A as in Anaphylaxis, All About Allergies, Egg allergy

The Sniffle Study-why it is essential to take part in research

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Last week, we had the opportunity to take part in the SNIFFLE study, a multicentre study researching the now in the UK available flu vaccine. It has been used in the US for years and no severe allergic reactions to its content (among other ingredients, it contains egg) have been observed. The aim of the study here in the UK is to proof the safety of the vaccine for egg allergic children. The new thing about the vaccine is that it is given via the nostrils. No more needles, no more tears? We were especially looking forward to a needle free day at hospital (since it is a research project, vaccines are administered under supervision with easy access to emergency treatment).

So we happily decided to take part with our now 3 year old allergyBabe. We were welcomed with a friendly #hellomynameis, allergyBabe went straight for the train track and mum was seated in a comfy armchair. So far, so good.

After the usual observations (blood pressure, oxygen level, pulse, temperature) we were informed, consented and told that there would be a couple of skin prick tests prior to the administration of the vaccine. SKIN PRICK TEST. That means needles. So despite the fact that the vaccine is given as a spray, we still had to undergo the nasty procedure of skin pricking. Despite allergyBabe’s earlier statement not to want any needles, he was very brave and underwent the to him so familiar procedure without a big fuss. The test confirmed his egg allergy.

The vaccination itself was a walk in the park. 1 puff in each nostril, followed by one sneeze, and it was over. To make sure no delayed reaction would occur, we stayed for an hour afterwards, happily engaged in the play area. AllergyBabe showed no adverse effects whatsoever.

Around the third day, he complained about joint paint in his knees, which were gone after one dose of paracetamol. He also developed a slight head cold. Nothing else.

It was a very pleasant experience, from the initial call prior to our appointment to the courtesy call 3 days after the vaccination.

Thinking of taking part? You may think about the following:

If the aim of this study (to proof that the egg containing nasal vaccine is safe for egg allergic children) is achieved,

– egg allergic children will be able to be vaccinated with an easy and painless procedure

– GPs in Primary Care will be confident to administer the vaccine to egg allergic children

– parents will have proof that this vaccine is safe

It the above mentioned points can be achieved, it was worth the inconvenience of traveling to hospital, staying there and getting pricked.

After all, every vaccination that is performed is not only protecting the individual, but also the community in which they live and thrive.

Further reading:

Parent information sheet Oxford Groupdiscussion of the subject on mumsnet.com

WHO study listing

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Egg allergy, Uncategorized

Flu vaccine and egg allergy – an update about the latest developments

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In reference to yesterday’s #allergyhour on twitter, the topic of the influenza vaccination came up and I got inspired to post the latest developments in regards to the flu vaccine’s application, safety and allergenic potential.

In the UK, the flu vaccine is currently administered to high risk children (kids with comorbidities such as severe asthma) only and requires an intramuscular jab. From 2014, an annual influenza vaccine for all children will be introduced into the UK immunisation schedule, to reduce the morbidity and mortality associated with this disease. This new vaccine, known as LAIV (Live Attenuated Intranasal Vaccine) is given by a spray into the nose and has been successfully used in the US for a couple of years. You can see the results of a NEJM study here. The new vaccine is grown in hen’s eggs and contains egg protein, and there are NO existing data on the safety of LAIV in egg- allergic children. To prove the safety of the intranasal vaccine for egg allergic children, the SNIFFLE study will be performed in a multicentre setting shortly. The new application sounds very promising and I am looking forward to the results. Will keep you posted.

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Egg allergy

Egg allergy and the MMR – is it safe?

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Among the allergy community, there is a lot of doubt and uncertainty about the safety of the MMR vaccine in egg allergic children. This post sums up the latest research and recommendations.

What is the MMR?

The MMR Vaccine protects from measles, mumps and rubella. It is given around 12 month of age and again around 3 to 5 years of age. It is an active virus, consisting of weakened forms of the viruses.

Why is there a concern about giving the vaccine to egg allergic children?

The vaccine is cultured on embryo chick fibroblasts.

Though, it does not contain any hen’s egg protein. If traces of hen’s egg protein are detected, they are highly processed and their concentration is very low.

Recent studies:

MMR vaccination of children with egg allergy is safe:

a danish study published in 2013, investigating 32 children with egg allergy who had been referred to get their mmr vaccination (Priorix MMR) at hospital. None of the children had severe reactions

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

Published in September last year, the authors claim their study being  “one of the largest studies looking at childhood vaccinations performed in a hospital setting for children who are ‘at risk’ of allergy, anaphylaxis or hypersensitivity”. A total of 374 patients (with a medical history of anaphylaxis, allergic reaction or strong suspicion of a severe adverse reaction against egg) contributed to the findings. All of the children received their vaccinations in a hospital setting. “Only six patients (1.3%) experienced an immediate reaction to a vaccination. All reactions were minor”. The authors conclude that “A significant number of referrals were unwarranted and the majority could have been safely managed in the community”.

Latest expert opinion (BSACI, 2007):

BSACI Recommendations for Combined Measles, Mumps and Rubella (MMR) Vaccination in Egg-Allergic children:

The MMR has an excellent safety-record and may be administered to all egg-allergic children in a primary care setting. As with any other immunisation, adrenaline should be readily available in case of rare and unpredictable anaphylaxis. MMR should be postponed if child is unwell. A hospital based application is necessary after a previous severe reaction to a vaccination (MMR or other) after a specialist assessment. It might be possible that the reaction occured due to an allergy to other components of the shot (gelatine (beef and lamb allergy) or antibiotics (neomycin or other)).

Other vaccinations and egg allergy:

Flu vaccine: updated every year, the content level of ovalbumin, varies every year, some jabs do not contain egg. A split dose (1/10 of single dose, than 9/10 of dose) of the vaccine might be an option. Consult your GP or specialist for up to date advise.

Yellow fever vaccine: unsuitable for children with egg allergy

So what is the verdict?

Latest research suggests that the likelihood for an egg-allergic child to react to the MMR vaccine is about the same as to any other non-egg containing vaccine. Reactions are rare but non predictable due to other substances like gelatine and antibiotics.

Even though the MMR seems to be a safe shot, it is always recommended to seek advise from your specialist if in any doubt. Every child reacts differently and the risk profile of your allergic child can be best assessed by your trusted allergist.

Sources: the anaphylaxis campaign, nhs choices, pubmed, bupa, bsaci

Please note that this post does not imply any medical advise. Please always consult your specialist.

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