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| |  Patients With Egg Allergies Can Receive Both Pandemic and Seasonal Influenza Vaccines, With Dual Testing: Presented at ACAAI By Carole VanSickle Ellis PHOENIX, Ariz -- November 15, 2010 -- Pandemic and seasonal influenza vaccines can safely be administered to egg-allergic patients in a single visit, researchers noted here at the 2010 Annual Meeting of the American College of Allergy, Asthma and Immunology (ACAAI). Dual testing, however, is necessary. Testing to one influenza vaccine may not be a reliable predictor of sensitivity to another influenza vaccine, despite the fact that most egg-allergic patients can tolerate both seasonal and pandemic influenza vaccines, reported John Seyerle, MD, Nationwide Children’s Hospital, Ohio State University Medical Center, Columbus, Ohio, speaking here on November 14. Dr. Seyerle noted that the outbreak of pandemic influenza in 2009 resulted in the recommendation of 2 different flu vaccines, and that “while guidelines have been proposed for the safe administration of a single influenza vaccine to egg-allergic patients, there are no formal protocols for simultaneous testing of both H1N1 [pandemic] and seasonal influenza vaccines.” Dr. Seyerle and colleagues administered pandemic influenza vaccine to 42 egg-allergic paediatric patients following skin-prick testing and intradermal testing at 1:100 strength. At the same time, patients were offered testing for the seasonal influenza vaccine. If the testing was negative in one or both vaccines, then they were administered as a single dose. If testing in one or both was positive, however, then they were administered in divided doses over 60 to 90 minutes, following the protocol from the 2009 Joint Task Force and Centers for Disease Control guidelines. Four of the individuals tested to the pandemic influenza vaccine tested positive, and 41 of the 42 received the vaccine either as a single injection or a graded dose. In all, 14 of 41 patients had a positive test to one vaccine, while 2 had positive reactions to both. One refused the vaccine after a positive skin-prick test. 33 of the 42 patients were also tested to seasonal influenza vaccine, and 14 of those 33 tested positive. Twenty-eight patients received the seasonal influenza vaccine during the same visit, with a graded challenge if they tested positive. Dr. Seyerle reported that “one patient tolerated the pandemic vaccine but could not complete the graded-dose seasonal influenza vaccination due to wheezing.” That patient had exhibited cold symptoms but not wheezing on the initial examination. The team noted 4 variables that were “trending toward significance when comparing patients with positive skin testing to those with negative skin testing.” A history of prior egg ingestion (67% vs 39%, P =.057), a history of reactions to eggs (56% vs 35%, P =.17), and a history of reactions to baked goods (12.5% vs 0%, P =.065) all showed higher rates in patients with positive skin tests to at least one influenza vaccine. Additionally, the geometric mean specific immunoglobulin E to egg was 21.13 and 12.44 IU/mL in patients who tested positive and negative, respectively (P =.11). The research team concluded that “pandemic and seasonal influenza vaccines can safely be administered to egg-allergic patients in a single visit using our protocol.” Dr. Seyerle pointed out, however, that the variable allergic response to each of the vaccines was such that doctors should not necessarily rely on testing to one influenza vaccine to be a reliable predictor of sensitivity to another. Furthermore, a history of eating baked goods with eggs, receiving previous flu vaccines, reacting to previous flu vaccines, and a diagnosis of asthma did not correlate to positive testing. [Presentation title: Testing and Administration of Seasonal and Pandemic Influenza Vaccines in Egg Allergic Patients. Abstract P300]
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