Age: 7.0
Sex: M
Vaccine: RAB
Symptoms: Abdominal pain, Chest discomfort, Hypersensitivity, Skin test positive, Swelling face
Clinical narrative: Case number PHHY2015US038494, is an initial literature report received on 25 Mar 2015. The authors discussed about evaluation and subsequent safe administration of rabies vaccine to a child presumably allergic to the gelatin content of PCECV RABAVERT. This report refers to a 07 years old male patient. His medical history revealed no ancillary atopic problems to date. Specifically, he had no history of atopic dermatitis, asthma, allergic rhinitis, food and drug allergy. His growth and development were appropriate for his chronological age. He ate chicken frequently but did not care for egg although he could eat egg without obvious adverse effects. He had a history of eating gelatin-containing foods such as Jell-O without adversity. His family history was negative for atopic disease. Concomitant medication included amoxicillin. Historical medication included rabies immune globulin. His vaccination history included administration of all childhood immunizations including MMR (manufacturer and batch number unknown) and varicella vaccines (manufacturer and batch number unknown) without adverse reactions. His vaccination history also included administration first dose of PCECV RABAVERT (batch number: unknown) due to cat bite and experienced chest discomfort, nausea and facial swelling (see case: PHHY2015US037684). On an unknown date, 3 days after first dose, he was vaccinated with second dose of RABAVERT (batch number: unknown) at emergency department. Within 1 hour of receiving the vaccine, he returned to the emergency department with facial swelling, chest discomfort and abdominal pain. His clinical presentation was most compatible with an acute allergic reaction to RABAVERT and he was stabilized with only oral diphenhydramine. For his third dose of the rabies vaccine, he was brought to tertiary care center emergency department. Given his history of IgE-mediated-like symptoms with the first 2 rabies vaccine doses, consultation with allergy, infectious disease and the state department of health was initiated. Continued post-exposure prophylaxis was recommended. His remaining doses were administered with the gelatin-free HDCV IMOVAX (batch number: unknown, other manufacturer). However, because of the presence of neomycin and possible cross-sensitization to the antigenic component between HDCV and PCECV, 5 such administration was performed using a desensitization protocol. He tolerated the procedure without incident. On follow-up, he had negative skin prick testing to neomycin and IMOVAX, but positive skin prick testing to egg (5/20 mm) and gelatin (4/20 mm). A subsequent open food challenge to egg was negative. It was postulated that the reaction following RABAVERT was likely secondary to his sensitivity to gelatin. He was advised to receive future vaccines containing gelatin with allergist consultation and observation. The authors concluded that gelatin can cause IgE-mediated or non IgE-mediated reactions. Hence it was important to know the components of vaccines and be aware of the potential for reactions. Desensitization can be considered for vaccine administration in certain cases. Outcome of the events was not reported. Seriousness assessment of acute allergic reaction to RABAVERT was upgraded based on information in the source document.