No systemic reactions to influenza vaccination in egg-sensitized tertiary-care pediatric patients

Allergy, Asthma & Clinical Immunology

Julia Elizabeth Mainwaring Upton¹  David Brian Hummel¹  Anna Kasprzak¹  Adelle Roberta Atkinson¹ 

[1] Division of Immunology and Allergy, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada

关键词: squalene;    adjuvant;    influenza virus;    vaccination;    egg allergy;   

Others  :  792529
DOI  :  10.1186/1710-1492-8-2

 received in 2011-09-23, accepted in 2012-03-02,  发布年份 2012

【 摘 要 】

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.

【 授权许可】

   
2012 Upton et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]American Academy of Pediatrics, Influenza: Red book: 2009 report of the Committee on Infectious Diseases. 28th edition. Edited by Pickering LK, Baker CJ, Kimberlin DW, Long SS. Elk Grove Village (IL): American Academy of Pediatrics; 2009:400-412.
• [2]Influenza Vaccine [http://www.phac-aspc.gc.ca/publicat/cig-gci/p04-inf-eng.php] webciteCanadian Immunization Guide 2006 7th edition. Ottawa: Public Health Agency of Canada; 2006, 209-20.
• [3]Zeiger RS: Current issues with influenza vaccination in egg allergy. J Allergy Clin Immunol 2002, 110:834-840.
• [4]Murphy KR, Strunk RC: Safe administration of influenza vaccine in asthmatic children hypersensitive to egg protein. J Pediatr 1985, 106:931-933.
• [5]Anolik RA, Spiegel W, Posner M, Jakabovics E: Influenza vaccine testing in egg sensitive patients [letter]. Ann Allergy 1992, 68:9.
• [6]James JM, Zeiger RS, Lester MR, Fasano MB, Gern JE, Mansfield LE, Schwartz HJ, Sampson HA, Windom HH, Machtinger SB, Lensing S: Safe administration of influenza vaccine to patients with egg allergy. J Pediatr 1998, 133:624-628.
• [7]Chung EY, Huang L, Schneider L: Safety of Influenza Vaccine Administration in Egg-Allergic Patients. Pediatrics 2010, 125:e1025-e1030.
• [8]Wood RA, Setse R, Halsey N: Irritant skin test reactions to common vaccines. J Allergy Clin Immunol 2007, 120:478.
• [9]Kelso JM, Li JT (Eds): Adverse Reactions to Vaccines Practice Parameter In Ann Allergy Asthma Immuno 2009, 103:1-14.
• [10]The Canadian Society of Allergy and Clinical Immunology: [http://www.csaci.ca/include/files/CSACI_H1N1_Statement.pdf] webciteStatement: administration of H1N1 and seasonal influenza vaccine to egg allergic individuals.
• [11]Erlewyn-Lajeunesse M, Brathwaite N, Lucas J, Warner J: Recommendations for the administration of influenza vaccine in children allergic to egg. BMJ 2009, 339:b3680.
• [12]European Academy of Allergy and Clinical Immunology: [http:/ / www.eaaci.net/ attachments/ 1282_091026_EAACI_Release_%20H1N1_E gg%20Allergy_pub%20-%20Health%20Pro fessionals.pdf] webciteRecommendations for Health Professionals Regarding Seasonal and Swine Influenza Vaccination in Egg Allergic Patients. 2009.
• [13]O'Hagan DT: MF59 is a safe and potent vaccine adjuvant that enhances protection against influenza virus infection. Expet Rev Vaccine 2007, 6:699-710.
• [14]Beck F, Butters D, Matsumoto G, Whitehouse M: Queries about vaccines containing squalene. Immunol Cell Biol 2010, 88:497-499.
• [15]Sampson HA, Munoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, Brown SG, Camargo CA Jr, Cydulka R, Galli SJ, Gidudu J, Gruchalla RS, Harlor AD Jr, Hepner DL, Lewis LM, Lieberman PL, Metcalfe DD, O'Connor R, Muraro A, Rudman A, Schmitt C, Scherrer D, Simons FE, Thomas S, Wood JP, Decker WW: Second symposium on the definition and management of anaphylaxis: summary report - Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol 2006, 117:391-397.
• [16]University of Michigan Health System; American College of Allergy, Asthma and Immunology: Safe Administration of Flu Vaccine to Egg Allergic Children (SAFE). [http://clinicaltrials.gov/ct2/show/NCT01264601] webciteClinicalTrials.gov [Internet] Bethesda (MD): National Library of Medicine (US); 2000. [September 9 2011]. NLM Identifier NCT01264601
• [17]Gagnon R, Primeau MN, Des Roches A, Lemire C, Kagan R, Carr S, Ouakki M, Benoît M, De Serres G: Safe vaccination of patients with egg allergy with an adjuvanted pandemic H1N1 vaccine. J Allergy Clin Immunol 2010, 126:317-323.
• [18]Kelso JM, Li JT, Greenhawt MJ: [http:/ / www.aaaai.org/ Aaaai/ media/ MediaLibrary/ PDF%20Documents/ Practice%20and%20Parameters/ Egg-Allergy-and-Influenza-Vaccine-1 12111.pdf] webciteAmerican Academy Of Allergy Asthma and Immunology: Update on Egg Allergy and Influenza Vaccine . November 2011.
• [19]Kelso JM: Administration of influenza vaccines to patients with egg allergy. J Allergy Clin Immunol 2010, 125:800-802.
• [20]Greenhawt MJ, Li JT: Administering influenza vaccine to egg allergic recipients: a focused practice parameter update. Ann Asthma Allergy Immunol 2011, 106:11-16.
• [21]American College of Allergy Asthma and Immunology: [http:/ / www.acaai.org/ news/ Pages/ egg-allergy-influenza-vaccination-g uideline-statement-2009-2010.aspx] webciteEgg Allergy & Influenza Vaccination Guideline Statement (2009-2010).
• [22]Clark T, Skypala I, Leech SC, Ewan PW, Dugu'e P, Brathwaite N, Huber PAJ, Nasser SM: British Society for Allergy and Clinical Immunology guidelines for the management of egg allergy. Clin Exp Allergy 2010, 40:1116-1129.
• [23]Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2011, 60(33):1128-1132.
• [24]Canadian Pediatrics Society, Statement: [http://www.cps.ca/english/statements/ID/ID11-06.htm] webciteAdministration of H1N1 and Seasonal Influenza Vaccine to Egg Allergic Individuals.
• [25]Greenhawt M, Chernin A, Howe L, Li J, Sanders G: The Safety of H1N1 Influenza A Vaccine in Egg Allergic Children. Ann Allergy Asthma Immunol 2010, 105:387-393.