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Readministration of influenza vaccine after a "desensitization"11/1/2009
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I have reviewed some of the thorough responses on influenza and egg allergy questions. Thank you for this wonderful resource. If we skin test and desensitive a patient with egg allergy to a seasonal flu vaccine, doesn't that mean we have to do a similar procedure to the H1N1 vaccine and subsequent seasonal flu vaccines in the years to come. Egg contents I assume will be variable with each production. I thought in the past the recommendation was not to put a patient through this protocol on a regular basis. Has the recommendation changed and are we to encourage this protocol for all patients with egg allergy? Thank you for your help and insight. |
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Thank you for your recent inquiry.
Unfortunately, we do not know the answer to your question. The "double influenza" immunization this year because of H1N1 is a new phenomenon, and therefore, at least to my knowledge, no one has accumulated any experience with the question you posed. Thus we can only "guess" at the proper approach.
In the past, my practice has been to readminister influenza vaccine to a patient who has taken it without difficulty in the past without retesting or performing a second "graded challenge" or "desensitization." Thus far this has not been a problem. However, to my knowledge there is no consensus approach to this issue, and I have spoken with other physicians who have taken the opposite stance. There is a theoretical risk for readministration without retesting in a patient who was truly allergic to the vaccine, and therefore the decision as to whether or not to retest and "re-desensitize" if the test is positive is one that is simply made after an individual physician's own assessment of risk/benefit ratio. Since we have no consensus on this, the approach is based on an individual risk/benefit decision.
As far as the H1N1 vaccine, as mentioned above, we have no data for a second influenza vaccine given in the same year. Clearly, the most cautious approach would be to retest with the H1N1. This would be true in a patient who has exhibited a positive skin test. If, however, the skin test was negative, and a graded challenge rather than a desensitization was given, then we have been suggesting just to readminister the H1N1 without retesting.
Nonetheless this approach, as in the previous example noted above, is a matter of individual assessment of risk/benefit ratio by the physician caring for the patient.
In answering this question previously, we have assumed that the H1N1 would be given shortly after the seasonal flu vaccination. In that case, I would clearly favor the administration of H1N1 without having to test. However, because of the delay of receipt of the H1N1 vaccine, the readministration becomes, as you pointed out, problematic in a patient who has received the seasonal flu vaccine without problem, but who did so only after testing and a desensitization procedure. Unfortunately we do not know the exact amount of time a previous "desensitization" would "hold." Therefore we have no data to offer that would help you make this decision.
Thank you again for your inquiry and we hope this response is helpful to you.
Sincerely,
Phil Lieberman, M.D.
7205 Wolf River Boulevard, Suite 200
Germantown, TN 38138
Telephone: 901-757-6100
Fax: 901-757-6109
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