Vaccinations et allergie

In atopic patients, vaccine may induce allergic reactions to vaccine components and non specifically promote hyperreactivity to non related allergens. Several studies have also suggested that vaccinations may promote the development of allergic disease in atopy-prone subjects. Diagnostic and/or predictive value of skin tests with vaccines and specific antibody determinations is highly variable upon the type and chronology of the reaction, and the substances involved. In patients with proven or highly suspected allergy, withholding booster injections is advised if specific IgM/IgG levels are high. If the levels are low, sequential injections of vaccines containing a single vaccinating agent are usually tolerated. However, injections of the vaccine should be performed using a “desensitization” procedure in patients reporting anaphylaxis and immediate or accelerated urticaria and/or angioedema. Vaccines may also promote allergen-induced asthma and/or atopic dermatitis exacerbations in highly atopic patients. In patients with well-controlled asthma, influenza vaccines do not induce bronchial hyperreactivity and are usually well tolerated. In general practice, vaccine injections should be performed in patients with optimal control of their allergic disease only. Finally, most of the recent studies and meta-analyses strongly suggest that vaccines have no influence on the risk of atopic disease in children and adults.