Sharon asked
I have had a reaction to several drugs containing 'mycins', like erythromycin. I get a rash everywhere. I have had shingles and was told I can not get the vaccine because of my reaction to erythromycin. Is this true? Is there any other vaccine that I could get instead?
At a glance
- Shingrix, the recommended vaccine for the prevention of shingles, is safe to get if you have an erythromycin allergy. Zostavax, another vaccine is shingles, is also safe to get if you have an erythromycin (a macrolide antibiotic) allergy but should not be given in those with an allergy to neomycin (an aminoglycoside antibiotic).
Answer
There are two vaccines FDA-approved and indicated to prevent shingles infections in the United States:
- Zostavax
- Shingrix
Zostavax has been available since 2006, while Shingrix was approved more recently, in 2017.
The CDC (Centers for Disease Control) and ACIP (Advisory Committee on Immunization Practices) recommend Shingrix as the preferred vaccine for the prevention of shingles due to its superior efficacy when compared to Zostavax.[1]
Zostavax is generally only used in those who cannot get Shingrix for whatever reason (e.g. an allergy).
There is no known problem with getting Shingrix if you have an allergy to erythromycin or any antibiotic for that matter.
Zostavax must be used cautiously in those with a history of anaphylaxis to neomycin, but not to erythromycin.[2]
So, overall, if you have an erythromycin allergy, both Shingrix and Zostavax would be safe to get (but again, Shingrix is preferred).
Shingrix Allergy Information
The prescribing information for Shingrix doesn't list any specific allergy a person may have where the vaccine needs to be avoided. It only states the following:[3]
Do not administer SHINGRIX to anyone with a history of a severe allergic reaction (e.g., anaphylaxis) to any component of the vaccine or after a previous dose of SHINGRIX.
The components (i.e. ingredients) of the Shingrix vaccine are as follows:
- Recombinant varicella zoster virus surface glycoprotein E (gE) antigen
- AS01B (3-O-desacyl-4’- monophosphoryl lipid A (MPL))
- QS-21
- Dioleoyl phosphatidylcholine (DOPC)
- Cholesterol
- Disodium phosphate anhydrous
- Potassium dihydrogen phosphate
- Sodium chloride
- Water for injection
- Sucrose
- Polysorbate 80
- Host cell proteins (≤3.0%)
- DNA
Unless you have a specific allergy to any of the above vaccine components, Shingrix should be safe to get.
The only contraindication for the vaccine is if you do have an allergy to the vaccine or you had an allergic reaction following your first dose (Shingrix is a two-shot series with doses separated by 2 to 6 months).[4]
Zostavax Allergy Information
Zostavax does have more of an allergy concern than Shingrix.
In addition to an allergy to a component of the vaccine, it is contraindicated in those with a known hypersensitivity to:[5]
- Neomycin
- Gelatin
It should be noted that even though neomycin has a 'mycin' suffix, it is not in the same class of medication as erythromycin.
Neomycin is classified as an aminoglycoside while erythromycin is a macrolide.[6][7]
So, even if you have an allergy to erythromycin, there is no known issue with getting Zostavax.
Even other aminoglycosides don't seem to pose a problem. This issue is discussed on the 'Ask The Experts' section on Immunize.org regarding these vaccines:[8]
References
- ^ Centers for Disease Control: Shingles Recommendations. CDC
- ^ Zostavax Prescribing Information. Merck
- ^ Shingrix Prescribing Information. GSKPro
- ^ Centers for Disease Control: About The Vaccine. CDC
- ^ A Double-Blind, Randomized, Controlled, Multicenter Safety and Immunogenicity Study of a Refrigerator-Stable Formulation of Zostavax. PubMed
- ^ Elsevier ClinicalKey: Neomycin Monograph. ClinicalKey
- ^ Elsevier ClinicalKey: Erythromycin Monograph. ClinicalKey
- ^ Ask The Experts: Zoster (Shingles). Immunize.org
