Here are some tips (opinions of individual members) on the travellist server group of travel healths experts from across the world
1/ consult an allergologist/immunologist
2/ follow the procedure as mentioned in a very good article on recommendations for desensitisation.
3/ know that, even one needs to stop the procedure after 1/10 of the dose intradermal – there is (nearly) always a sufficient antibody
response – see the publications of the group of leo Visser (check in pubmed http://www.ncbi.nlm.nih.gov/
4/ know that the risk for an allergic reaction is very very low, even in case of egg allergy – see the experience described by M Jones in an abstract ISTM 2008 PO02.01 (or look again in Pubmed with search terms ” Jones M allergy vaccination” and find three final publications on this topic
ISTM 2008 PO02.01 Audit of Vaccination of Potentially Vaccine-Allergic Patients at an Edinburgh Travel Clinic MacDonald R.1, Duncan C.1, Jones M.1 1Western General Hospital, Regional Infectious Diseases Unit, Edinburgh, United Kingdom
Objective: We audited patients referred by GPs to the Infectious Diseases Unit Travel Clinic, Western General Hospital (WGH) Clinic in Edinburgh, during 2003-2006 for vaccination and a history of a previous adverse reaction to vaccination or allergy.
Methods: We retrospectively audited case notes of patients seen during 2004-2006. Patients were initially reviewed to assess whether vaccination was indicated and the level of risk suggested by the history of allergy or previous adverse reaction. Vaccination was undertaken in the day bed unit, where trained staff, and full resuscitation equipment is available and the hospital cardiac arrest
team can be called at short notice. Where the level of risk indicated some risk intravenous cannulation was performed prior to the administration of the vaccine. Observation was generally maintained for at least 2 hours after vaccination.
Results: At the time of submission of this abstract the records of 16 patients had been scrutinized. Fourteen were assessed as requiring vaccination and of these 4 required this for their employment. One patient was referred for a school age booster. Three vaccinees reported egg allergy, 8 previous allergy to a vaccine, 2 had multiple allergies, 1 nut allergy, 1 latex allergy, and 1 had penicillin
allergy. IgE levels were ascertained in 5 patients and were elevated in 2 patients. No serious adverse reactions occurred amongst the fourteen who were immunized. Two patients received intradermal test doses and after a flare reaction to yellow fever vaccine in one egg-allergic patient the full dose was not given. Seroconversion however was demonstrated, despite the use of only 0.1ml ID. Four vaccinees were given yellow fever vaccine, 6 diphtheria/tetanus/polio, 6 rabies, 5 hepatitis A/typhoid, 1 hepatitis B and 1 Japanese encephalitis vaccine.
Conclusions: The traveling public and family doctors are understandably worried about adverse reactions to vaccines. Our audit indicates that these concerns are largely unfounded, but Travel Clinics located in hospital environments with adequate resuscitation facilities provide a reassuring environment in which to vaccinate higher risk patients.
Source: TravelMed Clinical Discussion List – Individual ID information has been omitted