Sex: F
Vaccine: HEPAB
Symptoms: Nausea, Oedema, Palpitations, Paraesthesia, Pruritus
Clinical narrative: This case was reported by a health professional and described the occurrence of an anaphylactic response in a female pt who received hepatitis A inactivated & hepatitis B recombinant vaccine (Twinrix) for prophylaxis.  The reporter submitted a report directly to the CDC.  On an unspecified date, the pt received the 1st dose of Twinrix.  At an unspecified time post-immunization, she developed an anaphylactic response.  The Twinrix immunization series was discontinued.  The outcome of the event is unknown.  Anaphylaxis is considered to be medically serious by GSK (OMIC). The patient had a medical history notable for anaphylaxic reactions to bee and wasp stings and a possible allergic reaction to mixed vaspid immunotherapy. There was a question of wheter the patient had received the hepatitis A vaccination in 1988. On 13 March 2003, the patient received the first dose of Twinrix (lot Hab217A4). Ten minutes later, the patient developed a tingling in her lips, and a "feeling of doom". Five minutes later, she was diagnosed with an acute allergic reaction which was considered life-threatening and required clinical intervention. She presented to the emergency room and intravenous fluids and high flow oxygen were initiated. Physical examination revealed dysphagia, shortness of breath with feeling of "air hunger", mild nausea, puffiness and selling with recurrent angioedema symptoms, lip swelling, periorbital swelling, sinus tachycardia, jitteriness and tremulousness, and anxiety. Upon presentation, her condition was assesses as critical. diagnosis was "acute anaphylaxis with facial swelling and angioedema..." The patient was treated with 100 mg oral diphenhydramine and an injection of adrenaline. The same day, she presented to the emergency room with anxiety, agitiation, nervousness, voice alterations, difficulty breathing with gasping, and a feeling that her throat was closing. Approximately four hours later her symptoms recurred, and she was hospitalized overnight and treated with intravenous diphenhydramine, intravenous fluids, intramuscular Visaril, and methylprednisolone in addition to an anti-anxiety medication. The following day she again presented to the emergency department with acute shortness of breath, throat tightness, swelling of the mouth and tongue, chest tightness, palpitations, and some shakiness following her epinepherine injection. She was again admintted to the hospital for continuing allergic reaction, during which time treatment icluded corticosteroids, diphenhydramine, ranitidine, and intravenous fluids. She progresses well during hospitalisation, and on 16 March 2003 the patient was discharged from the hospital. She developed itching and swelling of the face, ears and eyes, heart palpitations, and eleveated white blood count and a decreased red blood cell count. She was treated with intramuscular diphenhydramine, intravenous fluids, prednisone, and ranitidine. On 19 March 2003, the patient developed and erythematous eruption on her chest, elevated blood pressure, lethargy, weakness, fever and night sweats. She was treated with montelukast, fexofenadine, and lorazepam. As of 26 March 2003, the symptoms resolved with sequelae. The Twinrix immunization series was discontinued. The health profession considered the events to be related to vaccination with Twinrix.