Age: 4.0
Sex: F
Vaccine: DTAP, IPV, MMR, PNC13, VARCEL, DTAP, IPV, MMR, PNC13, VARCEL, DTAP, IPV, MMR, PNC13, VARCEL
Symptoms: Urticaria, Wheezing
Clinical narrative: Initial report was received from a health care professional on 23 March 2011. Additional information was received on 25 March 2011, under temporary VAERS E-Report Number of E-52580. A four year-old female patient with a history of allergies to egg, chicken and peanuts, had received the following vaccines on 23 March 2011 at 8:30 AM: a fifth dose intramuscular left thigh injection of DAPTACEL, lot number C3618AA; a fourth dose subcutaneous left thigh injection of IPOL, lot number D0480; a second dose subcutaneous right thigh injection of VARIVAX, Merck lot number 1319Z; a second dose subcutaneous left thigh injection of MMR II, Merck lot number 0741Z and a first dose intramuscular right thigh injection of PREVNAR 13, Pfizer/Wyeth lot number 915346. At 9:00 AM, the patient experienced an anaphylactic reaction with circulatory collapse, stridor, wheezing, hives, itching, runny nose (reported as note) and eye redness. The patient was treated with epinephrine, albuterol and BENADRYL. She was transported to the ER (emergency room) by ambulance. The patient was reported to be improving several hours later. No further information was available at the time of the report. The patient's outcome was reported as recovered. Follow-up information was received from the health care professional on 19 April 2011, and included copies of consultations with the patient's allergist. The first consult was dated March 2008, at which time the patient was noted to have atopic dermatitis and chronic rhinitis. Allergy survey revealed positive prick tests for egg white, peanut, and chicken; prick tests were negative for milk, soybean, and wheat. Recommendations at that time were to avoid peanut, egg white, and chicken; use Eucerin lotion after daily bath; hydrocortisone cream 1% qid prn; and Desonide lotion prn. She was seen again in June and September of 2008, at which time it was noted that she ate beef and turkey with no apparent significant reactions despite positive skin prick tests. At that time the recommendation was to use Aquaphor lotion, hydrocortisone cream 2.5% bid prn, and to follow-up in 6 months. The patient was seen again on 02 April 2009, and impression was atopic dermatitis and eosinophilic esophagitis. Allergy testing was negative for milk, wheat, molds, dust mites, birch, oak, and timothy grass. Recommendation was to continue avoiding chicken, egg, and peanut; use EPIPEN Jr. prn, and return in 6 months. On 07 January 2011 she was seen again by her allergist for administration of an influenza vaccine. Allertec had been discontinued one week prior to the visit, with no symptoms. It was noted that she had facial swelling in June 2010 after licking from the dishwasher, and was treated in the emergency department with epinephrine. No throat swelling or wheeze was noted, and the patient's mother thought the reaction might have been due to chicken. During her appointment, she was challenged with 0.05 mL of influenza vaccine (manufacturer and lot not reported), observed for 30 minutes, and then given the remaining 0.45 mL intramuscularly with no reaction. It was also noted that the patient was tolerating egg in foods, and the recommendation was to administer influenza vaccine normally the following year. Follow-up information was received on 03 June 2011 from a health care professional. The patient had additional skin testing on 04 April 2011 and was found to have a positive 5mm reaction to gelatin and continued to be positive for beef, chicken and egg. According to the allergist, gelatin and neomycin remain suspicious as the causes of the patient's recent reactions. The allergist also stated gelatin was most likely the cause of the reaction based on skin tests and past reports of anaphylaxis to this vaccine component, as well as the large amount of gelatin that would have been administered cumulatively by the MMR and Varicella vaccines. The reporter notes again gelatin is commonly implicated in reactions to MMR and VARIVAX. No further information was provided at the time of the report. The patient was reported as doing well after the anaphylactic reaction. Documents held by sender: Temporary VAERS E-Report, allergy consults.