Giving the Influenza Vaccine to Egg Allergic Children

It is that time of the year again-Flu Shot Season. The influenza vaccine is available and there are recommendations for children to receive the vaccine to protect them and others from the ‘flu’.

In the past, influenza vaccination was a concern in a child who had an egg allergy. In this situation, the vaccine was either not given or the child underwent a desensitization procedure in the allergist’s office. Current research has caused a re-thinking of the previous guidelines. Now it is not just having an egg allergy that would preclude the vaccination, it is the nature of that allergic response to egg that guides the decision for vaccination.

The influenza vaccination does contain egg products. The amount of egg in the vaccine may vary depending upon the manufacturer and even within distributed lots of the vaccine from the same manufacturer. Once upon a time we thought that if food which contained egg was tolerated, but egg was not, then the vaccine could be given. A few years ago that adage was proven to be incorrect. The nature of the egg protein in the vaccine may differ from the egg in a ‘heated egg’ food product.

Our allergy clinic at Riley has received many calls from worried families and from primary care offices regarding egg allergy and the influenza vaccine.

My partner, Dr. Girish Vitalpur spoke at our recent ‘2010 Pediatric Pulmonary Update: Today’s Challenges’ on this very topic of egg allergy and the flu vaccine. The entire conference was dedicated to specific management problems that primary caretakers face: the issue of egg allergy and the vaccine was a notable concern.

Girish and I thought it may be of service to those who could not attend the meeting to post the recommendations and the approach to influenza vaccine in the child with egg allergy.

First a few fact that he shared (all were referenced)

  • 1969- one death reported due to anaphylaxis to the vaccine in someone with egg allergy
  • 1976- one case of anaphlyaxis per 4.4 million vaccinations with none occurring in an egg allergy individual
  • 1990-2005- 747 million influenza vaccine doses given with 4 cases of fatal anaphylaxis

Balance these facts with 540,000 deaths due to influenza during the same time interval.

Flu vaccine recommendations are dependent upon the type or severity of a reaction to egg. The following sorts out considerations for egg allergy severity.

Mild Egg Allergy

  • Hives around the mouth/face
  • Mild itching
  • Nausea
  • Itchy mouth

Severe Egg Allergy

  • Respiratory changes
  • Cardiac changes
  • Oral swelling or throat tightness
  • Systemic hives
  • Multiple organ reactions-hives with vomiting, hives and respiratory symptoms for example

Note- just having a positive test for egg and no history of a reaction is not listed here as a severity consideration.

Current Guidelines (6 months to 18 years of age)

No egg anaphylaxis- may receive the vaccine in a two dose graded manner (graded challenge).

INFLUENZA VACCINE ADMINISTRATION WITH EGG ALLERGY:  MANAGEMENT

  • Office must be prepared for anaphylaxis
  • Informed consent needed
  • Approaches

1.  Administration of vaccine as a single dose

2. Graded Challenge

                  Give 10% of vaccine.  Wait 30 minutes.  Give rest of vaccine.  Monitor for 30-60 minutes (30 minutes usually- 60 minutes depending upon the history).

 3.  Desensitization (for cases of egg anaphylaxis and/ or adverse reaction to the vaccine)

       Administer vaccine in 4-5 incremental doses, at 15-minute intervals

 Zeiger, 2002;Greenhawt, 2010

The desensitization for anaphylaxis should be performed in the allergist’s office.

The graded challenge has been done in primary care offices- it fulfills that gray zone when there are no clear answers and there is anxiety on behalf of the family and the primary caretaker.

Hopefully this posting will help to answer questions about giving the vaccination in someone with an egg allergy. My thanks to my colleague, Dr. Girish Vitalpur for putting this together.

FEL

November 13, 2010 · fleickly · No Comments
Tags:  · Posted in: Egg Allergy, Immunizations, Influenza vaccine, Uncategorized