Hepatitis B vaccine


Recombinant DNA techniques have permitted the development of vaccines to the hepatitis B virus prepared by cloning and expressing the Hbs antigen in yeast or CHO cells.
 
Incidence
Less than 1%.
 
Risk factors
Contact sensitization to formaldehyde or thiomersal.
 
Yeast allergy.
 
Clinical manifestations
  • Local reactions: local urticaria or aluminum granuloma.
     
  • General reactions: arthralgias, myalgias, generalized urticaria, Arthus phenomenon, erythema multiforme (2/200 000), erythema nodosum, pruritus (1/122 500), thrombocytopenic purpura, eczema exacerbation.
Diagnostic methods
Cutaneous testing.
 
Prick tests: full vaccine 1/10, saccharomyces cerevesiae, thiomersal 0.1%, aluminum chloride 0.5%, latex.
 
Intradermal skin tests: full vaccine 1/100.
 
Patch tests: thiomersal 0.1%, aluminum chloride 0.5%, formaldehyde 2%.
 
Few cases with positive tests to thiomersal, aluminum chloride, saccharomyces cerevesiae, latex or formaldehyde.
 
Specific IgE: saccharomyces cerevesiae.
 
Mechanisms
Aluminum hydroxide, thiomersal, formalin, yeast or latex are responsible for the few reported allergic reactions to the hepatitis B vaccine.
 
Management
If revaccination is necessary, use vaccine containing a different preservative.
 
In patients with latex allergy, use a glass syringe and remove the rubber bung.

References

  1. Lear JT, English JSC, "Anaphylaxis after hepatitis B vaccination", Lancet. 1995;345: 1249
  2. Barbaud A, Schmutz JL, Mougeolle JM, "Reactions immunoallergiques cutanées dues aux vaccins", Ann. Dermatol. Venereol. 1995;122: 129-38
  3. Mac Mahon B, Helminiak C, Wainwright R, Bulkow L, Trimble D, Wainwright D, "Frequency of adverse reactions to hepatitis B vaccine in 43,618 persons", Am. J. Med, 1992;92: 196-9
  4. Hudson TJ, Newkirk M, Gervais F, Shuster J, "Adverse reaction to the recombinant hepatitis B vaccine", J. Allergy. Clin. Immunol. 1991;88 (5): 821-2
  5. Brightman CAJ, Scadding GK, Dumbreck LA, Latchman Y, Brostoff J, "Yeast derived hepatitis B vaccine and yeast hypersensitivity", Lancet. 1989; i: 903
  6. Ring J, "Exacerbation of eczema by formalin-containing hepatitis B vaccine in formaldehyde allergic patient", Lancet. 1986;i: 522-3

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.