Anaphylaxis after zoster vaccine: Implicating alpha-gal allergy as a possible mechanism

Cosby A Stone Jr; Jonathan A Hemler; Scott P Commins; Alexander J Schuyler; Elizabeth J Phillips; R Stokes Peebles Jr; John M Fahrenholz

doi:10.1016/j.jaci.2016.10.037

Anaphylaxis after zoster vaccine: Implicating alpha-gal allergy as a possible mechanism

J Allergy Clin Immunol. 2017 May;139(5):1710-1713.e2. doi: 10.1016/j.jaci.2016.10.037. Epub 2016 Dec 14.

Authors

Cosby A Stone Jr¹, Jonathan A Hemler², Scott P Commins³, Alexander J Schuyler⁴, Elizabeth J Phillips⁵, R Stokes Peebles Jr⁶, John M Fahrenholz⁶

Affiliations

¹ Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn. Electronic address: [email protected].
² Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn.
³ Division of Rheumatology, Allergy & Immunology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
⁴ Asthma and Allergic Disease Center, Carter Immunology Center, Department of Medicine, University of Virginia Health System, Charlottesville, Va.
⁵ Division of Infectious Diseases, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tenn; Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tenn; Institute for Immunology & Infectious Diseases, Murdoch University, Murdoch, Australia.
⁶ Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Allergy and Immunology Section, Medical Service, Veterans Administration Medical Center, Tennessee Valley Healthcare System, Nashville, Tenn.

Abstract

A patient with alpha-gal allergy presented with anaphylaxis after receiving zoster vaccine. Subsequent testing of selected vaccines revealed the presence of alpha-gal allergen in MMR and zoster vaccines, which have in common a higher content of gelatin and content of bovine calf serum.

Publication types

Case Reports
Letter
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Allergens / immunology*
Anaphylaxis / diagnosis*
Anaphylaxis / etiology
Drug-Related Side Effects and Adverse Reactions / diagnosis*
Emergency Medical Services
Epinephrine / administration & dosage
Excipients / adverse effects*
Female
Galactose / analogs & derivatives
Galactose / immunology*
Gelatin / immunology
Herpes Zoster Vaccine / adverse effects*
Herpes Zoster Vaccine / immunology
Humans
Hypersensitivity / complications
Hypersensitivity / diagnosis*
Immunity, Heterologous
Immunoglobulin E / blood
Middle Aged

Substances

Allergens
Excipients
Herpes Zoster Vaccine
Immunoglobulin E
Gelatin
Galactose
Epinephrine

Abstract

Publication types

MeSH terms

Substances

Grants and funding