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BackgroundLive attenuated influenza vaccine (LAIV) is an intranasal vaccine recently incorporated into the United Kingdom immunization schedule. However, it contains egg protein and, in the absence of safety data, is contraindicated in patients with egg allergy. Furthermore, North American guidelines recommend against its use in asthmatic children.ObjectiveWe sought to assess the safety of LAIV in children with egg allergy.MethodsWe performed a prospective, multicenter, open-label, phase IV intervention study involving 11 secondary/tertiary centers in the United Kingdom. Children with egg allergy (defined as a convincing clinical reaction to egg within the past 12 months and/or >95% likelihood of clinical egg allergy as per published criteria) were recruited. LAIV was administered under medical supervision, with observation for 1 hour and telephone follow-up 72 hours later.ResultsFour hundred thirty-three doses were administered to 282 children with egg allergy (median, 4.9 years; range, 2-17 years); 115 (41%) had experienced prior anaphylaxis to egg. A physician's diagnosis of asthma/recurrent wheezing was noted in 67%, and 51% were receiving regular preventer therapy. There were no systemic allergic reactions (upper 95% CI for population, 1.3%). Eight children experienced mild self-limiting symptoms, which might have been due an IgE-mediated allergic reaction. Twenty-six (9.4%; 95% CI for population, 6.2% to 13.4%) children experienced lower respiratory tract symptoms within 72 hours, including 13 with parent-reported wheeze. None of these episodes required medical intervention beyond routine treatment.ConclusionsIn contrast to current recommendations, LAIV appears to be safe for use in children with egg allergy. Furthermore, the vaccine appears to be well tolerated in children with a diagnosis of asthma or recurrent wheeze.

Original publication

DOI

10.1016/j.jaci.2014.12.1925

Type

Journal article

Journal

The Journal of allergy and clinical immunology

Publication Date

08/2015

Volume

136

Pages

376 - 381

Addresses

Section of Paediatrics (Allergy & Immunology) and MRC & Asthma UK Centre in Allergic Mechanisms of Asthma, Imperial College London, London, United Kingdom; Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, United Kingdom; Division of Paediatrics and Child Health, University of Sydney, Sydney, Australia. Electronic address: p.turner@imperial.ac.uk.

Keywords

SNIFFLE Study Investigators, Humans, Egg Hypersensitivity, Respiratory Sounds, Immunoglobulin E, Vaccines, Attenuated, Influenza Vaccines, Vaccination, Prospective Studies, Adolescent, Child, Child, Preschool, Female, Male, Influenza, Human, United Kingdom