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Study Says Flu Shot Safe for Kids With Egg Allergy

Egg puzzlrMedscape November 7, 2011 — Trivalent influenza vaccine (TIV) is safe to use in children with severe egg allergy, and can be given as a single dose, according to research presented here at the American College of Allergy, Asthma & Immunology 2011 Annual Scientific Meeting.

This finding, from the interim results of a 2-year multicenter trial, confirms the recommendation made earlier this year by the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP) — that egg allergy is no longer a contraindication to vaccination with TIV.

Previously, the AAP Red Book considered anaphylaxis to egg or severe egg allergy a contraindication to receiving the vaccine.

"The benefits of flu shots are well established and clearly outweigh the risks for children with egg allergy," lead author Matthew J. Greenhawt, MD, from the University of Michigan in Ann Arbor, said in a statement.

"Children with food allergies are more likely to have asthma, which can increase their chance of respiratory complications from the flu. Expanding the population of children who receive flu shots will play an important role in decreasing influenza associated with hospitalization and in promoting the overall health of our children," he explained.

Dr. Greenhawt and his coinvestigators sought to evaluate the safety of TIV in children in this prospective double-blind placebo-controlled trial.

Using a 2-step approach, the group randomized 28 children who were contraindicated for TIV according to previous AAP Red Book criteria to receive either a 10%/90% split dose of TIV (n = 13), or to receive normal saline plus 100% TIV (n = 15) to mimic the split dose.

In these 28 children, the mean egg skin test wheal was 7.7 mm, mean egg white ImmunoCAP was 23.1 kuA/L, mean ovalbumin ImmunoCAP was 20.4 kuA/L, and mean ovomucoid ImmunoCAP was 18.1 kuA/L.

There were no differences in these values between the 2 groups, Dr. Greenhawt reported.

In addition, they investigators retrospectively analyzed 32 children with severe egg allergy who were vaccinated by their primary care physician despite the contraindication, for comparison.

This retrospective group consisted of 13 children who received TIV as a split dose as a safety precaution and 19 who received it as a single dose. The mean egg white ImmunoCAP was 18.2 kuA/L, and there was no difference between children who received a single or a 2-step split dose of TIV.

None of the children developed an allergic reaction.

"Use of 2-step split dosing appears unnecessary, as a single dose was well tolerated by those who received this either in an allergy clinic or in the primary care setting," Dr. Greenhawt concluded.

Todd A. Mahr, MD, director of pediatric allergy/immunology at Gundersen Lutheran Medical Center in La Crosse, Wisconsin, and clinical professor of pediatrics at the University of Wisconsin Medical School in Madison, was comoderator of the session. He told Medscape Medical News that "the nice thing about this paper is that it reaffirms the ACIP and the AAP recommendations that have come out for administration of TIV in egg-allergic patients. This paper was actually submitted before [those recommendations] came out. It is nice to have it at our meeting to reconfirm the new recommendations."

"What ACIP and AAP say now is that if the patient can eat egg cooked in things, the general practitioner can just go ahead and give TIV and watch the patient for 30 minutes afterwards," said Dr. Mahr, who was not part of the current study.

Patients with a history of anaphylactic reaction to egg should be sent to a specialist for vaccination. "That specialist can decide what to do. One option is to do a 2-step dosing; another is to give it in 1 dose and be prepared to handle anaphylaxis," Dr. Mahr said.

Dr. Greenhawt reports financial relationships with Phadia, Sunovion, and Nutricia. Dr. Mahr reports financial relationships with ISTA, Alcon, AstraZeneca, Genentech, GlaxoSmithKline, Merck, and Novartis.

American College of Allergy, Asthma & Immunology (ACAAI) 2011 Annual Scientific Meeting: Abstract 2. Presented November 6, 2011.

 

Authors and Disclosures

Journalist

Fran Lowry

is a freelance writer for Medscape.

Disclosure: Fran Lowry has disclosed no relevant financial relationships.

 

Comments

aed939

Whether or not it is safe for a child with an egg allergy to get another flu shot is not the point. The flu shots may be causing the egg allergy in the first place. My daughter was a regular egg eater until after she received her first flu shot at age 18 months. She then could not eat egg whites for about 2 months. She received a second flu shot at 2 1/2 years, and has since had an egg white allergy up to the present (6 years).

Don't get the flu shots unless you want to give your child potentially a lifetime of egg allergy. Just take Vitamin D3. Our family hasn't had any cold or flu for 6 years, including 2 children.

patrons99

This is very typical of the "bilge" that emanates with great regularity from Medscape. Bob Moffitt - once again your comment cuts right to the heart of the issue. The COIs are legion and too numerous count. This is a great example of why most of the published medical literature over the last 20 years should be piled-up and burned. It can not be trusted.

oneVoice

Give one dose and be prepared to handle an anaphylaxis???!!!
This is a very dangerous way to go.Then the patient needs
Epinephrin or Benadryl or other meds or even worse Iv. or
oxygen.Where is the common-sense? Where is the duty to care?
What about the best interest of the patient? The harm is greater then the benefit of the flu vaccine.Please do not harm the people with allergies.Pharma is desperate,like an
abusive boy friend,we can not get rid of these parasites.

Shiny Happy Person

"That specialist can decide what to do. One option is to do a 2-step dosing; another is to give it in 1 dose and be prepared to handle anaphylaxis"

Perhaps another option might be, oh, I dunno, maybe asking the stakeholder, the patient, the one who assumes all the risk, what they want to do, while explaining why the nurse is rolling in the crash cart.

Maybe it's just me cynically reading into the comments in the article, but there seems to be just a hint of medical fascism in the subtle undertones. Informed consent, primum non nocere - it may not have been the author's intent, but the article does not exactly reek of support for these basic principles.

Patrick

I was trying to find this study, but only found this about one Dr. :
http://projects.propublica.org/docdollars/top_earners/mahr-todd--3
When these guys get so much money to speak about these tiny, unethical studies that they are not involved with, it's hard to take the results seriously.

david burd

Quoting from Dr. Sheri Tenpenny: "The Cochrane Collaboration produced a series of articles in 2005. ---- In a review of 51 studies involving more than 260,000 children, including 17 papers translated from Russian, researchers concluded that there was “No evidence that injecting children 6-23 months of age with flu vaccines is any more effective than placebo.”

This Medscape article on possible egg allergies cited investigators reporting a total of 60 children in the two small study groups but conveniently gave no report as to any coming down with verifiable flu illness, or not. As Sherlock Holmes might say, 'the dog did not bark.'

Kevin

Donna, your comment cracked me up!

Bob, thanks for the research. Once again, Dr.'s will take money from where ever and defend them...

Joanna

Does anyone else think it's scary that they even tried this? "Your kid has an egg allergy, so we're going to test this vaccine made in eggs just to see. You're okay with that, right Mom?" And what if the results were different. "All the children died, so keep the contraindiction listed. Oops! Do we have egg on our face?" or would they have said "There is no proof these children didn't die from other things."?

Erik Nanstiel

In my mind, even if you can prove that flu shots administered to those with egg allergies won't produce a life threatening reaction... doesn't prove that egg ingredients in vaccines didn't cause the allergy... nor does it prove that you're not exacerbating that allergy when the person is confronted with exposure to eggs.

Sylvia

This is just freaky-scary!

Not an MD

I think it is a disgrace that doctors, public health officials, and of course, the vaccine manufacturers, are trying to force vaccines capable of causing deadly anaphylaxis in certain children and adults upon them on an annual basis, with no regard for their well being. What this study shows me is that the pharmaceutical industry doesn't want anyone to have the ability to opt out of any shots for any reason. Say goodbye to valid medical contraindications, everyone. Industry wants 100% compliance, so they can get 100% of the possible profits. This, to me, is evidence of an intent to harm, not to protect. Look for flu shot mandates for everyone, including those with severe egg allergies, in the future.

Imagine a law that mandates individuals with severe peanut allergy to eat peanuts on an annual basis, because peanuts are good for everyone. Just be sure to have an Epi-pen nearby. This is barbaric. But wouldn't the peanut farmers be happy?

Donna L.

Stay tuned next week for: Individuals Allergic to Penicillin Should Be Given Penicillin.

By 2012, the AAP hopes to do away with entirely that whole pesky "Is your child allergic to any medications?" question. Explains one AAP spokesperson, "That question simply takes up too much of the medical staff's valuable time. We don't think parents should know about their children's allergies anyway."

Bob Moffitt

"Dr. Greenhawt reports financial relationships with Phadia, Sunovion, and Nutricia. Dr. Mahr reports financial relationships with ISTA, Alcon, AstraZeneca, Genentech, GlaxoSmithKline, Merck, and Novartis."

I know I am a cynic .. but .. in this cynic's opinion .. these "researchers" appear to have been recruited by the same public health-vaccine industry "head hunters" .. as those that recruited the now infamously discredited Poul Thorsen that found autism actually increased in Denmark AFTER thimerosal had been removed.

By the way .. was this "study" funded BECAUSE of the "relationship" Dr. Mahr enjoys with GSK, Merck and Novartis?

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