Managing Allergies and Flu Vaccination for Premature Infants

Allergic constitution and influenza vaccine?

Dear Dr.
Chang,
My baby is a preterm infant born at 35 weeks and 3 days! Currently, his corrected age is one year old.
Since the end of May this year, he has had a cold that lasted until mid-August, during which he was treated with antibiotics and only then started to improve.
Due to the continuous colds, his weight has not been able to increase and has remained at the 3rd percentile! Each time he gets a cold, it always starts with a cough and bronchial issues, especially after receiving vaccinations, whether it's the pentavalent vaccine or the measles and varicella vaccines, he shows cold symptoms! The bronchial issues are particularly troublesome.
The doctor mentioned he has a soft larynx.
Recently, he developed a rash on his arm due to heat, which only improved after applying a topical ointment.
The doctor suggested that due to his weak immune system, he should receive the influenza vaccine, but he seems to have an allergic constitution! After eating egg yolk for a few days, his rash worsened (but we are unsure if it was due to the heat or the eggs).
Is it still safe for him to get the vaccine? If he is indeed allergic to eggs, what could happen if we take the risk of vaccinating him? If we choose not to vaccinate, how can we protect him, especially with the threat of avian influenza looming? We are unsure what to do.
Could you please provide us with some advice?
Concerned mother
Dr.
Chang, I would like to ask again! I want to vaccinate my baby against pneumococcal disease.
His current corrected age is one year and seven days.
How many doses of the vaccine are required if we pay out of pocket? How should it be administered, and what is the approximate cost?
Concerned mother

Zhu Zhu, 0~9 year old female. Ask Date: 2005/10/30

Dr. Zhang Wenwang reply Pediatrics

1) The growth curve records an individual's growth process, specifically the continuous tracking of height and weight.
If your baby consistently follows the same curve, it indicates that they belong to that particular percentile, and while they may be in the 3rd percentile and considered smaller, they are still growing normally.

2) Based on the symptoms you described, it seems more like allergic respiratory issues.
It is advisable to maintain a regular routine, engage in moderate exercise, and have a balanced diet, while particularly avoiding cold foods.
3) In fact, many everyday foods contain protein, including egg yolks.
If your baby is indeed allergic to eggs, consuming foods that contain egg ingredients (such as cakes, puddings, etc.) could potentially trigger severe skin reactions.
If there are no such reactions, in light of the potential pandemic this year, it is still recommended for children under 2 years old to receive the influenza vaccine.

Reply Date: 2005/10/30

More Info

When it comes to managing allergies and flu vaccination for premature infants, especially those with a history of respiratory issues and potential allergies, it is crucial to approach the situation with care and informed decision-making. Your concerns about your premature infant, who was born at 35 weeks and has experienced recurrent respiratory infections, are completely valid.
Firstly, regarding the flu vaccine, the Centers for Disease Control and Prevention (CDC) recommends that children, including those with a history of prematurity, receive the flu vaccine annually. This is particularly important for infants and children with underlying health conditions, as they are at a higher risk for severe complications from influenza. However, the presence of allergies, particularly to egg proteins, can complicate this decision. Many flu vaccines are produced using eggs, which can pose a risk for children with egg allergies.

If your child has a known egg allergy, it is essential to consult with a pediatric allergist or your child's healthcare provider before proceeding with the flu vaccination. There are flu vaccines available that are egg-free, such as the recombinant flu vaccine (FluBlok) and the cell-based flu vaccine (Flucelvax). These alternatives can be considered for children with egg allergies. Your healthcare provider can help determine the best option based on your child's specific health needs and allergy history.

In addition to the flu vaccine, you mentioned concerns about your child’s reaction to vaccinations, particularly following the administration of the five-in-one and measles vaccines. It is not uncommon for infants, especially those with a history of respiratory issues, to exhibit mild symptoms such as cough or congestion after vaccinations. However, if these symptoms are severe or prolonged, it is essential to follow up with your healthcare provider to rule out any underlying issues.

Regarding your child's skin reactions, such as the rash after exposure to heat, it is also important to monitor these closely. Skin reactions can sometimes be indicative of an allergic response, and keeping a detailed record of any reactions following food intake or environmental changes can be beneficial for your healthcare provider in assessing your child's allergies.

As for the pneumococcal vaccine, it is recommended for all children, especially those with a history of respiratory issues. The pneumococcal conjugate vaccine (PCV13) is typically administered in a series of four doses at 2, 4, 6, and 12-15 months of age. Since your child is now over one year old, they may be due for their final doses, depending on their vaccination history. The cost of the vaccine can vary based on your location and whether you are using insurance or paying out of pocket, so it is advisable to check with your healthcare provider or local pharmacy for specific pricing.

In summary, it is crucial to have open communication with your healthcare provider regarding your child's vaccination schedule, allergy management, and any reactions to previous vaccinations. They can provide tailored advice and help you navigate the complexities of vaccinating a child with a history of prematurity and allergies. Ensuring your child is vaccinated against influenza and pneumococcal disease is vital for their health, especially in light of the increased risks associated with their medical history.

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