Аллергические реакции к компонентам вакцин в обосновании тактики профилактической вакцинации чувствительных пациентов: аналитический обзор
Аллергические реакции к компонентам вакцин в обосновании тактики профилактической вакцинации чувствительных пациентов: аналитический обзор
Для цитирования: Максимова А.В., Смолкин Ю.С. Аллергические реакции к компонентам вакцин в обосновании тактики профилактической вакцинации чувствительных пациентов: аналитический обзор. Педиатрия. Consilium Medicum. 2019; 3: 24–32. DOI: 10.26442/26586630.2019.3.190585
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Maximova A.V., Smolkin Yu.S. Allergic reactions to vaccine components in the rationale for preventive vaccination tactics for sensitive patients: an analytical review. Pediatrics. Consilium Medicum. 2019; 3: 24–32. DOI: 10.26442/26586630.2019.3.190585Review
Аллергические реакции к компонентам вакцин в обосновании тактики профилактической вакцинации чувствительных пациентов: аналитический обзор
Для цитирования: Максимова А.В., Смолкин Ю.С. Аллергические реакции к компонентам вакцин в обосновании тактики профилактической вакцинации чувствительных пациентов: аналитический обзор. Педиатрия. Consilium Medicum. 2019; 3: 24–32. DOI: 10.26442/26586630.2019.3.190585
________________________________________________
Maximova A.V., Smolkin Yu.S. Allergic reactions to vaccine components in the rationale for preventive vaccination tactics for sensitive patients: an analytical review. Pediatrics. Consilium Medicum. 2019; 3: 24–32. DOI: 10.26442/26586630.2019.3.190585Review
Вакцинация является одним из самых больших достижений человечества. Вакцины содержат не только иммунизирующий компонент (актуальный антиген), но и балластные вещества, которые используются при производстве вакцинальных препаратов. В данном обзоре представлены основные аллергокомпоненты вакцин, к которым относятся казеин, a-лактальбумин, овальбумин, овомукоид, дрожжи, желатин, латекс, антибактериальные препараты из группы аминогликозидов, формальдегид, полисорбат 80, мертиолят (тиомерсал). Тщательный анализ частоты аллергических реакций при осуществлении вакцинации, проведенный на основании данных последних десятилетий, показал, что вакцинация пациентов, страдающих аллергическими заболеваниями, является не только необходимой, но и безопасной. Отягощенный анамнез по атопии не считается противопоказанием для вакцинации. В случае необходимости возможны проведение предварительного аллергологического обследования на основные компоненты вакцин, а также постановка кожных и внутрикожных тестов непосредственно с вакцинальным препаратом. В случае положительного результата и когда вакцинация признана необходимой, возможно проведение иммунизации согласно протоколу градуированных доз. Персонифицированный подход к проведению процедуры вакцинации, сопоставление данных анамнеза и аллергологического обследования с составом современных вакцинальных препаратов снижают вероятность развития аллергических реакций у сенсибилизированных пациентов. Ключевые слова: аллергия, вакцинация, дети, обзор, аллергокомпоненты вакцин.
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Vaccination is one of the greatest achievements of mankind. Vaccines contain not only an immunizing component (actual antigen), but also ballast substances that are used in the production of vaccines. In this review, the main a allergenic molecule of vaccines, which include casein, α-Lactalbumin, ovalbumin, ovomucoid, yeast, gelatin, latex, antibacterial drugs from the group of aminoglycosides, formaldehyde, polysorbate 80 and thimerosal (thiomersal). A thorough analysis of the frequency of allergic reactions during vaccination, conducted on the basis of data from recent decades has shown that vaccination of patients suffering from allergic diseases is not only necessary, but also safe. Burdened history of atopy is not a contraindication for vaccination. If necessary, it is possible to conduct a preliminary allergological examination of the main components of vaccines, as well as the formulation of skin and intradermal tests directly with the vaccine. In the case of a positive result and vaccination is recognized as necessary it is possible to carry out immunization according to the Protocol of graded doses. A personalized approach to the vaccination procedure, comparison of the history and allergological examination data with the composition of modern vaccines reduces the likelihood of allergic reactions in sensitized patients. Key words: allergy, vaccination, children, review, the main allergenic molecule of vaccines.
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1. The basics of vaccination in children with chronic pathology. Ed. M.P.Kostinova. Moscow: Meditsina dlia vsekh, 2002 (in Russian).
2. Larson HJ, De Figueiredo A, Xiahong Z et al. The state of vaccine confidence 2016: global insights through a 67-country survey. EBioMedicine 2016; 12: 295–301.
3. Solov'eva I.L. et al. Napriazhennost' spetsificheskogo immuniteta u detei s allergicheskimi zabolevaniiami pri vaktsinatsii protiv gepatita V. Epidemiologiia i vaktsinoprofilaktika. 2005; 1 (in Russian).
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5. Immunization Action Coalition. www.immunize-Europe.org
6. Bohlke K et al. Risk of anaphylaxis after vaccination of children and adolescents. Pediatrics 2003; 112 (4): 815–20.
7. American Academy of Pediatrics. Active and passive immunization. L.K.Pickering, ed. Red Book: 2006 Report of the Committee on Infectious Diseases, 28th edn. Elk Grove Village, IL: American Academy of Pediatrics, 2009.
8. Zent O et al. Immediate allergic reactions after vaccinations – a post-marketing surveillance review. Eur J Pediatr 2002; 161 (1): 21–5.
9. McNeil MM et al. Risk of anaphylaxis after vaccination in children and adults. J Allergy Clin Immunol 2016; 137 (3): 868–78.
10. Hox V et al. Estrogen increases the severity of anaphylaxis in female mice through enhanced endothelial nitric oxide synthase expression and nitric oxide production. J Allergy Clin Immunol 2015; 135 (3): 729–36. e5.
11. Nagao M et al. Highly increased levels of IgE antibodies to vaccine components in children with influenza vaccine – associated anaphylaxis. J Allergy Clin Immunol 2016; 137 (3): 861–7.
12. Sakaguchi M et al. Systemic immediate-type reactions to gelatin included in Japanese encephalitis vaccines. Vaccine 1997; 15 (2): 121–22.
13. Worm M et al. Gelatin-induced urticaria and anaphylaxis after tick-borne encephalitis vaccine. Acta Dermato-venereologica 2000; 80 (3).
14. Kattan JD et al. Anaphylaxis to diphtheria, tetanus, and pertussis vaccines among children with cow’s milk allergy. J Allergy Clin Immunol 2011; 128 (1): 215–18.
15. Vaccines and immunizations. www.cdc.gov/vaccines
16. EAACI Molecular Allergology User´s Guide. Pediatric Allergy and Immunology. Pediatr Allergy Immunol 2016; 27 (Suppl. 23): 1–250.
17. Slater JE, Rabin RL, Martin D. Comments on cow's milk allergy and diphtheria, tetanus, and pertussis vaccines. J Allergy Clin Immunol 2011; 128 (2): 434.
18. McNeil MM et al. Risk of anaphylaxis after vaccination in children and adults. J Allergy Clin Immunol 2016; 137 (3): 868–78.
19. Nakayama T, Onoda K. Vaccine adverse events reported in post-marketing study of the Kitasato Institute from 1994 to 2004. Vaccine 2007; 25 (3): 570–6.
20. Immunoprophylaxis – 2018. Spravochnik. 13-e izd., rasshir. V.K.Tatochenko, N.A.Ozertsovskii. Moscow: Borges, 2018 (in Russian).
21. Beveridge MG et al. Local vaccine site reactions and contact allergy to aluminum. Pediatric Dermatol 2012; 29 (1): 68–72.
22. Bergfors E, Trollfors B. Sixty-four children with persistent itching nodules and contact allergy to aluminium after vaccination with aluminium-adsorbed vaccines – prognosis and outcome after booster vaccination. Eur J Pediatrics 2013; 172 (2): 171–7.
23. Grechukha T.A. et al. Opyt primeneniia AaKDS-geksavaktsiny na baze otdeleniia vaktsinoprofilaktiki detei s otkloneniiami v sostoianii zdorov'ia FGBNU "Nauchnyi tsentr zdorov'ia detei". Pediatricheskaia farmakologiia. 2014; 11 (4) (in Russian).
24. Parisi CAS et al. Hypersensitivity reactions to the Sabin vaccine in children with cow's milk allergy. Clin Experiment Allergy2013; 43 (2): 249–54.
25. Sakaguchi M, Toda M, Ebihara T et al. IgE antibody to fish gelatin (type I collagen) in patients with fish allergy. J Allergy Clin Immunol 2000; 106 (3): 579–84.
26. Sakaguchi M, Nakayama T, Inouye S. Food allergy to gelatin in children with systemic immediate-type reactions, including anaphylaxis, to vaccines. J Allergy Clin Immunol 1996; 98 (6): 1058–61.
27. Sakai Y et al. Non-antigenic and low allergic gelatin produced by specific digestion with an enzyme-coupled matrix. Biol Pharm Bull 1998; 21 (4): 330–4.
28. Kumagai T et al. Gelatin-specific humoral and cellular immune responses in children with immediate-and nonimmediate-type reactions to live measles, mumps, rubella, and varicella vaccines. J Allergy Clin Immunol 1997; 100 (1): 130–4.
29. Sakaguchi M, Ogura H, Inouye S. IgE antibody to gelatin in children with immediate-type reactions to measles and mumps vaccines. J Allergy Clin Immunol 1995; 96 (4): 563–5.
30. Sakaguchi M et al. Systemic immediate-type reactions to gelatin included in Japanese encephalitis vaccines. Vaccine 1997; 15 (2): 121–2.
31. Worm M et al. Gelatin-induced urticaria and anaphylaxis after tick-borne encephalitis vaccine. Acta Dermato-Venereologica 2000; 80 (3).
32. Kuno-Sakai H, Kimura M. Removal of gelatin from live vaccines and DTaP – an ultimate solution for vaccine-related gelatin allergy. Biologicals 2003; 31 (4): 245–9.
33. Ozaki T et al. Safety and immunogenicity of gelatin-free varicella vaccine in epidemiological and serological studies in Japan. Vaccine 2005; 23 (10): 1205–8.
34. Nagel G, Hennig R, Broeker M. New gelatine-free TBE vaccines with improved safety profile. Klin Padiatr 2006; 218 (6): 379.
35. Nakayama T, Aizawa C. Change in gelatin content of vaccines associated with reduction in reports of allergic reactions. J Allergy Clin Immunol 2000; 106 (3): 591–2.
36. Рубан А.П., Пампура А.Н. Анафилаксия и вакцинация: риски и реалии. Рос. вестн. перинатол. и педиатрии. 2018; 63 (4): 15–22.
[Ruban A.P., Pampura A.N. Anafilaksiia i vaktsinatsiia: riski i realii. Ros. vestn. perinatol. i pediatrii. 2018; 63 (4): 15–22 (in Russian).]
37. Dreskin SC et al. International Consensus (ICON): allergic reactions to vaccines. World Allergy Organization J 2016; 9 (1): 32.
38. Kelso JM. Safety of influenza vaccines. Cur Opin Allergy Clin Immunol 2012; 12 (4): 383–8.
39. Nazarova E.V. Allergicheskie reaktsii na vaktsiny. Effektivnaia farmakoterapiia. 2016; 24: 10–3 (in Russian).
40. Plotkin S. History of vaccination. Proceed National Acad Sci 2014; 111 (34): 12283–7.
41. Majchrowicz H. Post-vaccination reactions to diploid rabies vaccine. Przeglad Epidemiologiczny 1989; 43 (3): 259–62.
42. Xepapadaki P et al. Incidence and natural history of hen's egg allergy in the first 2 years of life – the EuroPrevall birth cohort study. Allergy 2016; 71 (3): 350–7.
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Авторы
А.В. Максимова*1, Ю.С. Смолкин2
1 ООО «Научно-клинический консультативный центр аллергологии и иммунологии», Москва, Россия;
2 ФГБУ «Государственный научный центр "Институт иммунологии"» ФМБА России, Москва, Россия
*minaeva.a.v@mail.ru
________________________________________________
Anna V. Maximova*1, Yury S. Smolkin2
1 Scientific Clinical Center of Allergology and Immunology, Moscow, Russia;
2 National Research Center – Institute of Immunology, Moscow, Russia
*minaeva.a.v@mail.ru