provided. On an unspecified date, 2 days after vaccination, the patient had onset of dyspnoea, wheezing, throat tightness and worsening angioedema of the face. The patient was admitted to the critical care unit. This case has been considered serious due to hospitalisation. The patient was treated with parenteral antihistamines and high dose methylprednisolone. However, the symptoms including angioedema persisted, with further development of hives and lip paraesthesia. Intermittent epinephrine intramuscular (IM) injection provided temporary relief. Treatment with systemic glucocorticoids continued for 2 weeks with a combination of diphenhydramine, famotidine, cetirizine, montelukast, and hydroxyzine added. The patient was diagnosed with protracted and treatment resistant anaphylaxis (protracted anaphylaxis, defined as anaphylaxis lasting from hours to days after initial exposure without complete resolution). The patient slowly improved on this regimen. The authors considered the event of protracted and treatment resistant anaphylaxis related to unspecified HAV vaccine. The authors stated "We report a unique case of protracted and treatment resistant anaphylaxis to Hepatitis A vaccination. Protracted anaphylaxis is not widely reported and current literature is limited to case reports and small case series. Although rare, the clinician should be aware of the possibility of protracted anaphylaxis. Furthermore, severe allergic reactions to vaccinations are uncommon with the rate of anaphylactic reactions to vaccines ranging from 0.65 to 1.31 events per million vaccine doses. We aim to bring awareness of this potential complication of vaccinations".