Coordination of multidisciplinary resources for vaccination of egg-allergic individuals during an H1N1 (novel) influenza pandemic

Abstract

Egg allergy is a contraindication for influenza vaccination because of the presence of trace egg protein. Although recent reports suggest that egg-allergic individuals can be safely immunized with seasonal influenza vaccine, the safety of H1N1 influenza vaccine in this context has not previously been reported. This study was designed to investigate how to safely immunize high-risk populations during the H1N1 influenza pandemic for whom the vaccine would be contraindicated. Vaccination of egg-allergic children was conducted at a large, multispecialty practice. Pediatricians raised awareness of vaccination and referred egg-allergic individuals to allergists. Allergists performed skin testing to H1N1 vaccine and, if negative, performed graded vaccine desensitizations in the office. Mass immunization of egg-allergic individuals was achieved within a 3-week period after receipt of vaccine. Sixty-three children (average age, 3.7 years) were evaluated and skin tested to the H1N1 influenza vaccine. All had a clinical history of egg allergy and recent positive skin-prick to egg. All had negative skin-prick test to the H1N1 vaccine and received graded challenge with three divided doses. All 62 children were successfully immunized without allergic reactions. Vaccination of egg-allergic individuals during a pandemic can be safely and efficiently accomplished with the coordination of multidisciplinary resources. Although this was conducted at a multispecialty practice, we believe that this invaluable public health service can be done outside of this context. Allergists, with the help of local pediatricians and urgent care centers or hospitals, can effectively mobilize to help protect the most vulnerable populations during pandemics.

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2023–24 Influenza Season

“…Less severe reactions not described as anaphylaxis but involving cardiovascular symptoms, respiratory symptoms, angioedema, or generalized urticaria, or which involved treatment with medications or outpatient or emergency department attention occurred with low frequency (<1%). A similar profile was noted among 13 studies of monovalent H1N1pdm09 influenza vaccine, with no reported instances of anaphylaxis; frequency of reactions involving cardiovascular symptoms, respiratory symptoms, angioedema, or generalized urticaria events of <1%, and of events involving treatment with medications or outpatient or emergency department attention of approximately 1.5% (certainty level: very low) (114,115,(123)(124)(125)(126)(127)(128)(129)(130)(131)(132). One US Department of Health and Human Services/Centers for Disease Control and Prevention instance of anaphylaxis meeting a surveillance case definition (i.e., Brighton Level 1 criteria) in a person with possible egg allergy was noted in a summary of VAERS reports after administration of monovalent H1N1pdm09 influenza vaccine during the 2009-10 influenza season; no denominator of doses administered was available but it was noted that approximately 127 million doses of monovalent IIV were distributed in the United States that season (133).…”

A review of a paediatric emergency department vaccination programme for patients at risk of allergy/anaphylaxis

“…Although this is a small number of patients relative to the overall study population, more patients may be referred for this vaccine in the future as a national programme has been rolled out. Allergic reaction to this vaccine is uncommon, however (23).…”

Vaccination in children with allergy to non active vaccine components

“…These allergic reactions rates did not differ significantly from those in non‐egg‐allergic controls [24‐26]. In investigations published in the last ten years [21,23‐37] the frequency of allergic reactions to vaccine was 2.62% in 6532 subjects (Table 1). The American Academy of Paediatrics [19] has recently stated that the risks of missing influenza vaccination outweigh those from vaccination itself.…”