I would wait 24 hours to be sure there is no delayed reaction and then administer the MMR.
If there is a history of allergy to beef, cow’s milk or pork or inability to eat food items with gelatin, then I would suggest a similar desensitization/graded challenge protocol in hospital. I would then observe for several hours before discharge (total time 5-7 hours). I would be comfortable with initiating an outpatient challenge with oral gelatin beginning with a dose of 3-5 mg (first minute of IV dosing) and increasing 10 fold every 15-30 minute to a dose of 300-500 mg and then doubling every 30 minutes until a cumulative dose of more than 20-30 grams. In summary, if your patient has no history of anaphylaxis to beef, cow’s milk or pork meat, there is a reduced likelihood of anaphylaxis to gelatin. However, extrapolating from the study we could conclude that the dose for an oral challenge could certainly start at the same dose used for the IV challenge in the study, 20 mg, and increase to 400 mg at intervals of every 15 minutes. The Mullins reference refers to gelatin challenge intravenously, which I would not suggest. They also showed that bovine and pork gelatin show extensive in vitro cross-reactivity. The same paper noted that 16% of the beef meat allergic children and 38% of the pork meat sensitive subjects were sensitive by testing to gelatin, and only 4 had a positive in vitro test to gelatin without meat sensitivity. The paper from Bogdanovic et al also associated milk allergy in children with gelatin allergy so you might consider testing for milk sensitivity. I am not aware of delayed reactions occurring from gelatin but the overlap between alpha-gal, collagen and gelatin allergy at least raises the question. Commins group at the University of Virginia uses an intradermal test to identify sensitive individuals with a delayed reaction to mammalian meat due to alpha-gal sensitivity. You could also test for mammalian meat allergy with prick testing and Dr. One consideration would be to test for alph-gal sensitivity since your patient had a systemic response to the vaccination. There is an extensive literature discussing the relationship between gelatin allergy, collagen allergy and 1,3 alpha-gal sensitivity, most of this with bovine products.
0 kommentar(er)
