Nasal flu vaccine unlikely to trigger reaction in children with egg allergy and asthma

The nasal flu vaccine is unlikely to trigger a reaction in children with egg allergy, well-controlled asthma or recurrent wheeze, suggests a study published in The BMJ
^[1]
.

Live attenuated influenza vaccine (LAIV) is a nasal spray developed specifically for young people and is given to children aged 2–16 years as part of the NHS childhood vaccination programme. However, some guidelines^[2]
recommend against using LAIV in children under the age of five years with a history of recurrent wheeze or asthma, so UK researchers set out to assess its safety.

A total of 779 young people (aged 2–18 years) with egg allergy were immunised with LAIV. A total of 315 (40%) people had experienced an allergic reaction to egg in the past 12 months, 270 (35%) had experienced previous anaphylaxis to egg, and 445 (57%) had doctor diagnosed asthma or recurrent wheeze.

No systemic allergic reactions occurred within two hours of vaccination, but nine young people (1.2%) experienced mild symptoms suggestive of a local allergic reaction, including a skin rash, sneezing, itchiness and a blocked or runny nose.

Delayed events, potentially caused by the vaccine, were reported in 221 young people, but none of them were admitted to hospital and there was no increase in lower respiratory tract symptoms in the four weeks after vaccination.

“The vaccine is appropriate for use in children at risk of wheeze, in whom symptoms are well controlled and with no evidence of active wheezing in the 72 hours before immunisation,” the researchers conclude.

They add that their results support the revised Department of Health guidance^[3]
for the 2015–2016 season, which says that with the exception of children “with severe anaphylaxis to egg which has previously required intensive care, children with an egg allergy can be safely vaccinated with Fluenz Tetra in any setting (including primary care and schools)”.