Tag: food allergies

Do Vaccines Cause Food Allergies?

Why do some folks think that vaccines can cause food allergies?

It’s likely for the same reason that they think that vaccines can cause eczema and reflux.

Many infants develop the first signs of food allergies around the same time that they are getting their first vaccines

Do Vaccines Cause Food Allergies?

To be clear, vaccines can be associated with food allergies, including:

  • eggs – most children with an egg allergy can get the flu shot, although the yellow fever vaccine could still be an issue
  • gelatin – some vaccines use gelatin, like in Jell-O, as a stabilizer
  • yeast – although they aren’t thought to be an issue for kids with yeast allergies, a few vaccines can have residual amounts of yeast in them
  • milk – very rarely and mainly based on scattered case reports, it is thought that residual casein proteins in DTaP/Tdap vaccines could trigger allergic reactions in some kids with severe milk allergies

But vaccines don’t cause these food allergies.

What about peanut allergies? Peanut oil is not actually a component of vaccines and vaccines have not caused a peanut allergy epidemic.

And FPIES?

“Food Protein Induced Enterocolitis Syndrome (FPIES) is a type of non-IgE mediated food allergy that can present with severe vomiting, diarrhea and dehydration.”

Food Protein-Induced Enterocolitis Syndrome (FPIES)

It is important to note that having FPIES is not a contraindication to getting vaccinated.

And that’s not surprising, as there is no biologically plausible mechanism for any association between FPIES and vaccines!

What about the rotavirus vaccines? Could they be causing FPIES?

FPIES was recognized in the mid-1970s. We didn’t have a rotavirus vaccine back then.

Could it have been the oral polio virus, which we were using in the 1970s?

“Some researchers have speculated that T cells play a central role in the development of the localized inflammation in the intestinal tract that characterizes FPIES, but this theory has not been confirmed.”

Food Protein-Induced Enterocolitis Syndrome

If it was, then why didn’t FPIES go away when we stopped using the oral polio vaccine in 2000. Or when we used neither OPV nor a rotavirus vaccine, from 2000 to 2007?

“The reviewed epidemiological evidence indicates that, although possibly not contributing to optimal stimulation of the immune system in infancy, current infant vaccines do not cause allergic diseases.”

Koppen et al on No epidemiological evidence for infant vaccinations to cause allergic disease.

There is also no evidence that vaccines are causing other types of food allergies.

Vaccines are safe, with few risks, and are obviously necessary.

As you wait for your child to hopefully outgrow their food allergy, don’t unnecessarily skip or delay their vaccines and leave them at risk to get a vaccine preventable disease.

Vaccines and Food Allergies

Can You Really Get a Flu Shot If You Are Allergic to Eggs?

Are you still worried about your child’s egg allergy and getting them a flu vaccine?

Everyone needs a flu shot. When will you get yours?
Everyone needs a flu shot. Even kids with egg allergies. Photo by Gabriel Saldana (CC BY-SA 2.0)

That’s not surprising, as we once warned people about residual egg proteins in flu vaccines and the possibility of immediate hypersensitivity reactions in those with severe egg allergies.

Flu Vaccines and Egg Allergies

Of course, that advice has now changed, even though most flu vaccines are still prepared in chicken eggs.

“Recent studies have shown that even individuals with confirmed egg allergy can safely receive the flu vaccine. The Joint Task Force on Practice Parameters of the American Academy of Allergy Asthma and Immunology and the American College of Allergy Asthma and Immunology as well as the American Academy of Pediatrics state that no special precautions are required for the administration of influenza vaccine to egg-allergic patients no matter how severe the egg allergy.”

Egg Allergy and the Flu Vaccine

In fact, it began to change in 2011, when we got the recommendation that it was okay to give flu shots to people with egg allergies, if they only get hives as their reaction. It was still recommended that those with more severe allergic reactions to eggs “be referred to a physician with expertise in the management of allergic conditions for further risk assessment before receipt of vaccine.”

Before that, we would sometimes do skin testing on high risk egg allergic kids, desensitization, or regular chemoprophylaxis.

In 2013, the recommendation changed so that those with severe allergic reactions to eggs should get their flu shot “by a physician with experience in the recognition and management of severe allergic conditions.”

The recommendations were again modified in 2016, removing the recommendation that egg-allergic flu vaccine recipients be observed for 30 minutes and that those with severe egg allergies “should be vaccinated in an inpatient or outpatient medical setting (including but not necessarily limited to hospitals, clinics, health departments, and physician offices), under the supervision of a health care provider who is able to recognize and manage severe allergic conditions.”

Why the changing advice?

It’s because severe allergic reactions to vaccine are rare (in a million doses rare). And even in the flu vaccines that still use eggs, almost all of the egg protein is removed from the final vaccine. So that residual amount of egg protein is unlikely to trigger an allergic reaction. And that’s what we saw as the recommendations were slowly changed year after year.

Getting a Flu Shot When You Are Allergic to Eggs

And that’s why we have our current recommendations:

  • Those with a history of egg allergy who only get hives can get any age-appropriate flu vaccine.
  • Those with a history of egg allergy who have severe reactions, including angioedema, respiratory distress, lightheadedness, recurrent emesis, or who required epinephrine or another emergency medical interventions, can still get any age-appropriate flu vaccine, but they should get it in an inpatient or outpatient medical setting (such as a hospital, clinic, health department, or physician’s office). And the vaccine administration should be supervised by a health care provider who is able to recognize and manage severe allergic reactions.
  • Those who can eat eggs without reaction can get any age-appropriate flu vaccine.

Do you still have to be observed after getting your flu vaccine if you have an egg allergy?

No postvaccination observation period is recommended specifically for egg-allergic persons.

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season

Nope. But that’s likely because although they are rare, reactions might not occur right away.

So yes, you can and you should get a flu vaccine if you are allergic to eggs.

More on Flu Vaccines and Egg Allergies

 

Which Flu Vaccine Should You Get?

After decades with a single type of flu vaccine – the flu shot – there are now many different kinds of flu vaccines that many of us can choose from. And your choices are not just between the nasal spray flu vaccine vs a flu shot. There are also a lot of different kinds of flu shots available now.

Everyone needs a flu shot. When will you get yours?
Everyone needs a flu shot. When will you get yours? Photo by Gabriel Saldana (CC BY-SA 2.0)

Having choices is nice.

It would be also be nice to have a little more guidance on what to do with these choices.

Are any of the flu vaccines better than others?

Which Flu Vaccine Should You Get?

This year, we will have:

  • quadrivalent flu shots – Afluria, Fluarix, FluLaval, Fluzone, Fluzone Pediatric Dose
  • quadrivalent flu shots that are cell-culture based – Flucelvax
  • quadrivalent flu shots that can be given intradermally – Fluzone Intradermal
  • trivalent flu shots – Afluria
  • trivalent flu shots that are adjuvanted – Fluad
  • high dose trivalent flu shots – Fluzone High-Dose
  • quadrivalent flu shots that are made with recombinant technology – Flublok
  • nasal spray flu vaccine – Flumist

Which one should you get?

It is actually easy to start by asking which one you should get for your kids, as many of these flu vaccine options are only available for adults and seniors.

Flu Vaccine Options

Before you start thinking too long and hard about potential options, keep in mind that you might not have as many options as you think.

“Not all products are likely to be uniformly available in any practice setting or locality. Vaccination should not be delayed in order to obtain a specific product when an appropriate one is already available.”

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season

Doctors and clinics might not stock multiple brands or types of flu vaccines, so you might have to get whatever flu vaccine that they have available.

“Within these guidelines and approved indications, where more than one type of vaccine is appropriate and available, no preferential recommendation is made for use of any influenza vaccine product over another.”

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season

And that’s okay. In most cases, there haven’t been head to head studies showing that one flu vaccine is better than another.

Flu Vaccine Options for Kids

Still, since these options might be available to you, it is good to know about them.

This year, younger kids, between the ages of 6 months and 3 years, can either get:

  • FluLaval Quadrilvalent
  • Fluarix Quadrivalent
  • Fluzone Quadrivalent Pediatric

While you are unlikely to notice a difference, both FluLaval and Fluarix are given at a 0.5ml dose containing 15 µg of HA per vaccine virus, while Fluzone is given at a 0.25ml dose containing 7.5 µg of HA per vaccine virus. Why the difference? “Safety and reactogenicity were similar between the two vaccines,” even at the different doses.

Basically, these are just different brands of the same type of flu shot.

There are even more options as your kids get older though, including  Fluzone Quadrivalent (age three and above), Afluria Quadrivalent or Trivalent (age three and above), Flucelvax Quadrivalent (age four and above), FluLaval and Fluarix.

Of these, some folks wonder if Flucelvax, since it isn’t made in chicken eggs, might be more effective than the others. Remember, one of the things that are thought to make the flu vaccine less effective than most other vaccines is that they are made in eggs, leading to mutations. And there is actually some evidence that those flu vaccines that are not made in eggs might be more effective.

“And the University of Pittsburgh Medical Center is taking that a step further, saying it will only be buying the two egg-free vaccines on the market: Flucelvax and FluBlok. That’s because there is some evidence these two formulations may work better than the older vaccines grown in eggs, said Dr. Richard Zimmerman, who advises the UPMC Influenza Committee.”

Guidance on which flu vaccine to get: Shots for kids, maybe go egg-free

Again, remember that the CDC has made “no preferential recommendation” for one flu vaccine over another. Why not? We don’t have enough information to make that kind of recommendation.

Should parents only ask for Flucelvax? That would only work if they made enough doses for every kid to get vaccinated, which they didn’t. Should you hold out until you can find FluceIvax for your kids? No, since doing that might leave them unvaccinated once flu season hits.

What else should you know about your flu vaccine options? While over 80% of flu vaccines are now thimerosal free, most of these flu vaccines are still available in multi-dose vials with thimerosal.

Also thimerosal free, this year, Flumist is back as an option. It is available for healthy kids who are at least two years old. Although the AAP has issued a preference for flu shots this year, the ACIP says that kids can get either Flumist or a flu shot.

What about if your kids are allergic to eggs?

“Persons who report having had reactions to egg involving symptoms other than urticaria (hives), such as angioedema, respiratory distress, lightheadedness, or recurrent emesis; or who required epinephrine or another emergency medical intervention, may similarly receive any licensed, recommended, and age-appropriate influenza vaccine (i.e., any IIV, RIV4, or LAIV4) that is otherwise appropriate for their health status.”

Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices—United States, 2018–19 Influenza Season

Unless they had a severe allergic reaction to a previous flu vaccine, they can get any available flu vaccine, especially if the previous reaction was only hives or they are able to eat eggs.

What if you want a flu vaccine without aluminum? Take your pick. While it would be safe it was, aluminum is not an ingredient in flu vaccines.

Flu Vaccine Options for Adults

In addition to all of the flu vaccines available for older kids, adults have a few more options:

  • Afluria Quadrivalent or Trivalent can be given by jet injector  to those between the ages of 18 and 64 years
  • Flublok Quadrivalent – a recombinant flu shot that can be given to those who are at least 18 years old
  • Fluzone High-Dose – a trivalent flu shot with a higher dose of flu virus antigens (4 times the amount of antigen as a regular flu shot) that is available for seniors who are at least 65 years old
  • Fluad – a trivalent flu shot with an adjuvant that is available for seniors who are at least 65 years old

Why get a flu vaccine with a jet injector instead of a standard needle? High-pressure jet injectors don’t use needles!

Like FluceIvax, Flublok is not made in chicken eggs. The recombinant hemagglutinin(HA) proteins are made in insect cell lines. Does Flublok work better than egg based flu vaccines? That’s the theory, but again, there is no preference for one of these vaccines over another.

Seniors have even more choices.

Should they get Fluzone High-Dose, Fluad, or one of the other flu vaccines? Both have been shown to be more effective than standard flu vaccines in seniors, but they have not been compared against each other.

“In a Canadian observational study of 282 people aged 65 years and older conducted during the 2011-12 season, Fluad was 63% more effective than regular-dose unadjuvanted flu shots.”

CDC on People 65 Years and Older & Influenza

But neither Fluzone High-Dose nor Fluad are quadrivalent, so only protect against three flu virus strains.

Is there a quadrivalent flu shot for older adults that might work better than standard flu shots?

Yes. FluceIvax and Flublok are non-egg based quadrivalent flu shots that might be more effective than standard flu vaccines.

So are you more confused now that you know you have so many options? Just remember that for most people, the mistake isn’t about choosing the right flu vaccine, it is about not getting vaccinated.

What to Know About Your Flu Vaccine Options

While it might seem like you have a lot more options in a flu vaccine this year and that some might be more effective than others, keep in mind that availability will likely greatly limit these “options.”

And the best flu vaccine is the one that you actually get, as it will be the one that reduces your risk of getting the flu. Missing your chance to get vaccinated and protected because you are waiting for a specific brand or type of flu vaccine isn’t going to help keep the flu away.

More on Your Flu Vaccine Options

America’s New Normal: Propaganda About the Unhealthiest Generation

My son started to have migraines when he was about 11 years old.

Must be stress, BPA, poor eating habits, all of the screen time, or vaccines, right?

“Americans spend the least on food, the most on health care, have the most highly vaccinated kids, and have the sickest kids of any industrialized country. More kids than not are now chronically ill, developmentally delayed, and eating or injecting prescription medications from cradle to grave – which is going to be a quicker trip for them than it was for their parents, according to data on life expectancy in the US. We are inured to childhood autism, epilepsy, allergy, asthma, diabetes, obesity, Crohn’s disease and cancer. We are dying younger. We are going backwards.”

Judy Converse on America’s New Normal: Chronically Ill Kids

That likely seems like a young age to get migraines and would fit well with the narrative that kids today are part of the unhealthiest generation ever.

Except that I started to get migraines at about the same age, and so did my mother. Like many of the other conditions that seem to be ballooning today, migraines have a genetic component.

The Unhealthiest Generation?

The CDC has long kept statistics on everything from asthma and cancer rates to diabetes and life expectancy rates and helps folks see how healthy kids really are today.
The CDC has long kept statistics on everything from asthma and cancer rates to diabetes and life expectancy rates and helps folks see how healthy kids really are today.

Who says that today’s kids are part of the unhealthiest generation ever?

Mostly anti-vaccine folks who blame vaccines for making kids unhealthy and alternative medical providers who think their holistic remedies will fix all of the problems they see in our unhealthy kids who they claim are full of “toxins.”

Toxins? If you are going to believe that our kids are all sick, then you have to buy into the narrative that toxins are everywhere, especially in vaccines, and they are making kids sick.

Of course, none of that is true.

Vaccines are safe and work to prevent us from getting sick and there are 2 to 3 million fewer deaths in the world each year because people are vaccinated and protected.

“From developing groundbreaking treatments for deadly chronic diseases to saving babies who are born premature, pediatric researchers have increased the ability of children to live full and fulfilling lives that only a few decades before would have been tragically cut short.”

Sandra G. Hassink, MD on the 7 Great Achievements in Pediatric Research

And today’s kids, all 73.6 million of them in the United States, aren’t the unhealthiest. They are actually a very healthy generation, being born with the lowest child and infant mortality rates ever, low rates of hospitalizations, and one of the highest life expectancies in history.

Our Healthy Kids

How do we know today’s kids are healthy?

One easy way is to compare them to kids in the past…

If you have only been listening to the alarmists who talk about the unhealthiest generation all of the time, you likely wouldn’t know that:

  • while 2.6% of kids were thought to be in fair or poor health in 1991, that is down to just 1.8% today (2015)
  • fewer kids today (4.5%) report having had an asthma attack in the previous year than they did in 1997 (5.4%), and that fewer kids have asthma today (8.5%) than in 2003 (8.7%)
  • since 1997, fewer children, whether or not they have insurance, are visiting the emergency room
  • fewer children are requiring overnight hospital stays, down from 5.5% to just 2.1% today (2015)
  • rates of hay fever or respiratory allergy are down since 1997, from 17.5% of kids to 15.6% of kids today (2015)
  • rates of epilepsy have been stable in children for at least 40 years
  • fewer kids have multiple ear infections since 1997, when 7.1% of kids had 3 or more ear infections, to just 5% of kids today (2015)
  • fewer kids are being prescribed antibiotics
  • childhood cancer rates have been rising, but only slightly, and mortality rates have been declining
  • suicide rates are rising, but only from historic lows – they used to be about the same or higher in the early 1990s

Of course, some conditions are on the rise, including ADHD, type 1 diabetes, food allergies, eczema,  obesity, and most autoimmune diseases.

“A few conditions have decreased because of prevention (eg, lead encephalopathy), a few represent relatively new conditions (eg, human immunodeficiency virus type 1 infection), and some have increased after dramatic improvements in survival for individually low-prevalence childhood conditions that previously had high fatality rates (eg, leukemia, cystic fibrosis, congenital heart diseases). Most growth, however, reflects dramatic increases in incidence of a few high-prevalence conditions.”

James M. Perrin, MD on The Increase of Childhood Chronic Conditions in the United States

And autism rates have been up, but we mostly know why.

“…the numbers of people born with autism aren’t necessarily increasing dramatically. It’s just that we’re getting better and better at counting them.”

Emily Willingham

Although we don’t know why most other conditions are trending up (it isn’t vaccines), we will hopefully continue to develop new theories and reverse those trends.

It should be reassuring that many of the trends do show that our kids are indeed healthy.

What to Know About Our Healthy Kids

From gun violence and climate change to the threat of emerging infections, out children do face many threats and are certainly under a lot of stress. There is no evidence that this is the unhealthiest generation though. If anything, they are on track to be one of the healthiest.

More on Our Healthy Kids