We do receive a number of referrals every year (10–15) from GPs for MMR to be administered in a hospital setting. The live measles and mumps vaccine is grown on cultured chick embryo fibroblasts and there is a concern that there could be some amount of egg protein in the vaccine. The controversy surrounding MMR and egg allergy has been long standing even though the hen's egg protein in the vaccine is highly processed and the concentrations are very low to trigger any allergic reaction.1 There has been a vast amount of evidence2,3 published already about the safety of MMR in children with egg allergy. In spite of various recommendations and guidelines, children are still being referred for MMR to be administered in a hospital setting.
The guidance in the UK surrounding MMR and egg allergy has changed over the years. The recommendations for MMR vaccine in egg allergic children were published in 2000.1 It stated that children with mild egg allergy can be safely vaccinated in primary care and recommended that children with previous significant allergic reactions should be vaccinated in hospital. Most of our practice is still based on these recommendations.
The latest British Society of Allergy and Clinical Immunology (BSACI) guidance recommends that all children with egg allergy should be immunised in primary care. ‘Children who have had documented anaphylaxis to the vaccine itself should be assessed by an allergist’.4
Our approach has always been to write back to GPs or to speak to them directly about the safety of MMR in egg allergy. We, however, do not know if any of these children did ever go on to have the vaccine in primary care.
We agree with the recommendation by Ainsworth et al5 of attaching a copy of BSACI guidelines when we write back to our GPs. Although the guidelines have been published, there is still a possibility that many of our colleagues in primary care are not aware of them. We believe that inclusion of these recommendations in all the immunisation leaflets and related websites would lead to increased awareness and reduce the confusion surrounding this controversy. We hope that the green book would include the same advice in its next edition.
REFERENCE
- 1.Khakoo GA, Lack G. Recommendations for using MMR vaccine in children allergic to eggs. BMJ. 2000;320(7239):929–932. [PubMed] [Google Scholar]
- 2.James JM, Burks AW, Roberson PK, Sampson HA. Safe administration of the measles vaccine to children allergic to eggs. N Engl J Med. 1995;332(19):1262–1266. doi: 10.1056/NEJM199505113321904. [DOI] [PubMed] [Google Scholar]
- 3.Aickin R, Hill D, Kemp A. Measles immunisation in children with allergy to egg. BMJ. 1994;309(6949):223–225. doi: 10.1136/bmj.309.6949.223. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Clark AT, Skypala I, Leech SC, et al. British Society for Allergy and Clinical Immunology guidelines for the management of egg allergy. Clin Exp Allergy. 2010;40(8):1116–1129. doi: 10.1111/j.1365-2222.2010.03557.x. [DOI] [PubMed] [Google Scholar]
- 5.Ainsworth E, Debenham P, Carrol ED, Riordan FA. Referrals for MMR immunisation in hospital. Arch Dis Child. 2010;95(8):639–641. doi: 10.1136/adc.2009.162487. [DOI] [PubMed] [Google Scholar]