306. Immediate Hypersensitivity Reaction Related to Rabies Post-Exposure-Prophylaxis in Thailand with Subsequent Rabies Vaccine Change to Avoid Polygeline Vaccine Excipient with Successful Challenge and Treatment Tolerance in the United States
Session: Poster Abstract Session: Global Infections
Thursday, October 5, 2017
Room: Poster Hall CD
Posters
  • Rabies Vaccine Adverse Reaction Poster, Final Draft PDF.pdf (1.1 MB)
  • Background:
    Untreated rabies is fatal, globally killing 60,000 persons/yr. Rabies vaccine (RV) is life-saving, of various types and used in high-risk rabies exposure (HRRE) as a post-exposure prophylaxis (PEP) series of initial (RV-i) and completion (RV-c) doses. Polygeline has been implicated in immediate allergic reactions to tick-borne encephalitis vaccine and is an excipient in Rabipur, a purified chick embryo vaccine (PCECV) as part of Thai Red Cross (TRC) RV protocol. In United States (US), RVs are Rabavert (PCECV), containing polygeline, and Imovax Rabies, a human diploid cell vaccine (HDCV) that does not. RV-associated adverse reactions occur up to 6% as mostly non-IgE/skin-limited or immune complex and rarely non-fatal anaphylaxis. We describe TRC-RV-immediate allergic reaction in a male child traveling in Thailand and how after his return to US, we were able to overcome RV-PEP delays and demonstrate safe treatment tolerance with a different RV.

    Methods:
    Review of literature, Thai/US RV and Allergy Protocols, Pink Book/RV Inserts

    Results:
    A healthy 4-yr old US boy had HRRE from feral cat bite in Thailand with immediate disseminated hives at 1hr post-TRC-RVi (Day 0), resolved with oral antihistamine. Upon US return (Days 3-8), clinicians stopped RV-PEP due to RV allergy fears; Day 6 rabies-immunoglobulin given. On Day 9, US academic Allergist/Infectious Disease referral done: no other medical problems found; HDCV skin prick test (negative); TRC-RV (not available); 2-step HDCV-RV challenge performed (10%, then full); Days 13 & 20, HDCV-RV-c full tolerated; Days 30+, asymptomatic; serum tryptase 3.2 ng/ml; Rapid Fluorescent Foci Inhibition Test (RFFIT)

    Conclusion:
    RV type I hypersensitivity reactions are uncommon, components to RVs vary worldwide and such adverse RV reactions should not stop RV-PEP. Analysis of vaccine content, exposures and relevant testing is critical to deducing likely reaction type and candidate antigens as excipients in non-RVs and across RV types. IgE-vaccine tests may not be reliable/possible and mid-series RV change to non-polygeline type may be a viable option when RV-c must be done to reach timely RV-c-PEP treatment tolerance and avoid hypersensitivity reactions.

    J. Michael Beckham, Medical Student1,2, Lenora Noroski, MD, MPH1,3 and J. Chase McNeil, MD1,4, (1)Texas Children's Hospital, Houston, TX, (2)School of Medicine, Baylor College of Medicine, Houston, TX, (3)Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, TX, (4)Pediatrics, Section of Infectious Disease, Baylor College of Medicine, Houston, TX

    Disclosures:

    J. M. Beckham, None

    L. Noroski, None

    J. C. McNeil, None

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