Allergies and the MMR

Allergies and MMR

So MMR booster time swung around a fortnight ago and I immediately deferred the appointment.

I have been reading loads of papers and journals for this blog, so have recently read some interesting things about vaccinations, allergies and immunocompromised children (children with a reduced immune system) and as Anya’s immune system was taking a hit with increased eczema, asthma and hayfever symptoms I decided to defer.

The thought of vaccinations scares most parents, seeing their poor child stabbed with a needle and screaming.  Vaccination is even worse when you are the parent of an allergic child.  My daughter has an egg allergy amongst other things and sometimes it is suggested that such children shouldn’t have an MMR jab.  My allergist sent me a letter with recommendations from the Paediatric Allergy group, which can be viewed here, http://www.bsaci.org/Guidelines/MMREggRecommendations.pdf and with this information and a bit of Googling I felt reasonably happy to get my daughter the MMR.

The first and second time I went to take her to the surgery the nurse refused to give the injection based on her having an egg allergy, the second time I took my letter from my allergist which said it was safe, but she refused again.  Eventually after a strange argument with the doctor (he was happy to do it and I was happy for her to have it, I don’t know why he was so angry with me) she was given the injection.

She still had no reaction; I stayed longer than usual to make sure and has been fine ever since.

So why am I more nervous this time around with her booster?  The immediate reason I deferred the appointment is the symptoms she was having, she was suffering from hayfever, which didn’t seem to be improving with her anti-histamines, and this had led to an increase in her eczema, which had crept into her hair and up her arms from her wrists, which is where it usually stays.  I had also been advised by the asthma nurse to start to decrease her brown preventer inhaler, which had led to her asthma symptoms increasing over a period of days before the proposed MMR booster date.

So what do you need to know if you are about to give your allergic (or non-allergic) child their first MMR?

What MMR protects against

Measles – Is a highly infectious virus, which has recently been in the news in the UK due to a rise in the number of cases in Wales.  It is most common in children of pre-school age who haven’t been vaccinated.  It is spread very easily, by breathing in droplets that are released when an infected person coughs or sneezes.  Complications as a result fro measles can lead to blindness or even death.

Mumps – Is a virus which is also passed on like cold and flu, before the MMR vaccine it was responsible for over a thousand hospital admissions a year in England and Wales.  A mumps infection itself would not do any harm, however it can lead to viral meningitis if the virus moves to the outer layer of the brain.  Other complications can include swelling of the testicles in men or ovaries in women who have gone through puberty.

Rubella (german measles) – A mild infection caused by a virus, symptoms include red-pink rash, swollen glands and cold-like symptoms.  Rubella becomes a problem if a pregnant woman becomes infected as the virus can cause problems in the foetus such as eye problems, deafness, heart abnormalities and brain damage.  Since the MMR there has only been one recorded case of CRS (Congenital Rubella Syndrome) in 2007.  In the 1970s before the MMR was introduced it is estimated that 200-300 babies a year were born with CRS.  Rubella in pregnancy was estimated to cause 20% of congenital hearing loss and 2% of congenital heart disease.

MMR and Autism

You can’t discuss the MMR jab without mentioning autism as it is still in the mind of most parents.  I first read up on the MMR vaccination and all the evidence linking it to autism about 7 years ago when my eldest nephew was scheduled to have it.  I read the infamous Andrew Wakefield study and critiques of the study, and my sister and I discussed her concerns.  On that basis we have vaccinated all of our children (five between the two of us).

I since read the excellent book, Bad Science by Ben Goldacre, and have felt justified that we made the right decision.  There is a wealth of information out there on this subject, but the Danish study mentioned in the book (and on the Bad Science website, links at the bottom) show that when 440,000 children given the MMR were compared with 97,000 children who didn’t receive the jab it was found that the MMR children were no more likely to develop autism.

What is in MMR

As parents of children with allergies we are used to reading the ingredients of everything we give them to eat, but then do we just let a nurse inject them without knowing what’s in the vaccine?

The MMR vaccine contains weakened versions of live measles, mumps and rubella viruses, when injected it triggers the immune system to produce antibodies against the viruses.  If your child then comes into contact with one of the viruses the immune system recognises it and is able to quickly produce the antibodies against it.

Anya was given MMRvaxPro, the ingredients listed are:

  • Measles virus (produced in chick embryo cells)

  • Mumps virus (produced in chick embryo cells)

  • Rubella virus

  • Sorbitol

  • Sodium phosphate

  • Potassium phosphate

  • Sucrose

  • Hydrolysed gelatin

  • Medium 199 with Hanks’ salts

  • MEM

  • Monosodium L-glutamate

  • Neomycin

  • Phenol red

  • Sodium bicarbonate

  • Hydrochloric acid

  • Sodium hydroxide

Allergies related to MMR ingredients

The major ingredients for concern in the vaccine are the gelatin, the neomycin and the mumps and measles viruses which are made in chick embryo cells.

It is thought that the most severe reactions to the MMR are associated with IgE-mediated gelatin allergy and this is higher in certain ethnic groups, for example, the Japanese (but can be explained by other vaccines given in Japan which contained gelatin and caused sensitisation). Anaphylactic reactions caused by the MMR are thought to be mostly associated with a gelatin allergy.

Neomycin is a commonly used antibiotic in topical creams and is a common allergen which mainly causes contact dermatitis and rarely thought to cause anaphylaxis.

In relation to children who suffer from allergy to egg, a Canadian study of 500 allergic children was undertaken.  Skin testing was abandoned after the first 120 children due its lack of predictiveness.  All 500 children were successfully immunised without incident.  All in all egg allergy children have been well studied and no problems have been found with MMR of other vaccinations.

Recommendations for parents of allergic children

  • Consult your doctor if your child has an allergy to gelatin or neomycin

  • Consult your doctor if your child has severe allergic reactions to egg, especially anaphylactic reactions

  • Consult your doctor if your child is due for a booster and had a serious reaction to the initial injection

  • Contact your allergist if you are really concerned and they may be able to refer your child to the hospital to be immunised

General Recommendations for all parents

  • Reschedule your appointment if your child is sick when they are due for an appointment

  • Consult your doctor if

    • Your child is being treated with drugs which affect the immune system, like steroids (for example, in children with HIV or AIDS)

    • Your child is a cancer patient treated with radiation or drugs

    • Your child has a low platelet count or blood disorder

    • Your child has recently received a blood transfusion

Finally, I would personally recommend that if your child like mine, has an overloaded immune system from time to time from reacting to the high pollen count, allergic reactions, eczema flares or suffering from asthma symptoms, you may want to delay the MMR like I did.  If your child’s symptoms don’t seem to improve long enough for you to get the MMR done I would recommend talking to your doctor or allergist, as sometimes they do allow vaccinations to be done at hospital in case a severe allergic reaction occurs.

I do believe that vaccinations are worth the stress, especially for children like ours, that already seem so immunocompromised a lot of the time; illness for Anya is a trigger for all her atopic conditions, so in the long run, she should be a lot better off.

Final recommendation, take sweets they work a treat… Anya was given her MMR booster last week, she was very good, we stayed for longer than the recommended 15 minutes and we have not seen any side-effects which is wonderful.

References

www.anaphylaxis.org

www.bsaci.org/Guidelines/MMREggRecommendations.pdf

www.nhs.uk/conditions

www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/excipient-table-2.pdf

www.gpnotebook.co.uk/simplepage.cfm?ID=x20091011211216397761

www.ncbi.nlm.nih.gov/pmc/articles/PMC1718199/pdf/v082p00093.pdf

www.cdc.gov/vaccines/vpd-vac/should-not-vacc.htm

www.ncbi.nlm.nih.gov/pmc/articles/PMC3327424/

www.sense.org.uk/content/congenital-rubella-syndrome

http://www.badscience.net/2008/08/the-medias-mmr-hoax/

http://www.guardian.co.uk/education/2003/dec/11/science.highereducation

Bad Science,  Goldacre, Ben, 2009

J Allergy Clin Immunol. 1999 Feb;103(2 Pt 1):321-5, A clinical analysis of gelatin allergy and determination of its causal relationship to the previous administration of gelatin-containing acellular pertussis vaccine combined with diphtheria and tetanus toxoids, Nakayama T, Aizawa C, Kuno-Sakai H..

N Engl J Med. 1995; 332:1262-6, Safe administration of the measles vaccine to children allergic to eggs, James JM, Burks AW, Roberson PK, et al.

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This entry was posted in Asthma, Atopic Disease, Eczema, Egg Allergy, Food Allergy, Gelatin Allergy, Hayfever, MMR, Neomycin Allergy, Vaccinations and tagged , , , , , , , , , , , . Bookmark the permalink.

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