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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

Flow Diagram Showing Management and Outcome of Patients.
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Figure 2: Flow Diagram Showing Management and Outcome of Patients.

Mentions: Figure 2 presents the management of our patients. Of the 79 egg-allergic patients, 71 were not tested to the vaccine and 8 were tested to the vaccine. Of these 71 patients not tested to vaccine, 16 patients were given the vaccine as a single dose, 53 were given the vaccine as a two dose regimen (including 2 with a history of positive influenza vaccine skin test in a prior year), and two patients refused the vaccine (1 decided the wait was too long, 1 did not consent). The 16 patients who were vaccinated in a single dose had the following histories of reaction to egg ingestion: 7 had never eaten egg, 2 had urticaria and/or angioedema, 2 had anaphylaxis (skin and gastrointestinal symptoms), 2 had a perioral rash, 1 had pruritis alone, 1 had urticaria to an unknown food, 1 had gastrointestinal symptoms only, and for one patient there was no data. The 53 patients vaccinated in two doses had the following histories of reaction to egg: 18 had urticaria and/or angioedema, 17 had anaphylaxis to egg, 10 had never eaten egg, 1 had anaphylaxis to an unknown food, 1 had urticaria and throat tightness, 1 had a perioral rash, 2 had gastrointestinal symptoms only, 1 had a reaction to egg not remembered well enough to describe and for 2 patients there was no data. There were 13 patients with "mild egg allergy" based on their histories that were given the vaccine in the more cautious two graded dose regimen whereas the algorithm suggested a single dose. Three patients were given the vaccine in a single dose when two were suggested by our algorithm based on their egg history. No patient had any reaction to the vaccine.


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)

Flow Diagram Showing Management and Outcome of Patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Flow Diagram Showing Management and Outcome of Patients.
Mentions: Figure 2 presents the management of our patients. Of the 79 egg-allergic patients, 71 were not tested to the vaccine and 8 were tested to the vaccine. Of these 71 patients not tested to vaccine, 16 patients were given the vaccine as a single dose, 53 were given the vaccine as a two dose regimen (including 2 with a history of positive influenza vaccine skin test in a prior year), and two patients refused the vaccine (1 decided the wait was too long, 1 did not consent). The 16 patients who were vaccinated in a single dose had the following histories of reaction to egg ingestion: 7 had never eaten egg, 2 had urticaria and/or angioedema, 2 had anaphylaxis (skin and gastrointestinal symptoms), 2 had a perioral rash, 1 had pruritis alone, 1 had urticaria to an unknown food, 1 had gastrointestinal symptoms only, and for one patient there was no data. The 53 patients vaccinated in two doses had the following histories of reaction to egg: 18 had urticaria and/or angioedema, 17 had anaphylaxis to egg, 10 had never eaten egg, 1 had anaphylaxis to an unknown food, 1 had urticaria and throat tightness, 1 had a perioral rash, 2 had gastrointestinal symptoms only, 1 had a reaction to egg not remembered well enough to describe and for 2 patients there was no data. There were 13 patients with "mild egg allergy" based on their histories that were given the vaccine in the more cautious two graded dose regimen whereas the algorithm suggested a single dose. Three patients were given the vaccine in a single dose when two were suggested by our algorithm based on their egg history. No patient had any reaction to the vaccine.

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