title: Safety of live attenuated influenza vaccine in atopic children with egg allergy.
abstract: BACKGROUND
  Live 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.
  
  
  OBJECTIVE
  We sought to assess the safety of LAIV in children with egg allergy.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Four 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.
  
  
  CONCLUSIONS
  In 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.
authors: 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.
authors: Paul J
authors: PJ
authors: Turner
authors: Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, United Kingdom.
authors: Jo
authors: J
authors: Southern
authors: Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, United Kingdom.
authors: Nick J
authors: NJ
authors: Andrews
authors: Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, United Kingdom.
authors: Elizabeth
authors: E
authors: Miller
authors: Department of Paediatric Allergy & Immunology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
authors: Michel
authors: M
authors: Erlewyn-Lajeunesse
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D021181:Egg Hypersensitivity / Q000150:complications / Q000175:diagnosis / Q000276:immunology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000150:complications / Q000276:immunology / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D011446:Prospective Studies; D012135:Respiratory Sounds / Q000175:diagnosis / Q000276:immunology* / Q000503:physiopathology; D006113:United Kingdom; D014611:Vaccination; D014613:Vaccines, Attenuated
chemical_list: D007252:Influenza Vaccines; D014613:Vaccines, Attenuated; D007073:Immunoglobulin E
keywords: Egg allergy; asthma; live attenuated influenza vaccine; recurrent wheezing; safety