Should a patient with a history of allergic reaction to pneumococcal vaccine receive another dose?

No, Do Not Administer the Pneumococcal Vaccine

A history of allergic reaction to a previous dose of pneumococcal vaccine is an absolute contraindication to revaccination, and this patient should not receive another dose. 1

Clear Contraindication Based on Guidelines

The Advisory Committee on Immunization Practices (ACIP) explicitly states that both pneumococcal conjugate vaccine (PCV13/PCV15/PCV20) and pneumococcal polysaccharide vaccine (PPSV23) are contraindicated in persons with a severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component. 1

• Revaccination is specifically contraindicated for persons who had a severe reaction (e.g., anaphylactic reaction or localized Arthus-type reaction) to the initial dose they received. 1, 2, 3
• This contraindication applies regardless of time elapsed since the initial reaction. 1, 2
• The 2023 ACIP guidelines reaffirm that vaccination is contraindicated in persons known to have a severe allergic reaction to any component of the vaccine. 1

Clinical Reasoning

The risk-benefit analysis strongly favors withholding vaccination in this scenario:

• Morbidity and mortality risk from revaccination: Anaphylaxis is a potentially life-threatening reaction that can recur with re-exposure. 3, 4
• Alternative protection strategies exist: Antibiotic prophylaxis (oral penicillin V) can be used for pneumococcal disease prevention in high-risk patients who cannot receive vaccination. 1
• No safe revaccination protocol: Unlike some other vaccine allergies where desensitization protocols exist, ACIP provides no such pathway for pneumococcal vaccine reactions. 1, 2

Important Caveats

The severity and type of the previous allergic reaction matters critically:

• If the previous reaction was truly severe (anaphylaxis, Arthus-type reaction), vaccination is absolutely contraindicated. 1, 3
• If the previous reaction was mild and local (pain, erythema, swelling at injection site), this would be a precaution rather than contraindication, and vaccination could potentially proceed. 3
• Most pneumococcal vaccine reactions are mild, self-limited local reactions that resolve within 48 hours and do not contraindicate future doses. 3

You must clarify the nature of the previous "allergic reaction" before making a final decision. If it was truly anaphylaxis or severe systemic reaction, the answer is definitively No (Option B). If it was only mild local reaction, vaccination could potentially proceed with appropriate monitoring.

Documentation Requirements

• This contraindication must be clearly documented in the patient's medical record. 2, 3
• The previous allergic reaction should be reported to the Vaccine Adverse Event Reporting System (VAERS) if not already done. 3
• Consider allergy/immunology consultation if there is uncertainty about the nature or severity of the previous reaction. 4, 5

Answer: B. No