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Safe administration of yellow fever vaccine in patients with suspected egg allergy
Fernanda Tormin Tanos Lopes1, Roberta Maia de Castro Romanelli2, Lívia Isabela de Oliveira1
1Children's Department of Pneumology and Allergy, Hospital Infantil João Paulo II, Minas Gerais, Brazil.
Insights
Yellow fever vaccine is safe for children with egg allergies. Most children tolerated a single dose, even those with severe reactions to eggs, indicating a simplified administration protocol is effective.
Area of Science:
- Immunology
- Pediatrics
- Vaccinology
Background:
- Limited data exists on yellow fever vaccine safety in egg-allergic individuals.
- Egg allergy is a common concern for vaccine administration in children.
Purpose of the Study:
- To evaluate the safety and administration of the yellow fever vaccine in children with suspected egg allergy.
- To describe a simplified protocol for yellow fever vaccination in this population.
Main Methods:
- Children with suspected egg allergy were classified using history and IgE testing.
- A vaccine prick test was used for those with a history of anaphylaxis to egg.
- Vaccine administration involved a single dose for most, or a two-step protocol for a subset.
Main Results:
- Out of 435 children, 51.72% were probably egg-allergic.
- A vast majority (95.2%) experienced no vaccine reactions.
- One child developed possible anaphylaxis; the vaccine prick test did not predict reactions.
Conclusions:
- Yellow fever vaccine can be safely administered in a single dose to children with egg allergy.
- The simplified protocol is effective for children with confirmed or suspected egg allergy.
Background:
The evidence available in the literature on the administration and safety of the yellow fever vaccine in patients with egg allergy is limited.
Objective:
We sought to describe the administration of yellow fever vaccine in children with suspected egg allergy using a simplified protocol.
Methods:
Children referred to the service from February 2018 to January 2020 with a history of possible egg allergy were classified as probably egg-allergic or not on the basis of history and specific IgE testing. A vaccine prick test was performed only in those with a history of an anaphylactic reaction to egg ingestion and if the result was positive the vaccine was administered in a 2-step protocol (2 equal doses of 0.25 mL with an interval of 30 minutes between the 2 applications). All other children received the vaccine as a single dose.
Results:
A total of 435 children were evaluated; 48.27% were probably not allergic, and 51.72% were probably allergic to egg, of which 32.88% were considered anaphylactic. A total of 414 (95.2%) children had no vaccine reactions. Of the 21 (4.8%) children who had some reaction, 10 experienced a local reaction, 9 a mild skin reaction distant from the vaccine site, 1 presented local cutaneous reaction distant to the vaccination site, and 1 patient developed possible anaphylaxis. The vaccine prick test did not predict a vaccine reaction (odds ratio, 1.29; 95% CI, 0.25-6.72; P = .67).
Conclusions:
Yellow fever vaccine can be safely administered as a single dose in children with a confirmed or suspected egg allergy.
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