Immunisations

Parents often raise concerns about immunisations
in children with allergies. This is because the vaccines used contain substances which can, in some cases, cause an allergic reaction. However, in practice, allergy to vaccines is very unusual.

It used to be thought that the MMR (measles, mumps and rubella) vaccine should not be given to egg-allergic children. In fact, the information which is often provided with the vaccine continues to warn that egg-allergic children may react to the vaccine! This is incorrect. The measles vaccine is not grown in whole eggs, but in cells which are derived from hens – and these cells do NOT contain any egg protein. Therefore, the MMR vaccine is safe in all egg-allergic children (including those with severe allergy) and all egg-allergic children should have the vaccine.

Severe asthma or active wheezing

The live attenuated influenza vaccine given as a nasal spray (Fluenz®) is not recommended for children with active wheezing at the time of vaccination OR severe asthma (BTS SIGN step 4 or above) because of limited safety data in these groups.

Egg allergy

Inactivated influenza vaccines, given by injection, that are egg-free or have a very low ovalbumin content are safe for individuals with egg allergy (des Roches et al., 2012). There are no data on the use of live attenuated nasal spray vaccine (Fluenz®) in children with egg allergy and at the current time Fluenz should not be given to children with an egg allergy.

Patients with egg allergy can be immunised with an egg-free influenza vaccine if available.

If no egg-free vaccine is available, patients should be immunised in primary care using an inactivated influenza vaccine with an ovalbumin content less than 0.12 µg/ml (equivalent to 0.06 µg for 0.5 ml dose).

Only patients who have either confirmed anaphylaxis to egg or egg allergy with severe uncontrolled asthma (BTS SIGN step 4 or above) should be referred to specialists for immunisation in hospital.

Facilities should be available and staff trained to recognise and treat anaphylaxis.

Vaccines with ovalbumin content more than 0.12 µg/ml (equivalent to 0.06 µg for 0.5 ml dose) or where content is not stated should not be used in egg-allergic individuals.

Optaflu® is currently the only available ovalbumin-free influenza vaccine.

The ovalbumin content of influenza vaccines is given in Table 19.6 of the Government’s Green Book (updated September 2013), the reference for all health care professionals administering vaccines.

The vaccines against Yellow fever and typhus are produced in a similar way to Influenza. However, this vaccine is not a routine part of the UK immunisation schedule and are usually only given to people travelling abroad to high-risk destinations.

All available information about immunisation and allergy points to the fact that immunisation in children who are at high risk of developing allergy is safe and not a factor in their future allergic conditions.

 

Last updated: March 2012
Version 3