Age: 1.02
Sex: F
Vaccine: MMR, PNC13
Symptoms: Vulvovaginal swelling, Wheezing
Clinical narrative: Mom advised this 3 year old female began having problems with cough, wheezing, upset stomach, diarrhea from 2012 months of age with multiple visits to MD to rule out sinus infections. Mom reported after her daughter receiving her 1 year old vaccinations 5/25/2011 (MMR #1 PREVNAR 13 #4), child developed diarrhea and red macular rash to vaginal area with swelling and was sent to allergy clinic (after moving from one place to another) where it was identified she had an egg, peanut, grass and tree nut allergy (positive skin prick test). Mom advised when they adjusted her diet/environment all her symptoms eased. At age 2, mom advised when child was given annual flu vaccine 10/25/2012 with 2nd flu shot (2 weeks later) her daughter again experienced vaginal swelling, rash and loose stool similar to reactions after 1 year old vaccinations what again lasted 2-4 days each. Mom described swelling was to external labia with the rash as red patchy bumps and diarrhea as loose watery brown stool. She treated with oral BENADRYL and used DENTIN like cream to rash with resolution of all symptoms. Child is 3 years old now and needs annual influenza vaccinations. Mom advised Dr, allergist advised this was not an IgE mediated event and it was okay for child to get flu vaccine. She is requesting a second opinion. Comprehensive review electronic medical records: 2/22/2011 she received influenza and hepatitis B vaccine (transcribed, unknown lot #s), with Varicella vaccine on 2/25/2011 (9 month of age). There was no reported adverse reaction or worsening of existing skin irritation (under care of allergist). July-December 2011 patient was seen twice for runny nose, watery eyes, diarrhea, diaper rash and initial evaluation for possible food allergies. Mom reports "hives" and facial swelling to diary products with vomiting after cow's milk, mac/cheese, regular cheese, and peanut butter. Diarrhea was described as watery brown diarrhea on and off for 6 months with rash to lower abdomen as slightly erythema papules to mins pubis region-diaper region. A comprehensive evaluation identified child was being given 100% whole juice greater than 30 ounces/day. By late November 2011 with reduction of fruit juices, her diarrhea and diaper dermatitis had completely resolved. 2011-2012 Skin prick testing was positive (x2) to egg, peanut, tree nuts, grass, ragweed, mold, cats and dogs. Strict avoidance of these items was recommended and an epi pen jr was provided. Oral challenge to whole cow's mils was negative and child tolerated yogurt products without vomiting. Mom advised may use dairy products. Her allergist advised on 6/28/2012 that egg allergies was not a contraindication to the MMR or flu vaccines however he recommended repeat skin testing prior to receipt of yellow fever or HPV vaccine in future. On 10/15/2012 child received annual flu shot (SP U4481BA - FLUZONE (?)) with mom reporting that night onset of diarrhea and vaginal swelling (labia) with red papular rash with diarrhea that lasted 2-3 days. Two weeks later she was reported to receive a second flu shot (no documentation of found) with similar symptoms. Mom treated with BENADRYL and topical creams.