tory of thrombocytopenia may be at increased risk for developing thrombocytopenia following MMR.

ANAPHYLAXIS

Clinical Description

Anaphylaxis and anaphylactic shock refer to an acute, severe, and potentially lethal systemic allergic reaction. Most cases resolve without sequel. Signs and symptoms begin within minutes to a few hours after exposure. Death, if it occurs, usually results from airway obstruction caused by laryngeal edema or bronchospasm and may be associated with cardiovascular collapse. Chapter 4 contains a detailed discussion of anaphylaxis.

History of Suspected Association

The suspected relation between measles and mumps vaccines and anaphylaxis is based on several reports of anaphylactic reactions following administration of measles or measles-mumps vaccines or MMR in the literature and VAERS (Aukrust et al., 1980; Fescharek et al., 1990; Herman et al., 1983; McEwen, 1983; Pollock and Morris, 1983; Taranger and Wiholm, 1987; Thurston, 1987; Van Asperen et al., 1981). No reports of anaphylaxis following administration of monovalent mumps vaccine have been published, but the 1991 Red Book states that since 1967 there have been rare, isolated reports of allergic reactions (American Academy of Pediatrics, Committee on Infectious Diseases, 1991).

Anaphylaxis to egg proteins has been considered to be a relative contraindication to immunization with live attenuated virus vaccines grown in eggs or in tissue culture cells of chicken embryo origin (American Academy of Pediatrics, Committee on Infectious Diseases, 1991). In 1983, Herman et al. reported generalized urticaria, angioedema, and respiratory difficulty after immunization with MMR in two children who had allergy to egg white protein (ovalbumin). Both had serum immunoglobulin E (IgE) reactive with the ovalbumin-related antigens in measles vaccine and MMR.

Evidence for Association

Biologic Plausibility

Concern has been raised regarding the safety of egg-derived vaccines in individuals who are sensitive to egg protein, since some individuals are exquisitely sensitive. Measles and mumps viruses in currently available monovalent and combination (measles-mumps and MMR) vaccines are grown



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