A 6-year-old boy is brought to the clinic for influenza vaccination in September. He has been healthy and has no nasal congestion, rhinorrhea, or other symptoms. The patient had 2 episodes of otitis media during infancy and has mild intermittent asthma treated with inhaled albuterol as needed. He has no other respiratory problems and takes no other medications. His older brother had cystic fibrosis and recently died at age 10 from a severe influenza infection; the patient's sweat test was negative. The patient has no medication allergies but has developed a splotchy, itchy red rash to egg-containing products in the past. Eggs have since been excluded from his diet. He has no history of other reactions to egg or to immunizations. Vital signs and physical examination are normal. Which of the following is the best next step in management of this patient?

Question

A 6-year-old boy is brought to the clinic for influenza vaccination in September.  He has been healthy and has no nasal congestion, rhinorrhea, or other symptoms.  The patient had 2 episodes of otitis media during infancy and has mild intermittent asthma treated with inhaled albuterol as needed.  He has no other respiratory problems and takes no other medications.  His older brother had cystic fibrosis and recently died at age 10 from a severe influenza infection; the patient's sweat test was negative.  The patient has no medication allergies but has developed a splotchy, itchy red rash to egg-containing products in the past.  Eggs have since been excluded from his diet.  He has no history of other reactions to egg or to immunizations.  Vital signs and physical examination are normal.  Which of the following is the best next step in management of this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bde0_a868_8f63_91bf320d5aa0_MD0005_00 Annual influenza vaccination is recommended for children age >6 months to prevent the acute respiratory viral illness and spread of infection to patients at risk for life-threatening outcomes (eg, asthma, chronic illness, age <2 years). Inactivated intramuscular influenza vaccines are recommended; live-attenuated influenza vaccines are less efficacious and are not currently recommended (Choice B). Influenza vaccines are manufactured using egg-based products. Therefore, all patients should be evaluated for history of egg allergy prior to the administration of egg-containing vaccines, such as the influenza and yellow fever vaccines. Egg proteins in these vaccines may cause immediate-type hypersensitivity reactions in susceptible recipients. Severe reactions are extremely rare, occurring once per million administrations. Children with prior urticarial reactions to egg ingredients can receive inactivated influenza vaccine normally and do not require additional observation. Those with more severe reactions to eggs, including anaphylaxis, angioedema, hypotension, or persistent emesis, should receive their vaccine in a health care setting, supervised by a provider who can recognize and treat severe allergic reactions. The only contraindication to influenza vaccination is severe allergic reaction to the vaccine itself. (Choices C, D, and E) Urticarial reactions to egg protein are not a reason to defer influenza vaccination and do not require additional testing or consultation. Referral for allergy consultation can be considered for patients with prior anaphylaxis to egg products. Educational objective: Children with only urticarial reactions to egg protein can receive the inactivated intramuscular influenza vaccine without restriction. Those with more severe egg reactions should be immunized in a health care setting under the supervision of a provider who can recognize and treat allergic reactions. References: Influenza vaccination and egg allergy: another step forward. (http://www.ncbi.nlm.nih.gov/pubmed/27012268) Establishing the safety of influenza vaccine in egg-allergic individuals. (http://www.ncbi.nlm.nih.gov/pubmed/23805959)

A 6-Year-Old Boy Is Brought to the Clinic for Influenza