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PEDIATRICS Vol. 111 No. 3 March 2003, pp. 653-659

SPECIAL ARTICLE

Addressing Parents’ Concerns: Do Vaccines Cause Allergic or Autoimmune Diseases?

Paul A. Offit, MD* and Charles J. Hackett, PhD{ddagger}

* Division of Infectious Diseases, Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, and the Wistar Institute of Anatomy and Biology, Philadelphia, Pennsylvania
{ddagger} Division of Allergy, Immunology, and Transplantation, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

--> Anecdotal case reports and uncontrolled observational studies in the medical literature claim that vaccines cause chronic diseases such as asthma, multiple sclerosis, chronic arthritis, and diabetes. Several biological mechanisms have been proposed to explain how vaccines might cause allergic or autoimmune diseases. For example, allergic diseases might be caused by prevention of early childhood infections (the "hygiene hypothesis"), causing a prolongation of immunoglobulin E-promoting T-helper cell type 2-type responses. However, vaccines do not prevent most common childhood infections, and large well-controlled epidemiologic studies do not support the hypothesis that vaccines cause allergies. Autoimmune diseases might occur after immunization because proteins on microbial pathogens are similar to human proteins ("molecular mimicry") and could induce immune responses that damage human cells. However, wild-type viruses and bacteria are much better adapted to growth in humans than vaccines and much more likely to stimulate potentially damaging self-reactive lymphocytes. Consistent with critical differences between natural infection and immunization, well-controlled epidemiologic studies do not support the hypothesis that vaccines cause autoimmunity.

Flaws in proposed biological mechanisms that explain how vaccines might cause chronic diseases are consistent with the findings of many well-controlled large epidemiologic studies that fail to show a causal relationship.

Key Words: vaccines • vaccine safety • asthma • allergies • multiple sclerosis • diabetes • chronic arthritis

Abbreviations: IgE, immunoglobulin E • Th2, T-helper cell type 2 • Th1, T-helper cell type 1 • HMO, health maintenance organization • Hib, Haemophilus influenzae type b • MBP, myelin basic protein • HBsAg, hepatitis B surface antigen • OspA, outer surface protein A • LFA-1, lymphocyte function-associated antigen-1

Received for publication Jun 14, 2002; Accepted Sep 10, 2002.


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