EEaka Ελληνική Εταιρία Αλλεργιολογίας και Κλινικής Ανοσιολογίας
Greenhawt MJ, Spergel JM, Rank MA, Green TD, Masnoor D, Sharma H, Bird JA, Chang JE, Sinh D, Teich E, Kelso JM, Sanders GM.
Safe administration of the seasonal trivalent influenza vaccine to children with severe egg allergy.
Ann Allergy Asthma Immunol. 2012 Dec;109(6):426-30.
Abstract
BACKGROUND:
Anaphylaxis to egg or severe egg allergy has been considered a contraindication to receiving trivalent seasonal influenza vaccine (TIV).
OBJECTIVE:
To evaluate the safety of TIV among severely egg allergic children.
METHODS:
A 2-phase, multicenter study at 7 sites was conducted between October 2010 and March 2012. Inclusion criteria included a history of a severe reaction, including anaphylaxis, to the ingestion of egg and a positive skin test result or evidence of serum specific IgE antibody to egg. Phase 1 consisted of a randomized, prospective, double-blind, placebo controlled trial of TIV administration to egg allergic children, using a 2-step approach; group A received 0.1 mL of influenza vaccine, followed in 30 minutes if no reaction with the remainder of an age-appropriate dose, whereas group B received an injection of normal saline followed in 30 minutes if no reaction with the full 100% of the age-appropriate dose. Phase 2 was a retrospective analysis of single dose vs split-dose administration of TIV in eligible study participants who declined participation in the randomized controlled trial.
RESULTS:
Thirty-one study participants were prospectively evaluated in the randomized controlled trial (group A, 14; group B, 17); 45.1% had a history of anaphylaxis after egg ingestion. A total of 112 participants were retrospectively evaluated (87 with the single dose and 25 with the split dose); 77.6% of participants had a history of anaphylaxis after egg ingestion. All participants in both phases received TIV without developing an allergic reaction.
CONCLUSION:
TIV administration is safe even in children with histories of severe egg allergy. Use of 2-step split dosing appears unnecessary because a single dose was well tolerated.
http://www.annallergy.org/article/S1081-1206%2812%2900681-3/abstract
Des Roches A, Paradis L, Gagnon R, Lemire C, Bégin P, Carr S, Chan ES, Paradis J, Frenette L, Ouakki M, Benoît M, De Serres G; PCIRN (Public Health Agency of Canada/Canadian Institutes of Health Research Influenza Research Network).
Egg-allergic patients can be safely vaccinated against influenza.
J Allergy Clin Immunol. 2012 Nov;130(5):1213-1216.
http://www.jacionline.org/article/S0091-6749%2812%2901293-6/abstract
Απόσπασμα από το γράμμα προς τον εκδότη των Des Roches και συν. :
« As the influenza vaccine contains residual egg protein, its administration to egg-allergic patients had always raised theoretical concerns about anaphylaxis. We report our experience with the vaccination of egg-allergic patients with a trivalent inactivated seasonal influenza vaccine administered during 5 seasons (2007- 2011) and summarize the current published clinical experience with these patients.»
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« The published number of egg-allergic patients safely vaccinated against influenza is nearly 4 times as large as the number that ended the precautions regarding measles, mumps and rubella (MMR) vaccine (4172 vs 1227). »
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«The risk of anaphylaxis appears sufficiently low for patients with egg allergy to be vaccinated like all other individuals, without requiring administration by an allergist.»
Η χορήγηση του τριδύναμου εμβολίου της γρίππης είναι εξαιρετικά ασφαλής, ακόμη και σε παιδιά με σοβαρές αλλεργικές αντιδράσεις στο αυγό. Η χορήγηση του εμβολίου σε δύο δόσεις (0.1 ml και μετά 30 λεπτά του υπόλοιπου εμβολίου) δεν είναι απαραίτητη. Αν και αυτές οι κλινικές μελέτες πρέπει να επιβεβαιωθούν και στον δικό μας πληθυσμό, το συμπέρασμα είναι πως τα παιδιά με αλλεργία στο αυγό – ακόμη και σοβαρή – μπορούν να εμβολιασθούν με ασφάλεια.