Back to School Immunizations

What if your child suffers from certain food allergies found in these vaccines?

As we approach the beginning of the school year and it is time to finalize registration for schools and day cares, it may be time to think about booster shots. For kids with egg allergies, there are often questions about MMR vaccines and flu vaccines, as these two shots are often cultured in eggs. According to the Center of Disease Control and the American Academy of Pediatrics, egg allergy is not a contraindication to these vaccines. The MMR vaccine, even in children with severe egg allergies, can usually be safely administered. Additionally, results from a study presented by the American College of Allergy, Asthma and Immunology show that most people with egg allergies can safely receive the flu vaccine, including children with severe egg allergy. The benefits of the flu vaccine typically outweigh the risks, especially in those kids with asthma, to avoid complications of the flu. Individuals allergic to eggs should still continue to receive these vaccines from an experienced physician who is familiar with reactions to vaccines.

However, for kids with gelatin allergies, like that found in Jell-O, there are also questions about MMR, Varicella (chicken pox), influenza and DTaP (diphtheria, tetanus and pertussis) as gelatin is added as a heat stabilizer to many of these vaccines. It should be noted that allergic reactions to MMR vaccine are far more likely due to the gelatin in the vaccine rather than residual egg proteins. Essentially, any person who has experienced an allergic reaction after eating gelatin food products (Jell-O) should not be given any of the above vaccines without further testing prior to it being administered. However, as in the case with egg-containing vaccines in egg-allergic people, gelatin-containing vaccines may be able to be given to gelatin-allergic people under the direct supervision of a physician.

Another common childhood vaccine is hepatitis B, which is synthesized by Saccharomyces cerevisiae, otherwise known as common baker’s yeast--used for making bread. It is advised that any person who has experienced an allergic reaction after eating food products containing baker’s yeast should not be give hepatitis B vaccine without discussing this further with your physician or allergist.

Food Allergy Prevention in Infants

In 2015, The New England Journal of Medicine published the findings from the landmark Learning Early About Peanut Allergy (LEAP) study. This was the first randomized trial to study early allergen introduction as a food allergy prevention strategy. The LEAP study showed that early introduction of peanut-

containing foods to infants at high risk of developing peanut allergy led to an 81% relative risk reduction in the development of peanut allergy. In January 2017, the American Academy of Pediatrics, along with the NIH, NIAD, and AAAAI changed their recommendations and now advocate for early introduction of peanut. While most infants are encouraged to eat peanut starting at about 6 months of age, infants who are at high risk of developing a peanut allergy should be evaluated by their pediatrician (to have IgE blood test done) or by their allergist (to have skin prick testing or blood test done). Is your child “high risk”? The literature defines “high risk” as infants who have “severe eczema, egg allergy, or both”. Those with mild eczema (meaning they do not need to use a topical steroid cream) and those with egg allergy are strongly encouraged to be tested by their pediatrician or allergist, as the guidelines recommend that they introduce peanut between 4-6 months. Once peanut is introduced, it should be kept in the infant’s diet regularly, which means about 3 days per week, ideally until 5 years of age.

It is important to note that whole peanuts and peanut butter pose a choking hazard to infants. Age appropriate options to introduce peanut include: