Hypersensitivity reaction to human papillomavirus vaccine due to polysorbate 80

A 17-year-old girl reported generalised urticaria, eyelid angioedema, rhino-conjunctivitis, dyspnoea and wheezing 1 h after third intramuscular administration of quadrivalent human papilloma virus vaccine (Gardasil). She was treated with antihistamine, and corticosteroids with prompt relief of rhini...

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Bibliographic Details
Published in:BMJ case reports 2012-05, Vol.2012 (may07 1), p.bcr0220125797-bcr0220125797
Main Authors: Badiu, Iuliana, Geuna, Massimo, Heffler, Enrico, Rolla, Giovanni
Format: Article
Language:English
Subjects:
Adolescent
Allergies
Asthma
Diagnosis, Differential
Drug Hypersensitivity - diagnosis
Dyspnea
Europe (West)
Excipients - adverse effects
Female
Histamine
Human papillomavirus
Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18
Humans
Papillomavirus Vaccines - adverse effects
Polysorbates - adverse effects
Rhinitis
Skin
Skin Tests
Unexpected Outcome (Positive or Negative) Including Adverse Drug Reactions
Urticaria
Vaccines
White
Yeast
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Summary:A 17-year-old girl reported generalised urticaria, eyelid angioedema, rhino-conjunctivitis, dyspnoea and wheezing 1 h after third intramuscular administration of quadrivalent human papilloma virus vaccine (Gardasil). She was treated with antihistamine, and corticosteroids with prompt relief of rhinitis and dyspnoea, while urticaria and angioedema lasted 24 h. Intradermal test with Gardasil, which contains polysorbate 80 (PS80), resulted positive, while skin tests with the bivalent vaccine were negative. Prick test performed with PS80 resulted positive in the patient and negative in ten healthy controls. The CD203 basophil activation test result was negative for PS80 at all the tested dilutions and specific IgE was not found. As flu vaccine was recommended, the authors skin tested two flu vaccine, one containing PS80 (Fluarix, GSK), which resulted positive and another flu vaccine with no adjuvant or preservative (Vaxigrip, Sanofi Pasteur MSD), which gave negative results. The patient then received Vaxigrip without adverse reactions.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr.02.2012.5797