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Neomycin vaccination dilemma

Q A patient had patch testing for eczema and part of the batch was positive to neomycin, although to the best of his knowledge he had never had topical neomycin. Various vaccines including hepatitis A may be contraindicated if allergic to neomycin. Can he still have them?

A Certain vaccines, including hepatitis A, contain traces of neomycin. Others, such as MMR and varicella vaccines, contain more (approximately 25 microgramms of neomycin in the MMR).

Your patient shows a positive skin reaction to neomycin, but is exhibiting signs of contact dermatitis, a manifestation of a delayed-type (cell-mediated) immune response, rather than anaphylaxis.

A history of delayed-type reaction to neomycin is not a contraindication to receiving a vaccine with traces of neomycin.

Warn your patient he may experience a delayed-type local reaction two to four days after administration of a vaccine containing traces of neomycin, such as MMR, varicella, hepatitis A.

This reaction is usually in the form of an erythematous, pruritic papule. This is a minor reaction and of

little importance compared with the benefit of immunisation.

It is not considered a contraindication to the vaccine.

The patient you will need to exclude from such vaccination is the one who has experienced an anaphylactic reaction to the specific vaccine or the excipients in it.

All staff dealing with immunisations must be trained in the management

of anaphylaxis and resuscitation.

Appropriate in-date drugs and necessary, serviced equipment must always be available. Expect up to three anaphylactic events per million doses of vaccine administered.

Dr George Kassianos, immunisation spokesman for the RCGP and a GP in Bracknell, Berkshire

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