Abstract
Administration of inactivated trivalent or quadrivalent influenza vaccines is now believed to be safe for individuals with egg allergy. Unless children have experienced an anaphylactic reaction to a previous dose of influenza vaccine, they can and should be immunized with a full dose of trivalent or quadrivalent inactivated vaccine.
Keywords: Anaphylaxis, LAIV, QIV, TIV
Abstract
L’administration des vaccins trivalents ou quadrivalents inactivés anti-grippaux est désormais considérée comme sécuritaire pour les personnes allergiques aux œufs. À moins que les enfants aient présenté une réaction anaphylactique à une dose antérieure de l’un de ces vaccins, ils peuvent et devraient en recevoir une dose complète.
Français en page 554
Since the publication of a Canadian Paediatric Society position statement in 2011,(1) new evidence has been published showing that the risk of a severe allergic reaction following administration of the trivalent inactivated influenza vaccines (TIV) in egg-allergic patients is exceedingly low. Based on review of the recent literature,(2,3) including a study documenting lack of reaction to influenza vaccines in >4100 patients – including >500 with severe egg allergy – the CPS now recommends that all egg-allergic patients be vaccinated with a full dose of inactivated vaccine. There is no reason to believe that quadrivalent inactivated vaccine (QIV) would be less well tolerated than trivalent vaccine. Live attenuated influenza vaccine (LAIV) has not yet been evaluated in egg-allergic children and is not recommended at this time.(4)
The CPS endorses recommendations from the National Advisory Committee on Immunization for the 2014/2015 influenza season, including the following specific guidance: www.phac-aspc.gc.ca/naci-ccni/flu-grippe-eng.php:
All clinics that administer vaccines need to have the expertise and equipment to be able to deal with anaphylaxis, as per the Public Health Agency of Canada’s Canadian Immunization Guide.
All egg-allergic patients should be vaccinated with a full dose of TIV or QIV unless they have previously had anaphylaxis from influenza vaccine. There is no need for split doses or prevaccination skin testing. Postvaccination monitoring should be the same as after any other vaccine.
LAIV should not be used in egg-allergic patients because there are insufficient data to support a recommendation.
The use and safety of LAIV should be studied in egg-allergic patients.
Acknowledgments
This update was reviewed by the Community Paediatrics Committee and Allergy Section executive of the Canadian Paediatric Society.
Footnotes
CPS INFECTIOUS DISEASES AND IMMUNIZATION COMMITTEE
Members: Natalie A Bridger MD; Jane C Finlay MD (past member); Susanna Martin MD (Board Representative); Jane C McDonald MD; Heather Onyett MD; Joan L Robinson MD (Chair); Marina I Salvadori MD (past member); Otto G Vanderkooi MD
Liaisons: Upton D Allen MBBS, Canadian Pediatric AIDS Research Group; Michael Brady MD, Committee on Infectious Diseases, American Academy of Pediatrics; Charles PS Hui MD, Committee to Advise on Tropical Medicine and Travel (CATMAT), Public Health Agency of Canada; Nicole Le Saux MD, Immunization Monitoring Program, ACTive (IMPACT); Dorothy L Moore MD, National Advisory Committee on Immunization (NACI); Nancy Scott-Thomas MD, College of Family Physicians of Canada; John S Spika MD, Public Health Agency of Canada
Consultant: Noni E MacDonald MD
Principal author: Charles PS Hui MD
The recommendations in this document do not indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate. All Canadian Paediatric Society position statements and practice points are reviewed on a regular basis. Retired statements are removed from the website. Please consult the Position Statements section of the CPS website (www.cps.ca) for the full-text, current version.
REFERENCES
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