Is a Reaction to HBV Vaccine the “Yeast” of This Man’s Worries?

December 31, 2006

My patient has a test-proven Candida allergy. Because hepatitis B virus (HBV)vaccine contains yeast, another physician would not give it to him. I administereda diluted dose and then a full-strength dose of the HBV vaccine, and the patienthad no adverse reaction.

My patient has a test-proven Candida allergy. Because hepatitis B virus (HBV)vaccine contains yeast, another physician would not give it to him. I administereda diluted dose and then a full-strength dose of the HBV vaccine, and the patienthad no adverse reaction.What explains the absence of a reaction in this patient? In general, what precautionsshould be taken when HBV vaccine is given to persons with a documentedyeast allergy?-- William Morris, MD
  &nbspAthens, Tenn
The term "yeast" is not the most precise one to describe the mediumused in the development of HBV vaccine. Recombinant HBV vaccineis produced in a species of yeast cells, namely Saccharomyces cerevisiae.Most of the yeast components in the vaccine are removed by physicalseparation techniques (eg, chromatography and filtration). Thelack of reaction in your patient with a Candida allergy may be a result of thedifference in species and/or of the separation process.Anaphylaxis resulting from HBV vaccine has been reported in the literature.1 Vaccination is contraindicated in patients who have experienced anaphylaxisin response to the vaccine or to one of its components.-- Richard K. Zimmerman, MD, MPH
  &nbsp Associate Professor
  &nbsp Department of Family Medicine and Clinical Epidemiology
  &nbsp University of Pittsburgh School of Medicine

References:

REFERENCE:
1.

Vaccine Safety Committee, Institute of Medicine. Hepatitis B vaccine. In: Stratton KR, Howe CJ, JohnstonRB, eds.

Adverse Events Associated With Childhood Vaccines.

Washington, DC: National Academy Press; 1994:
228-231.