IM Deltoid Vaccine Injection With Text - Shingrix - Erythromycin

Overview

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.
Shingrix Prescribing Information

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]

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]

Q: We have a patient with a severe allergy to vancomycin who wants to receive zoster vaccine. According to the Zostavax prescribing information, an allergy to neomycin would be a contraindication to vaccination but we are not sure about allergy to vancomycin.


A: Vancomycin and neomycin belong to different classes of antibiotics. An allergy to vancomycin is not a contraindication to zoster vaccine [Zostavax]. RZV [Shingrix] does not contain either neomycin or vancomycin.
Ask The Experts: Immunize.org

Final Words

As discussed above, erythromycin is not a component of either shingles vaccine (Shingrix or Zostavax) nor is an allergy to erythromycin a contraindication for either.

Whoever told you that you cannot get the shingles vaccine due to your erythromycin allergy was mistaken and likely confused it with the contraindication for Zostavax in those that have a neomycin allergy (which is in a completely different class of drugs than erythromycin).

Erythromycin is a macrolide and an allergy to macrolides is not a problem with either shingles vaccine.


Summary

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).

References
  1. ^ Centers for Disease Control: Shingles Recommendations. CDC
  2. ^ Zostavax Prescribing Information. Merck
  3. ^ Shingrix Prescribing Information. GSKPro
  4. ^ Centers for Disease Control: About The Vaccine. CDC
  5. ^ A Double-Blind, Randomized, Controlled, Multicenter Safety and Immunogenicity Study of a Refrigerator-Stable Formulation of Zostavax. PubMed
  6. ^ Elsevier ClinicalKey: Neomycin Monograph. ClinicalKey
  7. ^ Elsevier ClinicalKey: Erythromycin Monograph. ClinicalKey
  8. ^ Ask The Experts: Zoster (Shingles). Immunize.org