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

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, TennThe 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.