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Live attenuated influenza vaccine is safe for use in children with moderate-severe asthma

Published online: December 18, 2019

Guidelines from USA, Canada and UK recommend annual influenza vaccination of children with a diagnosis of asthma. Vaccination in this age group can be via an injection or using the live attenuated influenza vaccine (LAIV) which is administered as a nose spray in children from age 2 years. The non-invasive route is preferred by children, parents and healthcare professionals; however, some guidelines recommend against its use in children with asthma or recurrent wheeze due to concerns over its potential to induce wheezing.

In a study recently published in The Journal of Allergy and Clinical Immunology (JACI), Turner and colleagues present the results of the SNIFFLE-4 Study, in which 478 children with a physician-diagnosis of asthma/recurrent wheezing were given LAIV in a prospective, multi-center study. Importantly, children were recruited from severe asthma clinics in the UK, and the cohort included 31% with severe asthma. 44% of participants were prescribed high-dose inhaled corticosteroids. The study was funded by the UK Departments of Health through Public Health England.

LAIV did not cause a significant change in asthma control in the four weeks after LAIV, including in preschool children and young people with poorly controlled or difficult asthma. 15% of participants reported a severe asthma exacerbation in the four weeks following immunization requiring short course of systemic corticosteroids; however, this was not unexpected for the time of year, and no association with asthma severity, baseline lung function or asthma control was identified.

These data provide evidence that children with asthma may safely be given LAIV irrespective of the dose of inhaled corticosteroids prescribed, although LAIV is not recommended in those with an acute exacerbation of asthma symptoms.

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.