Alum containing vaccines and food allergy
I have a 9 yo boy with cow's milk allergy (based on history and skin testing). His skin prick and serum IgE testing have now decreased to levels for which a baked cow's milk challenge can be considered and has been scheduled. However, in the meantime he received a vaccine containing alum and Mom read an article citing the abstract presented at the 2016 AAAAI meeting by Alice Hoyt, et. al entitled: "Alum-containing vaccines increase total and food allergen specific IgE..." . She is concerned vaccines with alum may be contributing to his food allergies. It seems much more is to be learned on this topic but are there any current recommendations on why alum may increase IgE and whether this is clinically relevant? The patient's Mom would like her son to avoid future vaccines containing alum but I do not think this is in the best interest of the child at this time.
We shared your inquiry with Dr. Anna Nowak-Wegrzyn, an internationally recognized investigator in food allergy and atopic disease and Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai. Her response was:
“It has been known for many years that aluminium adjuvants stimulate both Th1 and Th2 responses, including IgE production. However there is no conclusive evidence that childhood immunizations predispose to sustained IgE production that might lead to development of symptomatic IgE-mediated allergy.”
Although there is evidence of an increase in total and specific-IgE with the use of alum, there is no evidence of any long term effect on allergic disease. Some examples in the literature are:
Ann Allergy. 1985 Feb;54(2):148-51.
Total and IgE antibody levels following booster immunization with aluminum absorbed and nonabsorbed tetanus toxoid in humans.
Cogné M, Ballet JJ, Schmitt C, Bizzini B.
Total and IgE serum antibodies to tetanus toxoid were measured in 32 healthy adults, 3-4 weeks following booster immunization with either plain or aluminum hydroxide-absorbed tetanus toxoid. Whereas no difference in the total antibody values was observed, the level of anti-tetanus toxoid IgE antibodies was significantly higher in the group boostered with the adjuvanted vaccine.
Alum-Containing Vaccines Increase Total and Food Allergen-Specific IgE, and Cow's Milk Oral Desensitization Increases Bosd4 IgG4 While Peanut Avoidance Increases Arah2 IgE: The Complexity of Today's Child with Food Allergy
Hoyt, Alice EW; Schuyler, Alexander J; Heymann, Peter W; Platts-Mills, Thomas AE; Commins, Scott P. Journal of Allergy and Clinical Immunology, suppl. S; St. Louis 137.2 (Feb 2016): AB151.
Although the data are of some interest and raise epidemiologic questions related to alum containing vaccines and the increase in atopic disease in the population, all of these ideas remain speculative. Furthermore, it is common practice in other countries, particularly Europe, to use alum containing allergen vaccines to treat allergic conditions. If alum had a significant effect on specific-IgE responses it would likely have become apparent with the repetitive uses of these products in allergic patients. There have been reports of contact allergy to aluminum developing with the use of such vaccines but this also remains unproven. However, this is a cell mediated immune response and not due to IgE.
Contact Dermatitis. 2009 Jan;60(1):41-9. doi: 10.1111/j.1600-0536.2008.01474.x.
There is an association between contact allergy to aluminium and persistent subcutaneous nodules in children undergoing hyposensitization therapy.
Netterlid E, Hindsén M, Björk J, Ekqvist S, Güner N, Henricson KA, Bruze M.
BACKGROUND: The development of persistent itchy nodules at the injection site following hyposensitization therapy with aluminium-precipitated antigen extract has been described in several reports. Occasionally, contact allergy to aluminium has been reported in individuals with such nodules.
OBJECTIVES: To investigate if hyposensitization therapy can induce contact allergy to aluminium and examine if there is any association between persistent subcutaneous nodules and aluminium allergy.
PATIENTS/METHODS: Sixty-one children with allergic asthma and/or allergic rhinitis participated in the study of whom 37 had had hyposensitization therapy. The study consisted of a non-clinical part based on a questionnaire and a clinical part with a physical examination, self-assessment of itching, and patch testing. To secure an unbiased evaluation of possible reactions, the investigators were blinded.
RESULTS: Contact allergy to aluminium was found in eight participants, all in the exposed group (8/37 versus 0/24, P = 0.02). Examination showed nodules on the upper arms in 13 participants, all in the group exposed to hyposensitization therapy. Nodules were over-represented in patients with contact allergy to aluminium.
CONCLUSIONS: There was a statistically significant association between contact allergy to aluminium and persistent subcutaneous nodules in children who had had hyposensitization therapy.
In summary, the benefits of vaccination for infections and allergy, including the use of vaccines containing alum, far outweigh current theoretical concerns.
I hope this information is of help to you and your practice.
All our best.
Anna Nowak-Wegrzyn, MD, FAAAAI
Dennis K. Ledford, MD, FAAAA