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Posted on: Wed, 07/12/2006 - 5:56am
Carefulmom's picture
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Joined: 01/03/2002 - 09:00

I think the implication of "a previous anaphylactic reaction to egg is a contraindication" means an anaphylactic reaction requiring treatment with epi. I had to use the epi for dd the first time she ate egg. Her anaphylactic reaction required treatment. You raise a good point about what if you take necessary precautions to avoid exposure therefore your child does not have a history of an anaphylactic reaction to egg. According to the AAP guidelines, your child technically does not have a contraindication to MMR. I cannot say what I would do in your situation. Our situation was very clear cut since she required epi the first time she ate egg. There is always the route of doing titres to check for antibodies, and if they have antibodies to all three, then no need for second MMR. This is assuming they had their first MMR at age 12 months and wasn`t yet known to have severe egg allergy. But according to the guidelines, the only contraindication is a past anaphylactic reaction to egg. Severe egg allergy according to the guidelines is not a contraindication without a past anaphylactic reaction.
[This message has been edited by Carefulmom (edited July 12, 2006).]

Posted on: Wed, 07/12/2006 - 6:15am
JenniferKSwan's picture
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Joined: 06/19/2006 - 09:00

Danielle - here is the info for Florida [url="http://www.vaclib.org/exempt/florida.htm"]http://www.vaclib.org/exempt/florida.htm[/url]
They do allow for religious exemptions. I personally went back and forth over whether or not to seek a religious exemption for many reasons. Was I willing to lie and say it was my religious beliefs that kept me from immunizing my child? I know the Catholic church will back me on certain vaccines contain aborted fetal material. I hate that they have backed me into a corner, but call me a "Momma Bear", I will come out fighting. I think God will forgive me.
When faced with the MMR, my son at that point had had several severe reactions to eggs at that point, each encounter being worse than the one before (but not ana yet). DH and I were debating at that point about delaying further vaccinations because we noticed his eczema had horrible flares after each immunization. Our pediatrician's answer to that was to prescribe Elidel. Okay, a possible cancer causing steroid to mask another issue. When I explained my concern about the MMR and DS's egg allergy, I was told "Well that's why you carry an Epi-pen, right?" Okay - that's it! Not doing it. I delayed vax'ing from that moment on. Everytime I went back to that practice I was met with a fight - it made me not want to take my son there.
Now I have a new pediatrician who is willing to delay all vaccinations until both children are two. I have concerns that they exacerbate the eczema and possibly contribute to allergies (may or may not be true, but would rather err on the side of caution).
------------------
Mommy to Aiden 1/26/05 PA,wheat,barley,soy,egg and others yet to be discovered DS#2 is due July 15, 2006 who we hope will be AF
[This message has been edited by JenniferKSwan (edited July 12, 2006).]

Posted on: Wed, 07/12/2006 - 6:33am
Corvallis Mom's picture
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Joined: 05/22/2001 - 09:00

Thanks for clarifying, Carefulmom.
DD hasn't ever eaten egg. Only well-cooked traces when she was 1 yr and shared lines. (Which have caused rxns that qualified for epi.) Given her Hx, there is no doubt in my mind that she would anaphylax if she ever actually consumed egg. (Nor in her allergist's mind, either, actually....)
Her skin test caused (we think) her RAST number to go from about 3 up to 50 something, as she certainly had no exposures during that period.
I can only assume that the MMR vax she recieved really didn't have any remaining egg protein in them.

Posted on: Wed, 07/12/2006 - 7:58am
Carefulmom's picture
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There are so many possible reasons for the cap rast to go up. It might have been the skin test or it might not. Lots of people on this board have seen the cap rast go up with no exposures. You probably saw my post that Dr. Sampson did a study where they sent several samples on the same patient to a lab, but they gave the patient a different name each time. The purpose was to see if the lab was consitent within itself on the cap rast. Dr. Sampson found that only two labs gave accurate results. The other labs were all over the map as far as results, even on the same patient in the same lab.
Since 1198 out of 1200 can get MMR without a reaction to the egg protein in it, it`s no surprise that your child was one of them. But there are still the two who are anaphylactic to egg who had a reaction to MMR. That, in addition to everything else I have read, would lead me to believe there must be some miniscule amount of protein in it. After all, it is prepared with chick embryo. I see it sort of like the cold pressed/heat pressed peanut oil. One of them (cannot remember which) is supposed to be safe for those with pa, as there is supposed to have no peanut protein in it. Yet people on this board have had a reaction to the one that is supposed to have no peanut protein. I don`t think it is possible to be 100% sure that all doses of MMR using chick embryo are free of egg protein. The 2 out 0f 1200 that reacted pretty much shows that.

Posted on: Wed, 07/12/2006 - 8:18am
Corvallis Mom's picture
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Joined: 05/22/2001 - 09:00

That's what I meant-- she got lucky and clearly there weren't traces. I think this just means that though MMR vax lots are often contaminated (too often to risk giving them to EA/anaphylactic) it is by no means consistent. I mean, there is a threshold dose for [i]everything[/i]-- she got lucky that day. [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img]
Some flu shot lots tested are below detectable limits, too-- but not most. Flu shot prep is quite crude in comparison to other vaccine manufacturing.
Allergist felt that even taking a flu vax lot with "zero" protein and splitting doses would present a totally unacceptable risk for DD. Not even in a hospital setting, he emphasized.
My confusion is why on earth her regular physician felt the MMR was okay...my guess is that the chart her PCP has doesn't include the current EA info that the allergist has. When I was told "NO risk for egg allergic," I assumed this meant at any level of severity.
Thanks for your input. I'm just trying to figure this out so that I can discuss it with both physicians if I feel it is something that wasn't handled very well. I think I am coming to that conclusion.
As far as the SPT and RAST numbers go, well... I know that there isn't necessarily any connection between exposure and RAST value. BUT her numbers had been between 1 and 7 kU/L for years prior to that SPT, so I have to think that there was a connection.
We're always had allergists who insisted on IBT lab work. Might not be anything close to perfect.... but at least it is precise, right? [img]http://uumor.pair.com/nutalle2/peanutallergy/biggrin.gif[/img]
[This message has been edited by Corvallis Mom (edited July 12, 2006).]

Posted on: Wed, 07/12/2006 - 9:13am
Beth V's picture
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Joined: 01/15/2000 - 09:00

Hi All,
I am pretty well read on the subject of vaccines. My husband is a Chiropractor and very holistic in his thinking. I am a Registered Nurse and my thinking was very traditional when it came to vaccinations. I never thought this would be a problem---then the twins came. We realized we had very different ideas!!! We decided to selectively vaccinate in the beginning. Soon after we stopped altogether. We are on our 6th pediatrician---many won't let you in their practice if you don't vaccinate. With our current doc we had to sign a waiver. We have a religious exemption with the Church or Congregation of Universal Wisdom (I'm not sure which one it is). We have never been questioned regarding this with the schools. A good website to go on for vaccine info is [url="http://www.nvic.org."]www.nvic.org.[/url] If you have any other questions my husband or I can answer my e-mail address is:
[email]aviscusi@bellsouth.net[/email]
Hope this helps
Beth

Posted on: Wed, 07/12/2006 - 10:12am
Sarahfran's picture
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Joined: 06/08/2000 - 09:00

Our situation is somewhat different, but we had no problem getting a medical exemption for our DS. He has a primary immune deficiency so most vaccines just have no effect on him whatsoever, but vaccines with live viruses can cause him to get the full-blown version of the virus, and because of his lack of immune response, these can be life threatening. So clearly vaccines were something to avoid, but we also still wanted/needed him to have immunity to these illnesses (he's one of the people they are referring to when they say a virus isn't dangerous except to the elderly and those with compromised immune systems) so he gets IV gammaglobulin every four weeks to give him the IgG that his body can't produce.
The process of getting the medical exemption was very straightforward--just a state form that the pediatrician fills out and it's entirely up to him whether he fills it out or not. It's kept on file at the school (because the school is the only institution that really cares if your child is immunized or not), so I don't understand why a doctor would be unwilling to fill it out--doesn't he trust his own judgment? It's not as if it's going to the state medical licensing board or anything. If your doctor supports your decision at this time, he can give a medical exemption that is temporary--he could revisit the issue each year depending on your DD's situation at that time. Do you think he'd agree to a 12 month or 6 month exemption? And is it even an issue now if she's only three? Would it make sense to just put the issue on the back burner until six months before she is due to start school? A lot can change in that time.
The other thing you can do (as someone else mentioned) is to check her blood for the antibodies to these viruses--she may have enough immunity from the vaccines she had before you became aware of the food allergies. And if you can convince your doctor and insurance company of it, you might want to consider IV gammaglobulin. It's insanely expensive, but it DOES give the same level of immunity that vaccines do. If your doctor still thinks that vaccines could be dangerous for your DD, you might be able to get a referral to an immunologist to look into other options that would satisfy the school and keep your DD safe.
Good luck!
Sarah

Posted on: Wed, 07/12/2006 - 1:34pm
ceross's picture
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Joined: 01/27/2004 - 09:00

This might be helpful regarding egg and the MMR. My DD was skin tested for the MMR at age 1 and again at age 2. She passed at 2 and was rewarded with the shot. She had no reactions. ([url]http://www.jcaai.org/pp/anaph_10_avian.asp[/url]) Our current allergist was supportive of vaccinating DD and felt that it was safe enough for her to have the second dose at the pediatrician's office. Her first dose was administered at his office at Georgetown University Hospital.
Corvallis, you made a good point about testing and history of reactions. Sometimes, children test positive before a reaction. This was the case with my DD and her PA. She tested positive at 23 months but had her first anaphylactic reaction at 32 months of age.
The risks from measles is still very great. This is from an AAP policy document: "From 1989 through 1991, more than 55 000 cases and 147 measles-related deaths were reported. Most cases occurred in children equal/less than 5 years of age who had not received measles immunizations, although the number of cases in school children also increased substantially." ([url]http://aappolicy.aappublications.org/cgi/reprint/pediatrics;101/1/129.pdf[/url])
It's a balance as is anything with allergies. If you don't feel the benefit outweighs the risks, then clearly not vaccinating is the appropriate choice.

Posted on: Thu, 07/13/2006 - 6:40am
Samber's picture
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Joined: 06/22/2006 - 09:00

We were told by our allergist that there isn't really a reason to NOT give MMR. Our 2 year old daughter is EGG and PA. She had never been given egg, had her first flu shot, and broke out in aggressive hives, then tested positive on RAST and skin testing for egg, and PA. Next week she will have her first MMR in his office. They will apply it to the skin topically, if no reaction they will scratch it in, still no reaction they will inject small doses over an extended period of time until she receives the full dose and hopefully will have NO reaction. Everything I have read has basically stated that it is "safe" to administer MMR under clinical/hospital supervision.
Will let you know how it goes next week. Wish us well.
Samber

Posted on: Thu, 07/13/2006 - 7:50am
Carefulmom's picture
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Joined: 01/03/2002 - 09:00

That makes sense. Since your child has not had a previous anaphylactic reaction to egg, there was no contraindication for her to get MMR, just that certain precautions were necessary.

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