ACIP Recommends Flu Vaccine for Egg-Allergic Persons



ATLANTA – Influenza vaccine should be given to persons with less severe egg allergies, as long as certain conditions are observed, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices voted at its June 23 meeting.

People with a less severe allergy were defined as "individuals who have experienced only hives following exposure to egg." Flu vaccination information for persons at risk for more severe reactions will be handled differently, said ACIP chair Dr. Carol Baker, who is professor of pediatrics, molecular virology, and microbiology at the Baylor College of Medicine, Houston.

The ACIP voted that individuals who have experienced only hives following exposure to egg should receive influenza vaccine with the following additional measures:

• As studies published to date involved use of TIV (trivalent inactivated vaccine), TIV rather than LAIV (live attenuated influenza vaccine) should be used.

• Vaccine should be administered by a health care provider who is familiar with the subject of egg allergy.

• Vaccine recipients should be observed for at least 30 minutes for signs of a reaction following administration of each vaccine dose.

The ACIP recommendation also notes that "other measures, such as dividing and administering the vaccine by a two-step approach and skin testing with vaccine, are not necessary." In addition, "egg allergy may be confirmed by a consistent medical history of adverse reactions to eggs and egg-containing foods, plus skin and/or blood testing for IgE antibodies to egg proteins," according to the recommendations.

During the discussion period, several ACIP members emphasized that the recommendations are for the upcoming 2011-2012 flu season.

In a separate vote, the ACIP voted to accept the virus strains for the upcoming season, which are the same as last year: A/California/7/2009 (H1N1-like), A/Perth/16/2009 (H3N2-like), and B/Brisbane/60/2008-like.

"We will be making note of the new intradermal vaccine, which is proposed to be an alternative" for the indicated age groups, Dr. Baker noted.

The vote on vaccine strains also included the recommendation for influenza vaccine in children aged 6 months through 8 years. For this age group, children who received at least one dose of vaccine during the 2010-2011 flu season should have one dose this year. Children in this age group who are receiving their first flu vaccine in 2011-2012, or whose vaccination status is unknown, should receive two doses at least 4 weeks apart.

The ACIP also voted to include a footnote stating that children aged 6 months through 8 years who received at least one dose of flu vaccine prior to the 2010-2011 season should receive one dose this season.

The ACIP recommendations were based on data presented by Dr. John M. Kelso, an allergist and immunologist at the Scripps Clinic in San Diego, Calif. Dr. Kelso and members of the Clinical Immunization Safety Assessment (CISA) Network Hypersensitivity Working Group reviewed data from 17 studies, including more that 2,600 egg-allergic persons, most of whom were children, who showed no serious reactions (such as respiratory distress or hypertension) and a low rate of minor reactions (such as hives and wheezing).

"It is very likely that there’s just not enough ovalbumin in the vaccine to cause a problem," Dr. Kelso said.

Although specific recommendations for the amount of ovalbumin in flu vaccines were cut from the ACIP recommendations, Dr. Kelso noted that the studies he reviewed showed no serious reactions at doses up to 0.7 mcg per 0.5 mL of vaccine.

None of the presenters reported any relevant financial disclosures.

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