Editorials

Live attenuated influenza vaccine for children with egg allergy

BMJ 2015; 351 doi: http://dx.doi.org/10.1136/bmj.h6656 (Published 09 December 2015) Cite this as: BMJ 2015;351:h6656
  1. Matthew Greenhawt, assistant professor of pediatrics
  1. 1Allergy Section, Children’s Hospital Colorado, University of Colorado Denver School of Medicine, Aurora, CO 80045, USA
  1. Matthew.Greenhawt{at}childrenscolorado.org

Policies should change to allow vaccination, after compelling new evidence of safety

Influenza vaccine is egg derived and has been contraindicated in people with egg allergy. It contains low residual levels of the egg protein ovalbumin and its use in people with egg allergy theoretically risks an allergic reaction.1 However, no study has shown that residual ovalbumin content can cause adverse events (including anaphylaxis related morbidity or mortality) in egg allergic recipients, or that vaccination is riskier for these recipients than for the general population.2 Many allergy specialists have circumvented the contraindication by using vaccine skin testing, vaccine desensitisation, and vaccines containing low concentrations of ovalbumin (<1.2 µg/mL). But governmental agencies and vaccine manufacturers have continued to issue this contraindication annually.2 3

The infectious risk attributable to this contraindication is substantial. Influenza infection caused 49 000 deaths between 1976 and 2006, and each year in the United States it contributes to 294 128 admissions to hospital (including 21thin>156 in under 5s).4 5 Egg allergy affects approximately 2-6% of children. One third of these children have asthma, making egg allergic children a vulnerable subgroup at high risk of influenza related complications, who are often denied a protective vaccine.6 …

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