Blog | Thursday, October 11, 2012

QD: News Every Day--Egg-allergic patients can receive flu vaccines normally

Patients with egg allergies can be vaccinated without requiring administration by an allergist, researchers concluded.

Researchers reported vaccination of egg-allergic patients from a prospective study from five Canadian hospitals, augmented by five years of results from the literature. Results were reported in a letter in the Journal of Allergy and Clinical Immunology.

Egg allergies were defined in one year of prospective study recruitment as symptoms confirmed by testing, and in a second year of recruitment as anaphylaxis or cardiorespiratory symptoms after consuming eggs. Researchers also conducted a retrospective cohort study of all egg-allergic patients referred for flu vaccines for the years 2007-08, 2008-09- and 2009-10 flu seasons.

Over five flu seasons, 457 doses of trivalent inactivated seasonal influenza vaccines were administered to 367 patients, 132 (153 doses) of whom had a history of severe allergy. Four patients reported mild allergic-like symptoms after previous influenza vaccination (one urticaria, two vomiting, and one eczema), but none experienced an adverse event. While 13 patients developed mild symptoms in the 24 hours following vaccination, none developed anaphylaxis.

Researchers conducted a literature review of published studies and conference abstracts, finding 26 studies that, when combined with their research, enrolled 4,172 patients, 513 with a history of severe reactions. These patients received a total of 4,729 doses, and none developed anaphylaxis.

Egg allergies affect about 150,000 to 250,000 preschoolers who would otherwise be eligible for the flu vaccine. "Many of these patients have not benefited from the influenza vaccine in the past because of the fear of anaphylaxis or the difficulty of accessing an allergist as is often recommended," researchers wrote. "Paradoxically, given their young age and the high rate of concurrent asthma, these patients have a higher risk of complications from influenza and are among those most likely to benefit from this vaccine. The evidence gathered over the past 15 years is overwhelmingly reassuring that this risk is minimal. The published number of egg-allergic patients safely vaccinated against influenza is nearly 4 times as large as the number that ended the precautions regarding measles, mumps and rubella (MMR) vaccine (4,172 vs. 1,227)."

(In a separate column, internist Yul Ejnes, MD, MACP, stepped up flu vaccination in his practice through a simple motto, "Get out of the way!")