Egg Allergy and Flu Vaccine Recommendations

It's flu vaccine time again. We've never gotten the flu shot for my egg allergic son, but this year the consensus in the medical community seems to be that most people with egg allergy can tolerate the vaccine. We will be doing a flu desensitization at the allergist's office on Monday. That involves a skin test with a control and the actual vaccine. Depending upon the results of that, the vaccine may be administered all at once, or in smaller doses.

We always have the doctor's office order Thimerasol-free flu vaccine for our family. No need for extra mercury, right? I found this link recently that lists each flu vaccine manufacturer and the amount of egg (ovalbumin) and thimerasol in their serum.

Talk to your doctor if you have any concerns about egg or mercury in your shot.

...and wish us luck on Monday...

New Flu Vaccines Safe for Egg Allergic

The 2009 swine flu scare has had an unexpected benefit for the food allergy community. On March 1, the US Department of Health and Human Services announced contracts with two companies to manufacture flu vaccine. The 2009 swine flu pandemic proved that companies were unable to meet the demand for vaccine quickly enough using traditional egg-based methods of production.

Novavax and VaxInnate are the manufacturers of these next-generation recombinant influenza vaccines. Novavax is to develop new technology to produce vaccines using insect cells to express influenza proteins and create virus-like particles that stimulate a strong immune response in humans.VaxInnate is developing a recombinant influenza vaccine technology based on combining influenza and bacteria proteins to stimulate strong immune response to protect against the flu.
People will be able to get the vaccine earlier in the season and these new vaccines by-pass the guessing game of which strain of the virus should be in the vaccine.

I'll keep you posted on more information as it is released.

Finally, egg allergic kids and adults won't have to weight the risk of their allergy against the risk of getting the flu!

Food Allergy Guidelines: What do They Really Mean?

There has been much buzz over the past week about the recently released "Guidelines for the Diagnosis and Management of Food Allergy in the U.S". I've been quietly digesting the information in an effort to form my own thoughts and opinions about it. I applaud the two year efforts of the 34 organizations, agencies, physicians and  others who were involved in creating these guidelines. We have had too many years of inconsistent diagnosis, unclear instructions and confusion about what a food allergy really is. I do believe that clear guidelines will allow for some consistency and better education about food allergies.

So, what have we got with these new guidelines?

1. We've got a lot of defined terms now. From food allergy to food intolerances to tolerance to oral allergy, we can all speak the same language by referencing the definitions included in this paper.
2. It seems that we mostly rely on self-reporting as a means to track the prevalence of food allergy. That can impact the statistics as people are generally unsure of what a food allergy is and what the symptoms of a reaction are.
3. It also appears that our current testing methods (blood and skin tests) are not very accurate and cause an over-diagnosis of food allergy. Oral challenges are our best means of diagnosis at the present time, but present the highest risk to patients. I would also argue based on our experience, that oral challenges become less helpful to a person who has anxiety about eating a food they're been told to avoid for many years. The challenge becomes very subjective when the person complains of vague symptoms, like "I think my tongue feels itchy" or "my throat feels funny".
4. While annual food allergy testing was the standard practice, there is no evidence to support this time interval. It is unclear what time interval should be recommended.
5. The guidelines suggest that doctors and professional organizations may be too conservative when it comes to their recommendations for egg allergic individuals to avoid certain vaccines such as influenza, rabies and yellow fever. Those allergic to egg may be able to tolerate these vaccines- according to some studies.
6. Maternal diet during pregnancy and breastfeeding should not be restricted. Introduction of solid foods to infants should also not be delayed.
7. Clear definitions for anaphylaxis are available in the guidelines with epinephrine listed as the first line of treatment, followed by evaluation in a hospital setting. Hospitals are advised to observe patients for 4-6 hours, longer if there are other complicating factors, even though we don't really have a feel for the true incidence of these bi-phasic or delayed reactions.

For those of us who have lived with food allergy for many years, I don't know that we have any more information now than we did before these guidelines came out. I've read and heard all of this before. That said, we needed to make sure all professionals and caregivers were on the same page, and I think these guidelines will accomplish that.

A patient friendly copy of the guidelines will be available in 2011, but in the meantime, if you want to slog through the lengthy document, I'll send you to the correct page in the December 2010 issue of The Journal of Allergy and Clinical Immunology.

I'd love to hear your thoughts!

Food Allergies and News From Annual Conference of ACAAI

Last week, the American College of Allergy, Asthma and Immunology (ACAAI) held its annual meeting in Phoenix. The organization, established in 1942, is made up of over 5500 health professionals and is dedicated to improving patient care in the areas of allergy and immunology.

Presenters at the meeting shared studies and research, much of it pertaining to food allergy. I've tracked down a few pieces of relevant presentations. As more is released, I'll share it. In the meantime, this will be of interest to those of us in the food allergy arena:

In a session titled "The Ability of Adults and Children to Visually Identify Peanuts and Tree Nuts", Co-authors: Todd L. Hostetler, MD, and ACAAI Member Bryan Martin, MD, (The Ohio State University/Nationwide Children's Hospital) report on a study in which only 50% of nut allergic people (ages 6 and up) could identify a picture of the nut they are are allergic to.

In "Adverse Reactions to H1N1 Vaccine after Tolerating Seasonal Flu Immunization", Amber M. Patterson, MD, (The Ohio State University/Nationwide Children's Hospital) says that tolerance to flu vaccine one year does not suggest future tolerance as the amount of egg in the vaccine varies widely.

In "If Kissing or Sex Leaves You Tingly, Is It Love or Allergies?" Dr. Sami Bahna talked about how allergic reactions to kissing and other intimate acts are more common for those with food and medication allergies.

Something else I've been watching for awhile is the use of Chinese herbs as a cure for peanut allergy. There was a session at the meeting, "Chinese herbs can complement proven allergy treatments", in which it was reported that Food Allergy Herbal Formula, previously shown to reduce anaphylactic reactions in peanut allergic mice, has now been shown to be safe for humans. Sounds promising!

Dr. Bahna, president of ACAAI, raised the ire of some in the food allergy community with several statements about bans 9or not) of peanuts in schools and airplanes.  Check it out and see what you think.

For more information on the ACAAI annual meeting, scroll through the Twitter conversation. More information about the organization can be found at their website.

Did any of these reports have a specific interest for you? I'm thrilled with the continued research on all fronts of food allergy. Let's continue to talk about egg allergy and flu vaccine and peanut allergy bans and promising food allergy cures. Let's keep making forward progress!

Flu Vaccine for People With Food Allergy

The American Academy of Allergy, Asthma & Immunology (AAAAI) has issued a statement about egg allergy and the flu vaccine after re-examining three studies. The conclusion?

We need more studies.

And thus a multi-center clinical trial is presently underway in the US.

Really? We still don't have enough information on this?????

Now, there is some good news. Many vaccine manufacturers are listing the amount of ovalbumin (egg) on their inserts. This means doctors can seek out low ovalbumin vaccine for their egg allergic patients.

The other finding is that most people with egg allergy do tolerate the vaccine. However, the numbers of severely egg allergic subjects in the study was low, and so it is with caution that researchers can recommend the flu vaccine to this sub-group.

So, it makes sense to explore this again this year. Talk to your allergist. Can they get low egg vaccine? What are the risks vs the benefits of the vaccine? What have they seen in their practice so far this flu vaccine season?

At this point we've done what we always do- the rest of the family gets the vaccine in the hopes of protecting the non-vaccinated egg allergic family member. We see the allergist in two weeks, though, and this is on my list...

...again...

Is it so hard to come up with a flu vaccine without growing it on chicken eggs? Sigh...

Some related posts for those of you dealing with this for the first time:

Flu Vaccine Recommendations and Egg Allergy
Flu Vaccine for Egg Allergic
Still Confused About Egg Allergy and Flu Shots?
Guidelines for H1N1Vaccine and Egg Allergy
Flu Shot Season

Alternative to Flu Vaccine?

For those of us concerned about the seasonal and H1N1 vaccines, there may be an alternative.

A recent study finds that the immune system can be stimulated with a combination of Vitamins C and D and the minerals selenium, zinc and silver. Check out this new choice which can be taken as a daily supplement throughout the pandemic of swine flu and for the duration of the seasonal flu.

This may be a good fit for egg allergic children and adults who can not get the vaccine. I do like the idea of natural substances stimulating the body's own immune system.