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

Upton JE, Hummel DB, Kasprzak A, Atkinson AR - Allergy Asthma Clin Immunol (2012)

Bottom Line: Egg allergy was confirmed with skin testing.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.The squalene adjuvant may cause an irritant reaction with intradermal testing.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Immunology and Allergy, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. julia.upton@sickkids.ca.

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.

No MeSH data available.


Related in: MedlinePlus

Protocol for the Management of Egg-Allergic Patients Referred for Adjuvuanted Pandemic H1N1 Influenza A Vaccination.
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Related In: Results  -  Collection

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Figure 1: Protocol for the Management of Egg-Allergic Patients Referred for Adjuvuanted Pandemic H1N1 Influenza A Vaccination.

Mentions: Egg-allergic patients were assessed at the time of clinic for the severity of their egg reaction, prior influenza reactions and co-morbid conditions. Figure 1 presents the algorithm provided to physicians. Patients were to be classified as "mild egg allergy" if they had never experienced any generalized reaction of urticaria, angioedema, or respiratory reactions to egg and were to be vaccinated in one dose and be monitored for 60 minutes. This "mild egg allergy" category would include, for example, gastrointestinal reactions alone and patients who had never ingested egg but had positive skin prick tests, Patients were to be classified as "severe egg allergy" if they had any generalized reaction to egg and were to be administered the pH1N1 vaccine in split doses of 10% and then the remainder if there was no reaction. This category of patients would include patients who had urticaria/angioedema to egg, or respiratory reactions to egg, as well as anaphylaxis. The classification of "exquisite egg allergy and/or significant co-morbidity" was to be used if it was determined by the physician that their egg allergy history or their co-morbidities were so severe that skin testing was indicated prior to vaccination. Examples of the type of patient that may be classified in this category may include a patient who experienced anaphylaxis requiring an intensive care admission, or one who experienced anaphylaxis from only touching an egg shell, or a non-verbal patient who would not be able to alert the physician to early signs of an allergic reaction. These patients were to have SPT with full strength vaccine. If negative they were to be intradermally tested with 1:200 of the antigen solution of the vaccine without the adjuvant. This dilution is 1:100 of the final concentration of the vaccine because in vaccine preparation equal parts of antigen vial and adjuvant vial are mixed. If skin tests were positive the vaccine was offered in a 5 step graded challenge. If testing was negative the vaccine was offered in a single or two dose regimen at the physician's discretion.


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

Upton JE, Hummel DB, Kasprzak A, Atkinson AR - Allergy Asthma Clin Immunol (2012)

Protocol for the Management of Egg-Allergic Patients Referred for Adjuvuanted Pandemic H1N1 Influenza A Vaccination.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3313878&req=5

Figure 1: Protocol for the Management of Egg-Allergic Patients Referred for Adjuvuanted Pandemic H1N1 Influenza A Vaccination.
Mentions: Egg-allergic patients were assessed at the time of clinic for the severity of their egg reaction, prior influenza reactions and co-morbid conditions. Figure 1 presents the algorithm provided to physicians. Patients were to be classified as "mild egg allergy" if they had never experienced any generalized reaction of urticaria, angioedema, or respiratory reactions to egg and were to be vaccinated in one dose and be monitored for 60 minutes. This "mild egg allergy" category would include, for example, gastrointestinal reactions alone and patients who had never ingested egg but had positive skin prick tests, Patients were to be classified as "severe egg allergy" if they had any generalized reaction to egg and were to be administered the pH1N1 vaccine in split doses of 10% and then the remainder if there was no reaction. This category of patients would include patients who had urticaria/angioedema to egg, or respiratory reactions to egg, as well as anaphylaxis. The classification of "exquisite egg allergy and/or significant co-morbidity" was to be used if it was determined by the physician that their egg allergy history or their co-morbidities were so severe that skin testing was indicated prior to vaccination. Examples of the type of patient that may be classified in this category may include a patient who experienced anaphylaxis requiring an intensive care admission, or one who experienced anaphylaxis from only touching an egg shell, or a non-verbal patient who would not be able to alert the physician to early signs of an allergic reaction. These patients were to have SPT with full strength vaccine. If negative they were to be intradermally tested with 1:200 of the antigen solution of the vaccine without the adjuvant. This dilution is 1:100 of the final concentration of the vaccine because in vaccine preparation equal parts of antigen vial and adjuvant vial are mixed. If skin tests were positive the vaccine was offered in a 5 step graded challenge. If testing was negative the vaccine was offered in a single or two dose regimen at the physician's discretion.

Bottom Line: Egg allergy was confirmed with skin testing.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.The squalene adjuvant may cause an irritant reaction with intradermal testing.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Immunology and Allergy, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. julia.upton@sickkids.ca.

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.

No MeSH data available.


Related in: MedlinePlus