Gelatin Allergy Research Articles

Intraoperative anaphylaxis to gelatin-based hemostatic agents: a case report.

Surgiflo Haemostatic Matrix is an absorbable gelatin matrix hemostatic material that has been widely used in various surgical operations to assist hemostasis. Nonetheless, as biologically active agents (contains porcine gelatin), there is potential for allergic reactions to these products. Here, we report the case of a 71-year-old man who had intraoperative anaphylaxis with cardiovascular events to gelatin associated with the use of a topical hemostatic agent (Surgiflo). The patient reported a history of red meat allergy and tick bites during his allergological examination after anaphylaxis. He also had high levels of specific IgE antibodies towards alpha-gal. Special consideration should be given before administering bovine- or porcine-derived gelatin products during surgery to patients with animal-related allergies, such as alpha-gal or gelatin allergy and an atopic background.

Reduction in Corticosteroid Use Among Patients Receiving Omalizumab in Real World Settings: A Systematic Literature Review of Non-Randomized Studies

Sarah W. Spriet, DO, Taylor A. Banks, MD, Cecilia Mikita, MD, MPH, FAAAAI; Walter Reed National Military Medical Center, Bethesda, MD. RATIONALE: Rabies post-exposure treatment is a medical necessity. Two rabies vaccines are available in the United States; purified chick embryo cell culture vaccine (PCECV, RabAvert ) and gelatin-free human diploid cell vaccine (HDCV, Imovax ). We report a case of PCECV-triggered anaphylaxis. METHODS: After clinical evaluation, patient and a volunteer control underwent skin prick and intradermal testing to the rabies vaccines, vaccine components, and rabies immunoglobulin. Vaccine challenge was then performed. RESULTS: A healthy 15 year old male presented to the Emergency Department after a live bat was found in his home, captured, and found to have rabies.Mucousmembrane exposure could not be ruled out and human rabies immunoglobulin (ImogamRabies – HT ) and PCECVwere administered. Within minutes, he developed dyspnea, stridor and generalized hives. Symptoms resolved within one hour after treatment with antihistamines and IV corticosteroids and he was referred to AllergyImmunology. On day 3 post-exposure, patient and control underwent skin prick testing to undiluted PCECV, egg, gelatin, HDCVand Imogam. Skin prick was positive to PCECV and gelatin. Intradermal testing (IDT) using 0.02 mL of 1:100 dilution to HDCV and Imogam was negative. IDT using 0.02 mL of 1:10 dilution was negative to Imogam, positive to HDCV; however, considered an irritating dose given identical results in control. Patient tolerated a 10/90 challenge to HDCV and completed post-exposure series using this vaccine. CONCLUSIONS: Skin test results and successful challenge to HDCV suggest gelatin allergy. Awareness of the potential for IgE-mediated reactions to rabies vaccine is important. Challenge to HDCV should be considered in select patients.

SENSITIZATION TO THE MAMMALIAN OLIGOSACCHARIDE GALACTOSE-ALPHA-1,3- GALACTOSE (ALPHA-GAL): EXPERIENCE IN A FLEMISH CASE SERIES

Background. Recent observations have disclosed that the galactose-α(1,3)-galactose (α-gal) moiety of non-primate glycoproteins can constitute a target for meat allergy.Objective. To describe adults with allergic reactions to mammalian meat, dairy products and gelatin. To investigate whether patients could demonstrate sensitization to activated recombinant human coagulation factor VII ectapog alpha that is produced in baby hamster kidney cells.Methods. Ten adults with mammalian meat, dairy products and gelatin allergies were examined using quantification of specific IgE and/or skin prick test for red meat, milk, milk components, gelatin, cetuximab and eptacog alpha.Results. Most patients demonstrate quite typical clinical histories and serological profiles, with anti-α-gal titers varying from less than 1% to over 25% of total serum IgE. All patients demonstrate negative sIgE for gelatin, except the patient with a genuine gelatin allergy. All patients also demonstrated a negative sIgE to recombinant milk components casein, lactalbumin and lactoglobulin. Specific IgE to eptacog was positive in 5 out of the 9 patients sensitized to α-gal and none of the 10 control individuals.Conclusion. This series confirms the importance of the α-gal carbohydrate moiety as a potential target for allergy to mammalian meat, dairy products and gelatin (oral, topical or parenteral) in a Flemish population of meat allergic adults. It also confirms in vitro tests to mammalian meat generally to be more reliable than mammalian meat skin tests, but that diagnosis can benefit from skin testing with cetuximab. Specific IgE to gelatin is far too insensitive to diagnose α-gal related gelatin allergy. IgE binding studies indicate a potential risk of α-gal-containing human recombinant proteins produced in mammalians.

Anaphylaxis Provoked by Bovine Gelatin Caused by Ingestion of Jelly Candy and Using Hair Gel.

Gelatin, a product obtained by the partial hydrolysis of collagen, is widely used in foods and pharmaceuticals. In the past, most commercially available vaccines, both live and inactivated, contained gelatin as a stabilizer, and allergic reactions to gelatin contained in measles, mumps, and rubella vaccine were reported. However, gelatin-allergy to foods was thought to be rare. It was unknown what factors predisposed recipients to vaccine-related gelatin allergy. There can be a genetic predisposition to gelatin allergy. We report a patient who experienced anaphylactic reaction on ingestion of jelly candy containing bovine gelatin and using hair gel.

Anaphylaxis After Ingesting Ibuprofen Liquid Gelatin-Capsule

Non-steroidal anti-inflammatory drugs are used daily by millions of patients worldwide for the management of various inflammatory diseases. Many well-documented adverse reactions are related to the use of these drugs. We report a fifty-four year-old woman with anaphylaxis after ingestion of ibuprofen liquid in a gelatin capsule. Eventually this was concluded to have resulted from hypersensitivity to the gelatin component of the capsule, which was likely IgE-mediated because of the positive skin test to gelatin. Gelatin allergy is only relevant for patients ingesting specific capsule formulation. The allergist/clinical immunologist must keep in mind the possibility of gelatin allergy.

Near fatal anaphylaxis from orally administered gelatin capsule

Near fatal anaphylaxis from orally administered gelatin capsule

Gelatin or Egg Protein Allergy May Not Rule Out Vaccines

Gelatin or Egg Protein Allergy May Not Rule Out Vaccines

Gelatin or Egg Allergy May Not Rule Out Vaccine

Gelatin or Egg Allergy May Not Rule Out Vaccine

Anaphylaxis after Booster Influenza Vaccine Due to Gelatin Allergy

Since 1993, there have been several reports describing severe allergic reactions to gelatin. The initial report described a 17-year-old girl who experienced anaphylaxis to MMR vaccine. Subsequent reports followed describing anaphylactic reactions to other gelatin-containing vaccines and medications. This is the first case report of an allergic reaction to influenza vaccine due to gelatin allergy. Although, the incidence of anaphylaxis to gelatin is extremely low (about one case per 2 million doses), gelatin is the most common identifiable cause of severe allergic reaction to vaccines. A review of the literature and management of these patients is discussed.

Vaccine adverse events reported in post-marketing study of the Kitasato Institute from 1994 to 2004

General physicians, pediatricians and parents realize that serious adverse events occur with an extremely rare incidence, but have no information on the incidences of vaccine-associated adverse events. A proper understanding of vaccine adverse events would be helpful in promoting an immunization strategy. Causal association can rarely be determined in adverse events through laboratory examinations. We examined the cases reported in the post-marketing surveillance of the Kitasato Institute, categorizing them into two groups: allergic reactions and severe systemic illnesses. Anaphylactic patients with gelatin allergy after immunization with live measles, rubella and mumps monovalent vaccines have been reported since 1993, but the number of reported cases with anaphylaxis dramatically decreased after 1999 when gelatin was removed from all brands of DPT. The incidence of anaphylactic reaction was estimated to be 0.63 per million for Japanese encephalitis virus (JEV) vaccine, 0.95 for DPT and 0.68 for Influenza vaccine, but the causative component has not yet been specified. Among 67.2 million immunization practices, 6 cases with encephalitis or encephalopathy, 7 with acute disseminated encephalomyelitis (ADEM), 10 with Guillain–Barré syndrome and 12 with idiopathic thrombocytopenic purpura (ITP) were reported. The wild-type measles virus genome was detected in a patient with encephalitis and in two of four bone marrow aspirates obtained from ITP after measles vaccination. Enterovirus infection was identified in two patients after mumps vaccination (one each with encephalitis and ADEM), one patient with encephalitis after immunization with JEV vaccine, and one with aseptic meningitis after immunization with influenza vaccine. The total estimated incidence of serious neurological illness after vaccination was 0.1–0.2 per million immunization practices. We found that enterovirus or wild-type measles virus infection was coincidentally associated with vaccination in several cases suspected of being vaccine adverse events.

Reactivity of IgE and IgG antibodies to human collagen type I in children with bovine gelatin allergy

Rationale This study was designed to investigate IgE and IgG reactivity to human collagen type I in bovine gelatin-sensitive children. Gelatin consists in collagen type I, which is a major allergen in gelatin allergy. Methods We collected serum samples from 50 patients with immediate-type allergic reactions to the vaccines and specific IgE to bovine gelatin, and from 50 children as a negative control with no reaction to the vaccines. The IgE and IgG reactivities to human collagen in serum samples were analyzed by ELISA. The cross reactivity between bovine and human collagen was analyzed by ELISA inhibition with the IgE in the serum samples. Results All 50 patients who had immediate-type allergic reactions to the vaccines had anti-bovine collagen IgE. Also, most of them showed IgE and IgG reactivity to human collagen type I. The IgE and IgG reactivity to human collagen was completely inhibited by bovine collagen. As a negative control, 50 children with no reaction to the vaccines had no specific IgE to bovine and human collagen. The levels of specific IgE and IgG in patients were significantly higher as compared with those in children with no reaction to the vaccines. Conclusions The IgE and IgG in sera of patients who had immediate-type allergic reactions to the vaccines reacted with human collagen and there is a cross reactivity between bovine and human collagen.

Prevention of anaphylactic reactions to anaesthetic drugs.

Although screening tests to prevent anaphylaxis during anaesthesia have been advocated, such tests are unlikely to have significant impact on reducing the incidence of anaphylaxis during anaesthesia. This is due to the low prevalence of the disease, the diversity of drugs used in anaesthesia and the incidence of false positive and negative tests. The suggested risk factors of allergy, i.e. atopy, asthma, family history, female sex, previous exposure, vasectomy, use of zinc protamine sulfate insulin and allergy to cosmetics, eggs, fish and non-anaesthetic drugs are not valid. Although all have theoretical or real associations with anaphylaxis during anaesthesia the majority of patients with such a history undergo uneventful anaesthesia. Fruit allergy, anaphylaxis to cephalosporins and penicillin, barbiturate allergy, gelatin allergy and allergy to metabisulphite and eggs require consideration in avoiding particular drugs. The incidence of anaesthetic anaphylaxis can be reduced by avoiding latex exposure in patients with spina bifida or latex allergy, and preventing second reactions in patients with a history of anaphylaxis, or major undiagnosed or undocumented adverse events during anaesthesia. Determining the cause of an adverse event and the drug responsible, and adequately communicating those findings can reduce second reactions. Avoiding neuromuscular blocking drugs (NMBDs) in patients who have reacted to an NMBD, and use of non-intravenous techniques should also reduce the incidence of second reactions. Desensitisation, and blocking with monovalent quaternary ammonium compounds may allow improved safety of NMBDs and pretreatment with antihistamines and corticosteroids may block or ameliorate the severity of reactions, but there is currently little evidence to support their routine use.

Removal of gelatin from live vaccines and DTaP—an ultimate solution for vaccine-related gelatin allergy

From the early 1990s infants started to receive acellular pertussis vaccine combined with diphtheria and tetanus toxoids (DTaP) before live vaccines such as measles, rubella, and mumps vaccines, which contained gelatin as a stabilizer. Then, an increasing number of cases of anaphylactic/allergic reactions to those live vaccines were reported. Almost all these cases had a previous history of receiving three or four doses of DTaP containing gelatin. Anaphylactic/allergic reactions to live measles vaccine were analyzed using information obtained from the Reporting System, a retrospective study, as well as from the Monitoring System, a prospective study. Dramatic decreases in anaphylactic/allergic reactions to live measles vaccines were observed immediately after each manufacturer marketed gelatin-free or gelatin (hypo-allergic)—containing live measles vaccine, and since the end of 1998 reports on anaphylactic/allergic reactions to live measles vaccine have almost ceased.

Analysis of the major epitope of the alpha2 chain of bovine type I collagen in children with bovine gelatin allergy.

Anaphylaxis to measles, mumps, and rubella vaccines has been reported. It has been found that most of these reactions to live vaccines are caused by type I allergy with the bovine gelatin present in the vaccines as an allergen. Gelatin mainly includes denatured type I collagen, which consists of alpha1 and alpha2 chains. We previously reported that allergic reactions to gelatin are caused by the type I collagen alpha2 (alpha2[I]) chain. To aid in the development of gelatin that has little or no allergenicity in human subjects, we investigated epitopes of bovine alpha2(I) chain with use of IgE in gelatin-sensitive children. Serum samples were collected from 15 patients who had systemic allergic reactions to vaccines and high levels of specific IgE to bovine gelatin. Eleven overlapping recombinant proteins that cover bovine alpha2(I) were prepared with a bacterial expression vector. We examined IgE reactivity to these recombinant proteins by means of ELISA. Fifteen peptides covering a major reactive recombinant protein were synthesized. The IgE-reacting epitope was identified by means of IgE-ELISA inhibition with these synthetic peptides and pooled serum from the patients. We found that of the 15 patients, 13 showed IgE reactivity to a recombinant protein (no. 3) spanning the central region of the collagenous domain ((418)Gly-(662)Pro). Furthermore, all 13 patients showed IgE reactivity to the 4-kd recombinant protein (no. 3a) spanning the region from (461)Pro to (500)Glu. In IgE-ELISA inhibition we found that a minimum IgE epitope of gelatin allergen was composed of the 10-amino-acid sequence (485)Ile-Pro-Gly-Glu-Phe-Gly-Leu-Pro-Gly-Pro(494). This sequence is not observed in the human type I collagen alpha1 and alpha2 chains, nor is it found in the bovine type I collagen alpha1 chain. We found that Ile-Pro-Gly-Glu-Phe-Gly-Leu-Pro-Gly-Pro is a major IgE epitope of the alpha2 chain of bovine type I collagen in patients with gelatin allergy. The degree of anaphylaxis to gelatin in vaccines might be reduced by digestion of this IgE-binding site in gelatin.

A practical approach to immunization in atopic children.

A practical approach to immunization in atopic children.

Analysis of HLA in children with gelatin allergy.

Systemic immediate reactions including anaphylaxis to gelatin in vaccines have been reported. However, the number of such reports is very small compared with the number of children exposed to gelatin. The present study was designed to investigate whether susceptibility or resistance to gelatin allergy is associated with human leukocyte antigen (HLA) class II gene. Blood samples were obtained from 49 patients with gelatin allergy and specific IgE to gelatin. DNA-based HLA class II typing was performed to determine the DRB1, DQB1 and DPB1 alleles. Genotype frequencies were compared with those found in 240 unrelated controls. The frequency of DQB1*0303 (55.1%) was significantly higher in the patients than in the control subjects (32.1%). The frequency of DPB1*0402 was also significantly higher in the patients (32.7%) than in the control subjects (15.4%). On the other hand, the frequency of subjects carrying DRB1*15 (DRB1*1501 and DRB1*1502) was significantly lower among the patients group (18.4%) than among the controls (40.8%). We found that DQB1*0303 and DPB1*0402 were positively associated with the IgE response for gelatin, while DRB1*15 was negatively associated with it.

A strong association between HLA-DR9 and gelatin allergy in the Japanese population

The frequency of HLA class I and II phenotypes was determined among 23 patients with positive gelatin IgE, eight of whom developed anaphylaxis, 18 patients who did not have gelatin IgE but who experienced non-immediate reactions after exposure to gelatin. HLA-DR9, which is unique to Orientals, was present in 56.5% of the gelatin IgE positive patients, as compared to control population frequency of 24% (P<0.002). In the non-immediate reaction group, who did not generate IgE, phenotype distribution resembled controls. HLA-DR9 positive individuals have a relative risk of 4.1 for developing gelatin allergy with positive IgE.

Allergic reactions to measles-mumps-rubella vaccination.

Immunization of egg-allergic children against measles, mumps, and rubella (MMR) is often deferred or even denied, although the safety of this vaccination has been clearly shown. Moreover, the majority of severe allergic reactions have occurred in egg-tolerant vaccinees. Other allergenic vaccine components have been sought, and gelatin has been suggested as one cause of allergic adverse events. The aim of this study was to further characterize the actual allergenic vaccine components. Serum samples from 36 recipients of MMR vaccine with anaphylaxis, urticaria with or without angioedema, asthmatic symptoms, or Henoch-Schönlein purpura were analyzed by CAP System radioallergosorbent test (RAST) and immunospot methods to detect the allergenic vaccine component. To evaluate the correspondence between the findings in the CAP System RAST or the immunospot and clinical symptoms, histories of allergies and present hypersensitivity symptoms were assessed. Of the 36 participants, 10 were demonstrated to be allergic to gelatin. Seven of them had persistent allergic symptoms, possibly attributable to foods containing gelatin or cross-reactive allergens. The results of the immunospot suggested concomitant allergy to gelatin and egg, chicken, and feathers, as well as cow's milk, or they reflected allergen cross-reactivity. Although severe allergic adverse events attributable to MMR vaccination are extremely rare, all serious allergic reactions should be further assessed to detect the likely causative vaccine component, including gelatin. The current recommendation for immunization of egg-allergic persons according to standard MMR vaccination schedules is reinforced. measles, mumps, and rubella vaccine, immunization, adverse effects, allergic reactions, gelatin allergy, CAP System, radioallergosorbent test, immunospot, immunoglobulin E.

Change in gelatin content of vaccines associated with reduction in reports of allergic reactions

Anaphylactic reactions after administration of measles, mumps, and rubella combined vaccine were first identified as gelatin allergy by Kelso et al.1 Beginning in 1993, anaphylactic reactions were increasingly reported after administration with gelatin-containing vaccines in Japan.2-4 IgE antibodies against gelatin were detected most frequently from patients with anaphylactic reactions and less frequently from those with urticarial eruptions.4 We analyzed the prior immunization history of acellular pertussis vaccine combined with diphtheria and tetanus toxoids (DTaP) among patients with gelatin allergy and suggested that the gelatin-containing DTaP may have a causal relationship to the development of gelatin allergy.

IgE antibody to fish gelatin (type I collagen) in patients with fish allergy

Background: Most children with anaphylaxis to measles, mumps, and rubella vaccines had shown sensitivity to bovine gelatin that was included in the vaccines. Recently, it was found that bovine type I collagen, which is the main content in the gelatin, is a major allergen in bovine gelatin allergy. Fish meat and skin also contain type I collagen. Objective: The present study was designed to investigate IgE antibody to fish gelatin in children with fish allergy. Methods: Serum samples were taken from patients in 3 groups: (1) 10 patients with fish allergy and specific IgE to fish meat; (2) two patients with allergies to both fish meat and bovine gelatin and specific IgE to fish meat and bovine gelatin; and (3) 15 patients with atopic dermatitis and specific IgE to fish meat. Various fish gelatins (type I collagen) were prepared from fish skin. IgE antibody to fish gelatin was analyzed by using ELISA and immunoblotting. Results: Of 10 patients with fish allergy, 3 had specific IgE to fish gelatin. Of two patients with fish allergy and bovine gelatin allergy, all had specific IgE to fish gelatin. Of 15 patients with atopic dermatitis and specific IgE to fish meat, 5 had specific IgE to fish gelatin. Furthermore, IgE from pooled serum of the patients reacted with both the α1 and α2 chains of fish type I collagen in immunoblots. There is cross-reactivity among gelatins from various fishes, but there is little cross-reactivity between fish and bovine gelatins. Conclusion: Some fish-sensitive patients possessed IgE antibody to fish gelatin. Fish gelatin (type I collagen) might be an allergen in subjects with fish allergy. (J Allergy Clin Immunol 2000;106:579-84.)