Abstract
BackgroundThere 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.MethodsEgg 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.ResultsNinety-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.ConclusionsOur 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.
Highlights
There are numerous, disparate guidelines for influenza vaccination in egg-allergic patients
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
* Correspondence: julia.upton@sickkids.ca 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 parameters [9] to recommend that if the ovalbumin content is known to be less than 1.2 mcg/ml the vaccine can be given as 10% followed in 30 minutes by 90%, or as a single dose, without prior testing
Summary
There are numerous, disparate guidelines for influenza vaccination in egg-allergic patients. In 2009 the Canadian Society of Allergy and Clinical Immunology (CSACI) [10] and a review in the British Medical Journal [11] included a risk-stratification suggestion such that low-risk individuals could be vaccinated in one dose while higher risk would receive split-dosing. This approach was not endorsed by some other guidelines, such as the Red Book [1], and the European Academy of Allergy and Clinical Immunology [12]
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