University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• Are egg allergic children more likely to have adverse reaction to the influenza vaccine as compared to non-egg allergic children?

Clinical Bottom Lines

1. While this study is promising, there is not enough data to recommend the administration of the influenza vaccine to children with egg allergy.

2. In this small study, there were no anaphylactic reactions to the influenza vaccine in any of the patients.

Summary of Key Evidence

1. 83 egg allergic patients and 124 control patients were enrolled. Egg allergic patients received the influenza vaccine in graded doses (1/10 then 9/10 30 minutes later), while control patients received one age appropriate dose.
2. All patients were skin tested to the influenza vaccine prior to immunization.
3. Patients were monitored for adverse reactions after vaccination for 1 hour, and then again at 24 and 48 hours by phone.
4. None of the 207 patients had anaphylaxis to the influenza vaccine
5. Patients who were skin test positive to the influenza vaccine all tolerated the vaccine without anaphylaxis.
6. All Egg allergic patients received the graded dose protocol safety. Exact 95% CI, 95.7%, 100%.
7. All control subjects received the vaccine in a 1 dose protocol safely. Exact 95% CI, 97.1, 100%.
8. To obtain a 99.9% CI, approx. 8000 patients would have to receive this vaccine without reactions.

Additional Comments

• •Small patient population led to unacceptable confidence interval.
  • Meta analysis performed on several studies of MMR tolerated in egg allergic patients vaccines led to the support of MMR for children with egg allergy.
  • There are variable amounts of egg content in various influenza vaccines, making it difficult to standardize research and apply it to all patients and all vaccines. Standardizing egg content in vaccines would also be helpful.

Citation

1. James, J, et al. Safe administration of influenza vaccine to patients with egg allergy. J Pediatr. 1998. Nov;133(5):624-8. 2. James, J. et al.

2. Safe administration of the measles vaccine to children allergic to eggs. The New England Journal of Medicine. 1995. May 11. 1262-1266.

CAT Author: Laura Howe, MD

CAT Appraisers: Kerry Mychaliska, MD

Date appraised: 04/01/2009