Family Allergy Asthma & Sinus Care is located in Charlotte, NC, (Pineville), Enjoy our Educational Blog:

9/27/2018: Allergy Myth Busters: Egg allergy and flu vaccine

It seemed to make sense:  Influenza vaccine is made in chicken-embryo cells so there are small amounts of egg protein (called ovalbumin) in the vaccine.  Therefore, egg-allergic patients could have reactions to influenza vaccine and special precautions should be taken.  Right?  Wrong!

Medical Studies: Where is the proof?

  • 27 published studies involving over 4100 egg-allergic individuals (over 500 with anaphylaxis after ingesting eggs) who received the flu vaccine were reviewed.  Results:  No serious reactions (low blood pressure “shock” or breathing problems)!  Minor reactions were no different between groups (egg allergic vs egg non-allergic).  Source: https://www.ncbi.nlm.nih.gov/pubmed/23021881
  • Studies using the “live” attenuated influenza vaccine Flumist® (which is no longer recommended as of 2016 due to lack of effectiveness) also showed no anaphylaxis and minor allergic reactions were no different between egg-allergic patients compared to non-egg allergic individuals.   The amount of egg ovalbumin in live attenuated form was less than 0.24 micrograms per dose (1/4 that of the killed influenza virus vaccine).

What does the CDC (Center for Disease Control and Prevention) recommend?

  • In the U.S., CDC and its Advisory Committee on Immunization Practices have updated their guidelines on egg allergy and receipt of influenza (flu) vaccines starting in 2016.  Based on the new recommendations, people with egg allergies no longer need to be observed for an allergic reaction for 30 minutes after receiving a flu vaccine.  Should it be required, people with a history of severe allergic reaction to egg (any symptom other than hives) can now be vaccinated in any setting, under the supervision of any health care provider who is able to recognize and manage severe allergic conditions.  There is no need for skin testing with the vaccine or splitting the dose.  Source:  https://www.cdc.gov/flu/protect/vaccine/egg-allergies.htm
  • What about in Canada?  Since 2014, Canadian Vaccine Guidelines have recommended influenza vaccine to individuals with egg allergy and there has not been an uptick in numbers of reports of allergic reactions.

What causes reactions to the influenza vaccine?

  •  Thimerasol: this preservative can lead to redness and swelling at the injection site.  Thimerasol contains a small amount of ethylmercury which is different than methylmercury (methylmercury builds up in fish and because it lasts much longer than ethylmercury can lead to toxicity).  Studies have shown that thimerosal in vaccines is not harmful, but influenza vaccines that do not contain a preservative are available.  Thimerosal was taken out of childhood vaccines in the United States in 2001.  Measles, mumps, and rubella (MMR) vaccines do not and never did contain thimerosal. Varicella (chickenpox), inactivated polio (IPV), and pneumococcal conjugate vaccines have also never contained thimerosal.
  • Unclear. Even the completely egg-free influenza vaccine known as Flublock® which was available in 2013 has led to reactions.  From 2013 to 2016, there were 88 reports of allergic reactions (10 anaphylaxis) reported through VAERS (Vaccine Adverse Event Reporting System).  Other symptoms were fatigue, fever, headache and muscle aches.  Source: https://www.ncbi.nlm.nih.gov/pubmed/28886946

Who should receive the flu vaccine?

  • Infants, children and adolescents: The American Academy of Pediatrics recommends all children over 6 months old should receive the influenza vaccine every year.  These recommendations for 2018-2019 season can be found at:  https://www.ncbi.nlm.nih.gov/pubmed/30177511
  • High Risk Groups
    • Pregnant women (and women up to 2 weeks after delivery): the vaccine can decrease risks of developing flu for mother and infant for several months after birth.
    • Children younger than 5 years old but especially children younger than 2 years old
    • Adults 65 years of age and older
    • Residents of nursing homes and long term care facilities
    • American Indians and Alaskan Natives
    • People who have medical conditions including:
      • Asthma or other chronic lung diseases (COPD, Cystic Fibrosis)
      • Heart disease (coronary artery disease, heart failure and congenital heart disease)
      • Neurologic Diseases (seizures, cerebral palsy, strokes, muscular dystrophy, spinal cord injury, moderate to severe developmental delay, mental retardation, brain disorders)
      • Blood disorders (sickle cell disease)
      • Metabolic disorders (mitochondrial disorders)
      • Other disorders: diabetes, kidney and liver disorders
      • Weakened immune system (HIV or AIDS, cancer, those on chronic oral steroids)
      • People younger than 19 years old on long-term aspirin therapy
      • People with extreme obesity (body mass index [BMI] of 40 or more)

Who should NOT receive a flu vaccine?

  • A person who previously had a severe allergic reaction to flu vaccine, regardless of the component suspected of being responsible for the reaction.
  • People who have a moderate-to-severe illness with or without a fever (should wait until they recover to get vaccinated)
  • People with a history of Guillain-Barré Syndrome (a severe paralytic illness) that occurred after receiving influenza vaccine and who are not at risk for severe illness from influenza.

Is the influenza vaccine perfect? 

  • No, even when the flu strains in the vaccine are well matched with the circulating viruses, the risk of illness is only reduced by 40 to 60%.  However, the flu vaccine is still the most effective prevention strategy currently available.
  • Can you get the flu from the killed influenza vaccine? No (it is killed).

What are the risks of NOT giving the influenza vaccine?

  • Average of 294,000 people admitted to the hospital each year in the U.S.
  • Average of 21,000 hospitalizations for children under 5 years old in the U.S.
  • Average of 23,000 deaths each year in the U.S.
  • Average of 124 childhood deaths each year in the U.S.

At Family Allergy Asthma & Sinus Care, we give you the facts on influenza, the latest recommendations and encourage you to make the right choice for you and your family!  Thanks to Doug Paauw, MD at the University of Washington in Seattle, WA for his inspiration on writing about “Medical Myths.”

Decoding Food Allergies: Break the Code

Do you want to know how severe your milk, egg or peanut allergy can be?  These tests can help!

Allergies to egg, peanut and cow’s milk are among the most common food allergies affecting children. These reactions can range from serious, life threatening reactions (such as anaphylaxis) to milder reactions such as hives.  But, how do you know if the reaction will be mild or severe?

While testing for egg, peanut and milk allergies have been available for many years, there have been limitations.  Allergy skin testing has been very useful but only offers insight into how likely a reaction will be.  A large skin test reaction suggests a reaction is “highly likely,” but is unable to predict how severe a reaction will be.  A negative reaction is helpful in predicting that a food allergy is not present.  Advances in food protein science have made it possible for allergists to now help predict the severity of food allergies to milk, egg and peanut.  A blood test where serum IgE (the allergic antibody) is measured to certain specific proteins in milk, egg, and peanut is now available.  This is called “component testing”.  Having these answers may alleviate the fear many patients and their families face every day.

Egg
The two major egg proteins individuals with egg allergy may be allergic to are ovalbumin and ovomucoid.

  • If a person is allergic to ovalbumin, serious reactions may occur if undercooked egg is ingested but most will tolerate egg in baked goods.  Furthermore, the likelihood of resolution of egg allergy is high.
  • In contrast, if a person is sensitized to the ovomucoid protein, he/she is at risk for a severe reaction and unlikely to develop tolerance over time.  Strict egg avoidance is necessary if allergy to ovomucoid is identified while a food challenge in the allergist’s office may be helpful if ovomucoid testing is negative.

Milk
There are 2 major classes of milk proteins that can be used in differentiating severity of milk allergy.

  • Casein protein in cow’s milk is responsible for severe allergic reactions and less likely to be “outgrown.”
  • In contrast, whey proteins (alpha-lactalbumin and beta-lactoglobulin) tend to be associated with less severe reactions and the milk protein allergy typically resolves over time.  A milk challenge in the allergist’s office using baked goods containing milk can be a useful tool to assess tolerance.

Peanut
The proteins in peanuts, Arachis hypogaea, are identified as Ara h and divided into Ara h 1,2, 3, 8 and 9.

  • Those individuals allergic to Ara h 1, 2, 3 are more likely to have severe allergic reactions (anaphylaxis) and need to strictly avoid all contact with peanuts and carry self-injectable epinephrine (EpiPen®).
  • However, if the allergy is to Ara h 8, the risk is moderate and if sensitized to Ara h 9, the risk is low for anaphylaxis.

Why perform food component testing?

  • Testing for the specific protein components of milk, egg or peanut, can help predict the severity of an allergic reaction which can impact the recommendations by allergists when advising patients about safety, lifestyle, and long term risk.  While allergy skin testing is still valuable, the availability of component testing via the Pharmacia ImmunoCAP® test by ThermoFisher Scientific offers additional information on which to make important medical decisions and even long term predictions.

At Family Allergy Asthma & Sinus Care, we help patients understand their food allergy and get to the answer— 1 component at at time!  These pearls of information were brought to you by Jared Bozeman, Senior Medical Student at The Medical College of Wisconsin.

New Treatments for Asthma: Change Your Lifestyle

While the diagnosis of asthma has not changed significantly, the treatment has (and should).  Asthma affects 25 million people (including 7 million children) in the U.S.  The incidence of asthma has increased in the last few decades, and while the exact reason for this is unclear, evidence suggests a link between nutrition/diet, weight, air pollution and allergies.  The treatment for asthma is not just taking medications!

Think of the new asthma treatments as “lifestyle” changes.

Diet:

  • Antioxidants: While no diet will eliminate or cure asthma, evidence suggests those who embrace diets high in Vitamin C and E, beta-carotene, flavonoids, magnesium, selenium, and omega-3 fatty acids have lower rates of asthma.  Foods high in carotenoids include carrots, watermelon, mango and tomatoes.  Children who grew up eating a “Mediterranean Diet” high in nuts and fruits (grapes, tomatoes, apples) had less asthma symptoms.  Studies show a low Vitamin D level has been linked to asthma attacks and low lung function.  Vitamin D supplements may improve asthma control.  A high fat meal (over 48 grams) can lead to more lung inflammation and less recovery of low lung function with albuterol.
  • Obesity is associated with severe asthma (requiring ER visits) and decreased lung function. Inhaled steroid medications don’t work as well in patients with body mass index (BMI) over 25.  How much weight do you need to lose to help improve asthma?  Only 5 to 10%, and aim for a BMI less than 25.
  • Acid reflux is associated with asthma symptoms.  Heartburn is more likely if a person eats too much, too fast, or too late at night.

Exercise:  Although exercise can sometimes be a trigger of asthma, this is no excuse to be a couch potato.  Exercise has been shown to improve quality of life in persons with asthma with more symptom-free days, better oxygen consumption, and less inflammation.  How much exercise is enough?  At least 30 minutes three times a week, with a goal of 150 minutes per week (30 minutes minutes a day, 5 times a week).  Exercise can also be helpful with weight control.

Stress control:  Individuals with asthma who have anxiety and depression are at increased risk of asthma attacks.  A disorder called vocal cord dysfunction triggered by anxiety can complicate asthma but not respond to asthma medications.  Interventions may include counseling, breathing relaxation techniques, and sometimes anti-anxiety medications.

Allergen control: Up to 90% of children with asthma may have allergies and these allergies can trigger asthma.  In adults, about 70% of patients with asthma have allergies.  By treating your allergies, the asthma can improve.

Air pollution.  Air pollutants that include small particles can trigger asthma.  Sources include cigarette smoking, wood smoke (campfires, wildfires, poorly ventilated indoor stoves), diesel exhaust, soot and ash.  Strong chemicals and fumes are also triggers.

Vaccines:  viruses such as influenza, RSV, and the common cold virus called Rhinovirus can trigger asthma.  The flu vaccine is recommended for all individuals over 6 months old, but especially for those with asthma according to the CDC.

Medications:  They are still important!

  • Quick relief:  albuterol is still the most common inhaler in use today to help relieve symptoms of asthma and prevent exercise-induced asthma when used 15 minutes before exercise.  Whether it is by a nebulizer or inhaler, keep it on hand.  The newer devices have dose counters and are easier to use.
  • Daily controller:  this group includes the inhaled corticosteroids deemed the most effective treatment for asthma.  When combined with long-acting bronchodilators, the combination is even better for those with moderate to severe asthma.  The newest combination medications are taken only once a day.  Medications like Singular® block an inflammatory pathway without being a steroid medication and are taken as a pill once a day.  Spiriva, an inhaled medication long known to be used for COPD (chronic lung disease from smoking), was recently approved for treating asthma.
  • Biologicals:  The injectable medication Xolair® has been available since 2003 and blocks the allergic antibody IgE.  Mepolizumab marketed as Nucala® and approved in 2015 is monthly injection that works by blocking the protein interleukin-5 to prevent buildups of white blood cells called eosinophils in the lungs that can trigger asthma.

Individuals with asthma have choices.  While there is no cure for asthma, the available treatment options and lifestyle changes can help control asthma so individuals can lead healthy, productive lives.  By controlling asthma, it will not control you!

Are hormones in our food causing kids to become to become sexually mature faster?






Nut allergy

Grass pollen allergy

Is there a cure for allergies?

Asthma...At my age!

Can a person be allergic to coffee or caffeine?

Don't let allergies derail your summer traveling!

Fatal peanut allergy

Raise Your Hand for Anaphylaxis Awareness™ $15,000 grants available!

Food Allergy Awareness Week. Were you aware that...

May is Allergy & Asthma Awareness Month. Were you aware that...

May is Asthma Awareness Month. Is your asthma controlled?

Hives: Why is this happening?

Got Milk! How about increase mucus?

Peanut Allergy Death

Allergies: Cats vs. Dogs

The Benefits of Exercise in Asthma

Anaphylaxis at School

Spring is in the air; which means March Madness for allergy sufferers!

Antihistamine or Decongestant; what should I take?

Allergic to Eggs? Eggcellent Ways to Celebrate Easter & Passover

Food allergies increase childhood bullying

Does your nose bleed when you use your nasal spray?

Dust mites: Just the Facts!

Will my child outgrow asthma?

Being safe on Valentine's Day with Food Allergies...Share the love

Should I buy an air purifier for my asthma and indoor allergies?

Is it a cold, sinus or allergies?

A "Talking" Epinephrine injector is now available

Beware: Anaphylaxis!

When life gives you mold, make penicillin...Outgrowing Penicillin Allergy

The Itch that Rashes!

Allergy to cold weather?

Are you using your inhaler correctly? Why it matters...

Does your nose run like a faucet when you eat?

Food allergies are not just for kids!

Injectable Steroids— Are they worth the risks?

What is causing this chronic cough?

Hives. How long will they last?

Does your mouth itch when you eat fresh fruits?

Back-to-School Tips: Food Allergies in Elementary School-Aged Children

These educational information does not take the place of your physician's advice.


Like Us on Facebook to Get Blog Updates: