# 4397
For years those with egg allergies have been cautioned not to accept a flu shot because the antigen is grown in eggs and the vaccine could contain trace amounts of egg proteins.
Now, that advice may be about to change – at least according to a report presented at the annual meeting of American Academy of Allergy, Asthma & Immunology (AAAAI).
Although the big concern of late has been the flu shot other vaccines, including ones for yellow fever and the MMR contain lesser amounts of egg proteins as well.
As egg allergies are the second most common childhood food allergy, fears of an allergic (or anaphylactic) reaction have proven to be a barrier for a significant number of children to receive vaccines.
The abstract appears in the agenda for the 2010 AAAAI meeting in New Orleans, Feb 28-March 2nd – and is listed as #90. It has not (yet) been published in a peer reviewed journal, and so readers are cautioned that their conclusions should be regarded as preliminary.
Administration Of Influenza Vaccine To The Egg Allergic Child Under 36 Months
L. E. Howe, A. Chernin, G. M. Sanders; University of Michigan, ANN ARBOR, MI.
RATIONALE: To determine which population of egg allergic children (EAC) can safely receive the influenza vaccine (INF), and how to optimize testing and administration.
METHODS: A retrospective chart review from 10/2004 to 1/2009 of EAC ages 6-36 months seen in Allergy Clinic during influenza immunizationseason (10/1-2/28). EAC were identified with positive skin (ST) or RAST test to egg. EAC who did or did not receive INF or INF testing were evaluated.
Adverse events after INF were compared to a non-EAC control group of our patients given INF. We reviewed likelihood of receiving full testing (prick and intradermal (ID)), graded vaccine, or full vaccine to determine the best protocol.
RESULTS: 140 EAC were tested for INF and 53 EAC were not tested. Morbidities of asthma and anaphylaxis were no different in the 2 groups (p>.3). Likelihood of receiving ID prior to INF decreased over time from 100%-2% (p<.0001). Likelihood of receiving full INF vs graded INF increased with repeat dosing, 65%-87.5% (p<.0024).
5/140 tested EAC did not receive INF after positive STor ID to INF (3 with anaphylaxis), but 14/17 EAC with anaphylaxis received INF (2 with positive ST to flu, 9 negative, 3 not-performed). 135/140 received INF without significant complications (equivalent to non-EAC). 28/135 EAC were safely given INF without prior ST.
CONCLUSIONS: 96% of skin tested EAC safely received INF (76% ST negative, 23% ST positive); and 21% who received INF had no prior ST. 70% of all EAC received INF. EAC can safely receive INF.
The upshot here is that a review of children with egg allergies receiving the influenza shot showed only mild, localized allergic reactions, and then only in about 5% of those studied.
Concerns over anaphylaxis among children with egg allergies, according to these researchers, has been overstated in the past.
Medpage Today has more on this study.
AAAAI: Egg Allergy No Bar to Flu Shot
By John Gever, Senior Editor, MedPage Today
Published: February 28, 2010
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse PlannerNEW ORLEANS -- Most children with egg protein allergies who received influenza vaccinations had no adverse reactions, researchers said here.
A retrospective chart review of egg-allergic children receiving at least one flu shot showed that only seven of 135 developed reactions, none systemic, Laura E. Howe, MD, of the University of Michigan in Ann Arbor, reported at the annual meeting of American Academy of Allergy, Asthma & Immunology.
Even children with a history of anaphylaxis appeared to have no problem with flu vaccines, with no reactions seen in 14 patients, she said.
The seven reactions were mainly hives and/or erythema, with one case of diarrhea and one eczema flare. Two responded to antihistamine treatment and five resolved spontaneously.
"Children with egg allergy can safely receive the seasonal influenza vaccine," Howe concluded.
My thanks to the CIDRAP News roundup last night for leading me to this study.
