Major Finding: After testing negative to skin prick tests with influenza vaccine, the children were given the full, age-appropriate vaccine dose in one injection. One patient had a large local reaction, and another developed cellulitis at the injection site. There were no systemic reactions.
Data Source: Prospective case series of 101 patients followed at Duke University's allergy/immunology clinic.
Disclosures: Dr. Boden said he had no relevant financial disclosures. Dr. Boden is sponsored by the U.S. Air Force. The views expressed are his and do not necessarily reflect the official policy of the Air Force, the Department of Defense, or the U.S. government.
SAN FRANCISCO – Influenza vaccine was safely administered to 101 children with severe egg allergy who had negative skin prick test results with the vaccine, a study has shown.
All patients had been strictly avoiding egg in their diet because of allergy confirmed by a history of reaction to egg, skin prick testing, and/or egg-specific IgE. Among 50 children who had a history of systemic reactions to egg, 24 developed urticaria, 22 had a gastroenterologic reaction, and 4 had respiratory reactions. Thirty-one children had a history of eczema after ingesting egg, and 20 had no history of ingestion at the time of diagnosis.
All underwent skin prick testing with the full-strength influenza vaccine along with saline and histamine controls. The tests used vaccine for seasonal or novel H1N1 influenza virus or both.
The vaccines came from three different manufacturers, with the majority from a manufacturer who had been known to produce several vaccine lots with ovalbumin content greater than 1.2 mcg/mL, Dr. Stephen R. Boden said in a poster presentation at the meeting.
None of the children developed a wheal at the vaccine skin prick site that was at least 3 mm larger than the wheal from the saline control, so all had negative skin prick test results, said Dr. Boden, an allergy fellow at Duke University, Durham, N.C. Tests were considered valid with at least a 3-mm wheal from the histamine control.
All patients then were given the full, age-appropriate vaccine dose in one injection and were observed in the clinic for 30 minutes. Two reactions were reported 24 hours after vaccination. One patient had a large local reaction, and another developed cellulitis at the injection site. There were no systemic reactions.
Patients who had tolerated vaccination were told to get booster doses from their primary care physicians, but could get the booster doses in the university's allergy/immunology clinic if they preferred. In all, the children received 211 vaccine doses, Dr. Boden reported.
The mean age of the cohort was 4 years (range, 7 months to 18 years). Wheals from egg skin prick testing averaged 9 mm in diameter (range, 1–28 mm). The mean egg-specific IgE level was 21 kU/L, with a range of less than 0.35 to more than 100 kU/L.
The Centers for Disease Control and Prevention recommend yearly influenza vaccination for all children older than 6 months. Current recommendations from the American Academy of Pediatrics say that children with severe egg allergy generally should not be given influenza vaccine because of the risk of reaction and other reasons, Dr. Boden said. Published schedules for giving influenza vaccine to some severely egg-allergic patients recommend skin prick testing, intradermal testing, and graded vaccine injection (J. Pediatr. 1985;106:931-3).
Had any of the patients in the current study had a positive skin prick test result, the patient would have received the vaccine split into 10% of the age-appropriate dose in the first injection followed 30 minutes later by the remaining 90% of the dose.