No systemic reactions to influenza vaccination in egg-sensitized tertiary-care pediatric patients
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ALLERGY, ASTHMA & CLINICAL IMMUNOLOGY
RESEARCH
Open Access
No systemic reactions to influenza vaccination in egg-sensitized tertiary-care pediatric patients Julia Elizabeth Mainwaring Upton*, David Brian Hummel, Anna Kasprzak and Adelle Roberta Atkinson
Abstract Background: There are numerous, disparate guidelines for influenza vaccination in egg-allergic patients. We aimed to describe the outcome of selectively applied guidelines, based on risk-stratification, to our high risk, egg-allergic, tertiary-care pediatric population. Methods: Egg allergy was confirmed with skin testing. The vaccine administered was an adjuvunated 2009 H1N1 influenza A vaccine with < 0.165 mcg/ml ovalbumin. Patients with mild egg allergy were to receive the vaccination in 1 dose, those with severe egg allergy were to receive 2 split doses, and patients with exquisite egg allergy or significant co-morbidities were to be skin tested with the vaccine (prick full strength, intradermal 1:100 of final concentration without adjuvant) and had 5 step desensitization if the testing was positive, or 1-2 step administration if negative. Patients were observed for 60 minutes after the final dose and anaphylaxis treatment was available. We report the frequency of allergic reactions. Results: Ninety-nine patients were referred and 79 had positive egg testing. Asthma was present in 67% and 30% had prior anaphylaxis to egg. We vaccinated 77 of 79 patients: 71 without performing vaccine skin testing. Two refused vaccination. No patient had a systemic reaction or required treatment. Two patients experienced positive testing to the adjuvanated intradermal vaccine, but were negative without adjuvant. Conclusions: Our results suggest that most egg-allergic tertiary care pediatric patients can be vaccinated with a low ovalbumin content influenza vaccine without prior vaccine testing. Vaccine skin testing, if used at all, can be reserved for special circumstances. The squalene adjuvant may cause an irritant reaction with intradermal testing. Keywords: egg allergy, vaccination, influenza virus, adjuvant, squalene
Background Influenza vaccination has traditionally been contraindicated in individuals with egg allergy [1,2] due to the possibility of an allergic reaction to residual egg proteins. Approaches have been recommended to vaccinate egg-allergic individuals. One approach recommends skin testing prior to vaccination [3] and use of a graded challenge [4]. However, there has been evidence demonstrating that the influenza skin testing may not be predictive of reactions [5-7] and intradermal testing has been shown to have an irritant response [8]. There is no such data on intradermal skin testing performance with an adjuvanated influenza vaccine.
* Correspondence: [email protected] Division of Immunology and Allergy, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
Another approach is to give the vaccine in two doses as described in 1997 by James et al. [6]. This evidence was used by the 2009 vaccine allergy practice parame
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