Age: 37.0
Sex: M
Vaccine: FLU3
Symptoms: Flushing, Hypoaesthesia oral, Lip swelling, Paraesthesia, Postnasal drip
Clinical narrative: Initial information received on 15 May 2008 from a literature article.  The following case report information is verbatim from the literature article.  "We present a patient who developed an immediate systemic anaphylactic reaction to the inactivated FLUZONE."  "A 37-year-old male returned to the immunization clinic complaining of a warm sensation over his entire body 15 minutes after receiving a 0.5-ml intramuscular injection of FLUZONE; Aventis Pasteur.  He also experienced face tingling and redness, pruritis, postnasal drip, and lip numbness.  He had a localized cutaneous reaction at his right deltoid injection site.  He denied chest tightness, shortness of breath, and wheezing.  Based on his symptoms, he was given 10 mg of cetirizine and observed.  Over the next 15 minutes he developed lip swelling, worsening facial flushing, and heartburn with audible belching.  He was then treated with 0.3 ml of epinephrine intramuscularly and 150 mg of ranitidine orally.  His symptoms resolved over the next 30 minutes."  "His past medical history was significant for a 4x4 cm right arm localized reaction to FLUZONE (unknown manufacturer) given four years prior that occurred within 15 minutes.  He had received other immunizations in the past without any adverse effects.  He denied food allergies including eggs and gelatin."  "The FLUZONE vaccine that our patient received contained hemagglutinin representative of the three relevant influenza strains.  It was prepared from influenza viruses propagated in chicken eggs.  It also contained 0.5% gelatin (0.025 mg) which acts as a stabilizer and the preservative thimerosal, a mercury derivative at 25 micrograms of mercury per dose."  "As part of his evaluation, the patient returned to the clinic on a separate day for skin prick testing.  He was skin tested to FLUZONE, native egg (white, yolk, and whole) and gelatin (Jell-O sugared gelatin, Kraft Foods).  His skin testing response to FLUZONE was positive (3 x 4 mm wheal and 5 x 7 mm flare), gelatin was positive (3 x 4 mm wheal and 5 x 5 mm flare) and egg was negative (egg white: 0 x 0 mm wheal and 4 x 4 mm flare; egg whole: 2 x 2 mm wheal and 3 x 3 mm flare, and egg yolk: 2 x 2 mm wheal and 4 x 4 mm flare).  His histamine-positive control was 4 x 5 mm wheal and 26 x 30 mm flare, and the diluent negative control was 0 x 0 mm wheal and 0 x 0 mm flare.  Results of concomitant gelatin skin tests on 2 control subjects (clinic staff) were negative (0 x 0 mm wheal and 0 x 0 flare).  Immunocap specific IgE testing to egg (white, whole, and yolk) and gelatin were negative (<0.35 kU/l).  IgE immunoblots were performed with 2 cord blood serums and the patient's serum at a 1:20 dilution against 20 micrograms of the FLUZONE.  The patient's IgE immunoblot showed a protein band at 100 kDa which is similar to the molecular weight of gelatin protein, a 68 kDa protein which is similar to the molecular weight of hemagglutinin protein from FLUZONE, and a 45-kDa protein band that is similar to the molecular weight of ovalbumin protein from chicken embryo/egg.  These IgE immunoblot bands were not found on the 2 cord blood non-atopic serum specimens."