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Nasal Influenza Immunisation with LAIV (FluMist) Is Safe in Egg-Allergic Children with Asthma or Recurrent Wheeze: Data from the Sniffle-2 Study
Saturday, March 5, 2016: 2:00 PM
Theatre, Room 411 (Convention Center)
Paul J. Turner, FRACP PhD, , , ,

Rationale: Live Attenuated Influenza Vaccine (LAIV; FluMist®; Fluenz®) is an intranasal vaccine widely available in USA and recently incorporated into the UK National Immunization Schedule. However, CDC guidelines recommend against its use in children under 5yrs with a history of asthma or recurrent wheezing. We sought to assess the safety of LAIV in egg-allergic children with asthma or recurrent wheeze.

Methods: Multi-centre phase IV study in egg-allergic children with a physician-diagnosis of asthma or recurrent wheeze, in whom symptoms were well-controlled. LAIV was administered under medical supervision in hospital. Respiratory symptoms were monitored pre- and post-LAIV through a validated questionnaire (Asthma Control Test, ACT). Local ethical and regulatory approval was granted, and informed consent was obtained.

Results: The cohort included 445 children (median 6.5yrs, range 2-18yrs) with asthma or recurrent wheeze. 81% received regular inhaled corticosteroids while 32% received multiple preventer therapy. There were no systemic allergic reactions. 48/445 children (10.8%, 95%CI:8.1-14.1%) experienced lower respiratory symptoms within 72hrs, including 27 with parent-reported wheeze (6.1%, 95% CI:4.0-8.7%). Children under 5yrs were slightly more likely to develop lower respiratory symptoms, although this did not reach statistical significance (22/149 (15%) vs 26/296 (8.7%), OR 1.8 (95% CI:0.98-3.3), P=0.07). Paired data for ACT was available for 394/445 (89%) children. There was no significant change in lower airway symptoms (assessed using ACT) following LAIV in participants over 12yrs, while those aged 2-5yrs and 2-12yrs reported a small but significant improvement (P<0.001).

Conclusions: LAIV is safe for use in egg-allergic children, including those with controlled asthma or recurrent wheeze.