EGG ALLERGY AND YELLOW FEVER IMMUNIZATION: A SAFE DESENSITIZATION PLAN

Abstract

<h3>Introduction</h3> Yellow fever is a viral hemorrhagic disease with a high-mortality rate endemic to tropical regions of South America and sub-Saharan Africa. While the egg-derived yellow fever vaccine (YF-VAX, Sanofi Pasteur, USA) is safe and provides life-long protection, it can pose a challenge for egg-allergic patients living in or traveling to endemic areas. <h3>Case Description</h3> We present the case of a successful desensitization to YF-VAX in a 10-month-old egg-allergic female traveling to Cameroon. The patient developed diffuse urticaria and facial angioedema with ingestion of boiled eggs at 6 months of age. Her egg white and component egg IgE testing was elevated. Skin prick testing (SPT) was positive to eggs and negative for 1:1 dilution of YF-VAX. Intradermal (ID) testing was positive to 1:10 dilution of YF-VAX. The patient successfully underwent a 5-step desensitization protocol. <h3>Discussion</h3> YF-VAX is a safe, effective immunization to prevent yellow fever. YF-VAX desensitization is easily tolerated and should be considered in egg-allergic patients at risk of complications resulting from the disease. While the American Academy of Pediatrics proposes a protocol to guide physicians in the desensitization of patients with suspected hypersensitivity reactions to immunizations, desensitization to YF-VAX in the United States is not a common occurrence as it is only recommended for people traveling to or living in endemic areas. Rutkowski et al. report a 7-step desensitization protocol of 4 egg-allergic patients with positive SPT to YFV. To our knowledge, this is the first reported case of successful YF-VAX desensitization in the United States using a 5-step desensitization protocol.