Egg-allergic children and vaccines

It was once said that if a child had an egg allergy, the child should be excluded from receiving certain vaccinations. However, as of recently these recommendations have changed.

The American Academy of Allergy, Asthma and Immunology (AAAAI) revised their previous recommendations concerning immunizations and egg allergy. These changes were reported in an October 18, 2010 Eurekalert! press release.

The AAAAI advised that egg allergy should not automatically exclude a child from being immunized. Instead, an allergist or immunologist can test the child to determine whether or not they are at risk from the vaccine.

Such vaccines that used to be recommended unsafe for an egg-allergic child were the flu vaccine and the measles, mumps and rubella (MMR) vaccine, all of which contain proteins related to eggs.

In the wake of the H1N1 pandemic last year, several research groups decided to re-investigate the risk of influenza vaccine, which contains egg protein in the form of ovalbumin, in egg allergic individuals. For many years, it has been assumed that the residual egg protein poses a potential allergy risk to egg allergic individuals. Thus, caution has been taken in vaccinating such individuals.

Examples of steps taken to reduce the risk of reaction include skin testing to the vaccine, graded/staged dosing and since the late 1990’s, use of vaccine that contained less than 1.2 micrograms of ovalbumin/mL.For those with a history of severe reaction to egg, the vaccine is technically contraindicated by the CDC, the American Academy of Pediatrics and the individual vaccine makers. Though many allergists have administered influenza vaccine to such patients for many years, using one of the aforementioned steps helps to reduce risk.

Three studies examined the safety issues surrounding the influenza vaccine. Interestingly, it appears that many past assumptions about the vaccine not being safe for egg allergic individuals may be wrong. There were several major findings from these studies.

The study determined that skin testing to the vaccine does not appear to be necessary or helpful in predicting if someone will tolerate the vaccine. Specifically, two of the large studies showed that patients could safely receive the vaccine without skin testing.A third showed that patients with positive skin tests to the vaccine did not react when given the vaccine and that the vaccine may actually be a skin irritant and cause false positive testing.

The study also showed that either a single dose or a two step graded challenge seem to be acceptable ways to vaccinate egg allergic individuals, but multi-step desensitization is not necessary.

Also, the amount of egg (ovalbumin) in influenza vaccine appears low and under what was previously established to be a safe level. Furthermore, nearly every manufacturer now lists how much ovalbumin is contained per mL of vaccine, which is of use in choosing the lowest ovalbumin containing vaccine.

Though 1.2 micrograms/mL is generally considered the “threshold” level below which the vaccine is safe, no evidence exists that higher levels are associated with reactions. Of note, there is also no evidence that egg allergic patients who have reacted to the influenza vaccine in the past actually reacted to the residual ovalbumin, as opposed to some other vaccine component.

Finally, the report showed that most, if not all egg allergic patients, can safely receive the vaccine. In fact, nearly 100 patients with a history of a severe allergy to egg received the vaccine in these studies without incident.

Although the research shows to be promising, if you have egg-allergic children and you desire to vaccinate your children, be sure to consult with your pediatrician or your allergist concerning these results.

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