Adverse reactions to vaccines practice parameter 2012 update

John M. Kelso, Matthew J. Greenhawt, James T. Li, Richard A. Nicklas, David I. Bernstein, Joann Blessing-Moore, Linda Cox, David Khan, David M. Lang, John Oppenheimer, Jay M. Portnoy, Christopher R. Randolph, Diane E. Schuller, Sheldon L. Spector, Stephen A. Tilles, Dana Wallace

Research output: Contribution to journalArticlepeer-review

213 Scopus citations


Mild local reactions and fever after vaccinations are common and do not contraindicate future doses. Anaphylactic reactions to vaccines are rare and should be evaluated with skin tests to the vaccine and its components. If the skin test results are negative, subsequent doses can be administered in the usual manner but under observation. If the skin test results are positive and the patient requires subsequent doses, the vaccine can be administered in graded doses under observation. Some nonanaphylactic reactions to vaccines might also require evaluation, but only a few are contraindications to future doses. Pregnant women and persons who are immune compromised should generally not receive live vaccines. Purported long-term sequelae of vaccination, such as autism, are not supported by epidemiologic studies. Patients with egg allergy of any severity should receive annual influenza vaccinations because studies have demonstrated a very low rate of reactions. Studies to date have evaluated the injectable trivalent nfluenza vaccine (TIV), and thus TIV, rather than the live attenuated influenza vaccine (LAIV), should be used for recipients with egg allergy. All influenza vaccines available in the United States contain low amounts of ovalbumin. Neither skin testing with the vaccine nor dividing the dose is required; however, the vaccine should be administered in a setting in which anaphylaxis can be recognized and treated.

Original languageEnglish (US)
Pages (from-to)25-43
Number of pages19
JournalJournal of Allergy and Clinical Immunology
Issue number1
StatePublished - Jul 2012


  • Vaccine
  • adverse reaction
  • allergy
  • egg allergy
  • immunization
  • influenza vaccine

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology


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