Produção Nacional
Revisado por pares
Yellow fever vaccine and egg allergy
2019; Elsevier BV; Volume: 19; Issue: 8 Linguagem: Inglês
10.1016/s1473-3099(19)30355-x
ISSN1474-4457
AutoresBarbara Luiza B Cancado, Carolina Sánchez Aranda, Márcia C. Mallozi, Lily Yin Weckx, Dirceu Solé,
Tópico(s)Mosquito-borne diseases and control
ResumoThe Article by Esper G Kallas and colleagues1Kallas EG Zanella LGFABD Moreira CHV et al.Predictors of mortality in patients with yellow fever: an observational cohort study.Lancet Infect Dis. 2019; 19: 750-758Summary Full Text Full Text PDF PubMed Scopus (29) Google Scholar about the yellow fever epidemic in Brazil underlines that, despite the availability of an effective vaccine against yellow fever, better vaccine coverage is needed. Several strategies have been implemented to increase vaccine coverage, including the yellow fever rapid desensitisation protocol in patients with a history of egg allergy. Egg allergy is classified as the second most common food allergy.2Urisu A Kondo Y Tsuge I Hen's egg allergy.Chem Immunol Allergy. 2015; 101: 124-130Crossref PubMed Scopus (32) Google Scholar European Union legislation has established a concentration of 2 μg/mL as the maximum permissible egg protein concentration that is considered safe in patients with prior egg anaphylaxis.3Ruíz G Sanchis-Merino E Monsalve B Pérez I Allue M Berbel C Yellow fever vaccination in egg-allergic patients.J Epidemiol Res. 2016; 2: 22Google Scholar In the yellow fever vaccine, egg concentrations range from 2·43 μg/mL to 4·42 μg/mL according to the vaccine batch, which means it is contraindicated in patients with egg allergies.4Smith D Wong P Gomez R White K Ovalbumin content in the yellow fever vaccine.J Allergy Clin Immunol Pract. 2015; 3: 794-795Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 5Marinho AKB Ouricuri AL Valente CFC et al.Vacina contra a febre amarela: reações adversas e populações de risco.Arq Asma Alergia Imunol. 2017; 1: 245-256Google Scholar Yellow fever is an acute febrile disease with high lethality, and vaccination is the most effective protective measure against this disease.5Marinho AKB Ouricuri AL Valente CFC et al.Vacina contra a febre amarela: reações adversas e populações de risco.Arq Asma Alergia Imunol. 2017; 1: 245-256Google Scholar Following the epidemic of yellow fever in 2018, the largest since 1980, vaccination has become indispensable. The Special Immunobiological Reference Center of UNIFESP (Centro de Referência de Imunobiológicos Especiais UNIFESP), in conjunction with the Division of Allergy and Clinical Immunology of the Federal University of São Paulo, adapted a rapid desensitisation protocol to the vaccine using the national yellow fever vaccine (Fiocruz/Bio-manguinhos; Rio de Janeiro, Brazil) in patients with a history of egg allergy. The diagnosis of specific food allergies is complex and requires oral challenge tests. Because of the yellow fever epidemic, all patients with history of egg allergy had standardised interviews and national yellow fever vaccine skin tests (skin prick test, intradermal skin test, or both). Patients with a positive skin prick test or intradermal skin test (after a negative skin prick test) underwent desensitisation, and those with a negative skin prick test and negative intradermal skin test were vaccinated under medical supervision. Desensitisation was adapted according to the Munóz-Cano5Marinho AKB Ouricuri AL Valente CFC et al.Vacina contra a febre amarela: reações adversas e populações de risco.Arq Asma Alergia Imunol. 2017; 1: 245-256Google Scholar protocol and four applications (1:10, 0·05 mL; pure, 0·5 mL, 0·15 mL, and 0·3 mL) were done every 30 min. 132 patients were vaccinated, 92 (70%) by use of the standard vaccine and 40 (30%; 17 with positive skin prick tests and 23 with positive intradermal skin tests) with desensitisation (with no adverse reactions). Vaccination protocol with national yellow fever vaccine proved to be safe for patients with a history of egg allergy. To the best of our knowledge, this is the first time that a large patient sample has been exposed to desensitisation with national yellow fever vaccine. This initiative might help other countries to safely vaccinate people when the vaccine might be contraindicated in certain populations. This online publication has been corrected. The corrected version first appeared at thelancet.com/infection on August 6, 2019 This online publication has been corrected. The corrected version first appeared at thelancet.com/infection on August 6, 2019 LW reports grants from Glaxosmithkline, Pfizer, and Sanofi, outside of the submitted work. All other authors declare no competing interests. Predictors of mortality in patients with yellow fever: an observational cohort studyWe identified clinical and laboratory predictors of mortality at hospital admission that could aid in the care of patients with yellow fever virus. Identification of these prognostic markers in patients could help clinicians prioritise admission to the intensive care unit, as patients often deteriorate rapidly. Moreover, resource allocation could be improved to prioritise key laboratory examinations that might be more useful in determining whether a patient could have a better outcome. Our findings support the important role of the virus in disease pathogenesis, suggesting that an effective antiviral could alter the clinical course for patients with the most severe forms of yellow fever. Full-Text PDF Correction to Lancet Infect Dis 2019; 19: 812Cancado B, Aranda C, Mallozi M, Weckx L, Sole D. Yellow fever vaccine and egg allergy. Lancet Infect Dis 2019; 19: 812—In this Correspondence, author name Caroline Aranda has been corrected to Carolina Aranda. This correction has been made to the online version as of August 6, 2019. Full-Text PDF
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