Anaphylactic Reaction With The Measles-Mumps-Rubella Vaccine In A Patient With Cow's Milk Allergy

Year 2024, Volume: 19 Issue: 3, 181 - 184, 04.11.2024

Ümmügülsüm Dikici , Öner Özdemir

https://doi.org/10.17517/ksutfd.1317061

Abstract

The most common food allergy in children worldwide is cow's milk allergy. The most known allergens from cow's milk proteins are casein, alpha-lactalbumin, and beta-lactoglobulin. Lactalbumin hydrolysate is used as a stabilizer in the measles mumps rubella (MMR) vaccine originating in India. Different commercial forms of the MMR vaccine are available. While neomycin stabilizes, lactalbumin hydrolysate is used in the other form. We present a patient who was followed up for cow's milk allergy and developed anaphylaxis after the MMR vaccine originating from India. A 4-year-old girl with a history of anaphylaxis with cow's milk whose vaccinations were applied by the routine vaccination schedule in the family health center. Sneezing and urticaria started 1 minute after immunization. The patient presented to the emergency department (within 10 minutes after vaccination) with severe respiratory distress and intercostal retractions. The patient was administered three doses of intramuscular adrenaline, 5 minutes apart, intravenous pheniramine and methylprednisolone, and a nebulizer short-acting beta agonist. Symptoms regressed approximately 40 minutes after hospitalization. In our patient with a history of cow's milk anaphylaxis and lactalbumin-specific immunoglobulin E value of 61.3 kU/L, anaphylactic reaction with MMR vaccine seems to be related to the lactalbumin contained in the vaccine. Families and physicians should be meticulous about reading labels in the follow-up of patients with known food allergies.

Keywords

anaphylaxis, cow’s milk, lactalbumin hydrolysate, rubella vaccine, measles mumps

İnek Sütü Alerjisi Olan Bir Hastada Kızamık-Kabakulak-Kızamıkçık Aşısı İle Anafilaktik Reaksiyon

Abstract

Dünya çapında çocuklarda en yaygın görülen gıda alerjisi inek sütü alerjisidir. İnek sütü proteinlerinden en bilinen alerjenler kazein, alfa-laktalbumin ve beta-laktoglobulindir. Lactalbumin hidrolizat, Hindistan menşeli kızamık kabakulak kızamıkçık (MMR) aşısında stabilizatör olarak kullanılır. MMR aşısının farklı ticari formları mevcuttur. Bir formda stabilizatör olarak neomisin kullanılırken, diğer formda laktalbümin hidrolizat kullanılır. İnek sütü alerjisi nedeniyle izlenen ve Hindistan menşeili MMR aşısı sonrası anafilaksi gelişen bir hastayı sunuyoruz. İnek sütü anafilaksi öyküsü olan, aile sağlığı merkezinde rutin aşı takvimine göre aşıları uygulanan 4 yaşında kız hastamızın aşıdan 1 dakika sonra hapşırma ve öksürme şikayeti başladı. Hasta acil servise (aşıdan sonraki 10 dakika içinde) şiddetli solunum sıkıntısı ve interkostal çekilmeler ile başvurdu. Hastaya 5 dakika arayla 3 doz intramusküler adrenalin, intravenöz feniramin ve metilprednizolon ve inhaler kısa etkili beta agonist uygulandı. Hastane başvurusundan yaklaşık 40 dakika sonra semptomlar geriledi. İnek sütü anafilaksisi öyküsü olan ve laktalbumin-spesifik immunoglobulin E değeri 61,3 kU/L olan hastamızda MMR aşısı ile anafilaktik reaksiyon gelişmesi aşının içerdiği laktalbumin ile ilişkili gibi görünmektedir. Bilinen besin alerjisi olan hastaların takibinde aileler ve hekimler etiket okuma konusunda titiz davranmalıdır.

Keywords

anafilaksi, inek sütü, laktalbumin hidrolizatı, kızamık aşısı, kabakulak aşısı

References

• Chafen JJS, Newberry SJ, Riedl MA, et al. Diagnosing and managing common food allergies: a systematic review. JAMA 2010; 303: 1848- 56.
• Host A, Halken S. Cow’s milk allergy: Where have we come from, and where are we going? Endocr Metab Immune Disord Drug Targets. 2014; 14:2- 8.
• Wal JM. Bovine milk allergenicity. Ann Allergy Asthma Immunol 2004;93:S2- 11.
• Pihlanto-Leppala A. Bioactive peptides derived from bovine whey proteins: Opioid and ace inhibitory peptides. Trends in Food Science and Technology 2001; 10:347- 356.
• The Republic of Turkey Ministry of Health Vaccination Calendar is available at https://asi.saglik.gov.tr/asi-takvimi2
• Shu M, Liu Q, Wang J, Ao R, Yang C, Fang G, et al. Measles vaccine adverse events were reported in the mass vaccination campaign of Sichuan province, China from 2007 to 2008. Vaccine. 2011; 29(18): 3507-10.
• Magistà S, Albanesi M, Chaoul N, Di Bona D, Di Leo E, Nettis E, et al. Safety of measles, mumps, and rubella vaccine in egg allergy: in vivo and in vitro management. Clin Mol Allergy. 2020; 18(1):2.
• Tan MS, Teoh EJ, Hor CP, Yeoh AAC. Measles-Mumps-Rubella vaccine for children with egg allergy: Is admission for inpatient vaccination necessary? Med J Malaysia. 2016; 71(4): 157-160.
• Andersen DV, Jørgensen IM. MMR vaccination of children with egg allergy is safe. Dan Med J 2013; 60(2):A4573.
• Yavuz ST, Sahiner UM, Sekerel BE, Tuncer A, Kalayci O, Sackesen C. Anaphylactic reactions to measles-mumps-rubella vaccine in three children with allergies to hen’s egg and cow’s milk. Acta Paediatr 2011; 100:e94-6.
• Ragno V, Giampietro PG, Bruno G, Businco L. Allergenicity of milk protein hydrolysate formulae in children with cow’s milk allergy. Eur J Pediatr 1993; 152:760-2.
• Nilsson C, Oman H, Halldén G, Lilja G, Lundberg M, Härfast B. A case of allergy to cow’s milk hydrolysate. Allergy 1999; 54:1322- 6.
• Uysal P, Alan Ş, Demir F, Erge D, Yenigün A. Anaphylaxis Developing after Measles Vaccine in an Infant with Cow’s Milk Allergy. Asthma Allergy Immunol 2017; 15:171-4.