Intranasal influenza vaccination is well-tolerated in egg allergic children with asthma or recurrent wheeze


Published Online: February 13, 2014

Guidelines from the US, Canada, and UK recommend annual influenza vaccination of children, including those with egg allergy. Live attenuated influenza vaccine (LAIV) is an intranasal vaccine administered via the nose licensed for use in children. However, this vaccine contains egg protein and it is currently suggested that it not be used on children with egg allergy. Furthermore, North American guidelines recommend against its use in children with asthma.

In a study recently published in The Journal of Allergy and Clinical Immunology (JACI), Turner and colleagues present the results of the SNIFFLE-1 Study, in which 433 doses of LAIV were administered to 282 children with egg allergy, two thirds of whom had a physician-diagnosis of asthma/recurrent wheezing. 41% had experienced a prior anaphylactic reaction to egg. The study was funded by the Department of Health, England.

Influenza vaccination using LAIV was safe in egg-allergic children – including those with a prior history of anaphylaxis – with no systemic allergic manifestations seen. Eight children experienced mild self-limiting symptoms, which may have been due to an IgE-mediated allergic reaction, but noting the intranasal reaction thresholds to egg the authors suggest these reactions were not likely to have been caused by egg protein and were probably due to other ingredients in the vaccine.

Importantly, in those children with a history of asthma or recurrent wheezing, there was no significant increase in respiratory symptoms requiring medical intervention in the 72 hours following LAIV. This suggests that the current guidelines may be unnecessarily over-restrictive in terms of this vaccine’s use in patients with asthma or egg-allergy.


The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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