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Case series of anaphylactic reactions after rabies vaccinations with gelatin sensitization

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Abstract

Side effects due to allergic reactions to vaccine antigen or to additives such as chicken protein or gelatin have been known for some time. Recent findings regarding reactions mediated via the carbohydrate epitope galactose-alpha-1,3-galactose (alpha-gal), a constituent of animal gelatin, broaden the spectrum of gelatin-related allergies. This case series presents four patients who developed anaphylactic reactions following rabies vaccination using the vaccine Rabipur®. After appropriate allergy testing by skin prick testing and the determination of specific IgE to allergens in the vaccine, triggering by alpha-gal could be excluded and an allergy to gelatin was detected. The absence of allergic symptoms following the consumption of gelatin could potentially be explained through intestinal hydrolysis resulting in a loss of allergenic potency. Further implications related to the use of gelatin-containing infusions in emergency medicine are discussed.

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Abbreviations

alpha-gal:

Galactose-alpha-1,3-galactose

IgE:

Immunoglobulin E

ImmunoCAP:

Method to determine the level of specific IgE antibodies

kUa/l:

Kilounits of antigen per liter

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Authors and Affiliations

  1. Department of Dermatology, Johannes Gutenberg University Hospital, Langenbeckstraße 1, 55131, Mainz, Germany

    Fabienne Bradfisch, Henner M. Stege & Joachim Saloga

  2. Department of Hygiene and Infection Prevention (Vaccine Center), Johannes Gutenberg University Hospital, Mainz, Germany

    Michael Pietsch, Regina Pietsch & Susanne Carstens

  3. Department of Dermatology, University Hospital Tübingen, Tübingen, Germany

    Stephan Forchhammer

  4. Department of Dermatology, University Hospital Heidelberg, Heidelberg, Germany

    Sophia Strobl, Knut Schäkel & Amir Yazdi

Authors
  1. Fabienne Bradfisch
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  2. Michael Pietsch
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  3. Stephan Forchhammer
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  4. Sophia Strobl
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  5. Henner M. Stege
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  6. Regina Pietsch
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  7. Susanne Carstens
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  8. Knut Schäkel
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  9. Amir Yazdi
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  10. Joachim Saloga
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Corresponding author

Correspondence to Fabienne Bradfisch.

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Conflict of interest

F. Bradfisch, M. Pietsch, S. Forchhammer, S. Strobl, H.M. Stege, R. Pietsch, S. Carstens, K. Schäkel, A. Yazdi and J. Saloga declare that they have no competing interests.

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Bradfisch, F., Pietsch, M., Forchhammer, S. et al. Case series of anaphylactic reactions after rabies vaccinations with gelatin sensitization. Allergo J Int 28, 103–106 (2019). https://doi.org/10.1007/s40629-019-0094-2

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  • DOI: https://doi.org/10.1007/s40629-019-0094-2

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