Age: 3.0
Sex: M
Vaccine: FLU3, FLUX, FLUX, FLUX
Symptoms: Anaphylactic reaction, Blood immunoglobulin E increased, Skin test, Skin test positive
Clinical narrative: Initial report was received from literature on 05 February 2014. The following is verbatim from the aforementioned article abstract: Introduction: Gelatin is a mixture of peptides and proteins produced by partial hydrolysis of collagen extracted from cow, pig, and fish. It is found in various foods, beverages, medications, plasma expanders, and vaccines. We present a case report of a 4-year-old patient with anaphylaxis to the influenza vaccine who was referred for evaluation of egg allergy, but was found to also have significant gelatin IgE sensitization. Methods: The patient was evaluated with both skin prick testing and serum levels of gelatin-specific IgE. Results: The patient was avoiding unbaked egg secondary to a history of perioral rash with ingestion of meringue icing, but the parents were more acutely concerned about an egg allergy given a recent reaction to the influenza vaccine. He had received the influenza vaccine in the past without any issue, but that year he developed diffuse hives, watery eyes, sneezing, and vomiting within 15 minutes of receiving the immunization. Upon further food reaction history, the patient's mother endorsed that in the past he developed a watery mouth, abdominal pain, and weakness with ingestion of gummy candies, gummy vitamins, and marshmallows. Skin prick testing showed a wheal of 4 mm and flare of 21 mm with commercial egg extract, and a wheal of 13 mm and flare of 33 mm with fresh gelatin [Knox, non-kosher]. Serum testing showed an IgE level of 4.76 kIU/L for egg white and 0.39 kIU/L for bovine gelatin [ImmunoCAP, ARUP Laboratories]. We offered follow up skin prick testing with fish derived gelatin to determine if the patient could tolerate non mammalian gelatin but the family declined further testing. We recommended avoidance of all foods containing unbaked egg and gelatin, and the family opted to defer additional immunization with gelatin containing vaccines. We prescribed an epinephrine auto injector, provided an emergency action plan, and reviewed the management of food allergies. Conclusion: Gelatin allergy should be considered in any patient with a history of reaction to gelatin containing foods or pharmaceutical products. Management of gelatin allergy includes provision of thorough avoidance measures, prescription of epinephrine, and periodic reevaluation to determine if oral food challenges should be considered with decreasing IgE levels and skin prick testing. A 4-year-old male patient had received a dose of influenza vaccine (manufacturer unknown, batch number, route and anatomical site of administration not reported) on an unspecified date. The patient was avoiding unbaked egg secondary to a history of perioral rash with ingestion of meringue icing. The patient had a history of watery mouth, abdominal pain, and weakness with ingestion of gummy candies, gummy vitamins, and marshmallows. On an unspecified date, the patient developed diffuse hives, watery eyes, sneezing, and vomiting within 15 minutes of receiving the immunization. Skin prick testing showed a wheal of 4 mm and flare of 21 mm with commercial egg extract, and a wheal of 13 mm and flare of 33 mm with fresh gelatin [Knox, non-kosher]. Serum testing showed an IgE level of 4.76 kIU/L for egg white and 0.39 kIU/L for bovine gelatin. The patient was prescribed an epinephrine auto-injector, provided an emergency action plan, and reviewed the management of food allergies. At the time of this report, the outcome was unknown. Documents held by sender: none.