Assistant Professor, Division of Allergy and Clinical Immunology, Department of Internal Medicine, the University of Michigan Medical School and the University of Michigan Food Allergy Center, Ann Arbor, Mich.
Associate Professor, Division of Allergy and Clinical Immunology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai and the Jaffe Food Allergy Institute, New York, NY.
J Allergy Clin Immunol Pract. 2013 Nov-Dec;1(6):602-7. doi: 10.1016/j.jaip.2013.07.007. Epub 2013 Sep 25.
Significant recent changes to the recommendations in providing trivalent seasonal influenza vaccine (TIV) to individuals with egg allergy were made, but their implementation has not been studied.
To investigate allergist-reported compliance with updated TIV administration guidelines for individuals with egg allergy.
A 22-question electronic survey was distributed via e-mail to American Academy of Allergy, Asthma, and Immunology members (allergists), which queried practice styles and attitudes that pertain to TIV administration to individuals with egg allergy.
Only 1% of 895 respondents believed that TIV should be contraindicated for individuals with egg allergy, 3.8% reported not administering TIV to individuals with egg allergy, and 17% reported only administering TIV to individuals with mild egg allergy; 13.2% reported that risk-mitigating precautions (eg, vaccine skin testing, graded-dose challenges) were necessary. Postimplementation change compared with preimplementation change included less intradermal testing (30.6% vs 64.9%), less multistep desensitization (34.7% vs 65.3%), observing more patients for >30 minutes after vaccination (79.1% vs 20.9%), administering TIV despite positive TIV skin tests (65.4% vs 34.6%) (all P < .001), but no significant reduction in performing TIV prick skin testing (46.2% vs 53.8%). Factors associated with not performing TIV skin testing included reading the guidelines (P = .028), academic practice (P < .01), and fewer years in practice (P < .01). Only 48.6% agreed that TIV can safely be administered in the primary care setting to individuals with egg allergy, and only 41.9% advised their patients accordingly.
There were significant shifts in practice style over time concurrent with newly established guidelines, except for vaccine skin testing. Physician opinions are also concurrent with guideline changes. Although TIV administration guideline recommendations are being successfully implemented, greater adherence should be promoted.
近期，三价季节性流感疫苗（TIV）接种建议发生了重大变化，适用于鸡蛋过敏者，但尚未对其实施情况进行研究。
调查过敏症专家报告的对更新后的鸡蛋过敏者 TIV 管理指南的遵循情况。
通过电子邮件向美国过敏、哮喘和免疫学学会（过敏症专家）成员分发了一份包含 22 个问题的电子调查问卷，调查与 TIV 接种有关的实践模式和态度，包括鸡蛋过敏者的 TIV 接种。
895 名受访者中，仅 1%认为 TIV 对鸡蛋过敏者应禁忌，3.8%报告未向鸡蛋过敏者接种 TIV，17%报告仅向轻度鸡蛋过敏者接种 TIV；13.2%报告需要采取风险缓解措施（如疫苗皮肤试验、分级剂量挑战）。实施前后变化包括：皮内试验减少（30.6%对 64.9%），多步骤脱敏减少（34.7%对 65.3%），接种后观察时间>30 分钟的患者增多（79.1%对 20.9%），TIV 皮试阳性时仍给予 TIV（65.4%对 34.6%）（均 P<0.001），但 TIV 皮试的实施率无显著降低（46.2%对 53.8%）。未行 TIV 皮试的相关因素包括阅读指南（P=0.028）、学术实践（P<0.01）和从业年限较短（P<0.01）。只有 48.6%的医生认为 TIV 可安全地在初级保健环境中应用于鸡蛋过敏者，只有 41.9%的医生相应地告知了患者。
随着新指南的建立，实践模式发生了重大转变，但疫苗皮试除外。医生的意见也与指南变化一致。尽管 TIV 管理指南建议得到了成功实施，但应进一步促进其应用。
