The flu shot and high risk of asthma

[Caden's Mom]

DS is at high risk for asthma and has shown a propensity to it already. He tends to get croupy with nearly every cold, blah, blah (note: the doctor thinks this in addition to me).

I *know* that the flu vax is going to be a battle with DS's ped. They are a huge pro-flu vax practice. This is one of the vaxes that I do not trust (not that I trust any of them very much) and always refuse for myself and refused for DS last year. I do not want to let him have it (not to mention it has egg in it and DS is allergic to egg). However, I'm nervous to say the least that he could get the flu and it could be more serious due to his risk for asthma. For the first time, in regards to this vax, I'm wondering if the risk is worth the benefit.

So, my questions. Has anyone encountered this with asthmatic kids or kids that are at high risk of asthma? Are there any books or links to read about asthma and the flu vax?

[Deborah]

I did a search on PubMed and found 99 articles. I used limits: children, human, English and then searched on the terms: influenza vaccination asthma.

Here are some articles that might be worth finding:

1: Carroll W, Burkimsher R.
Is there any evidence for influenza vaccination in children with asthma?
Arch Dis Child. 2007 Jul;92(7):644-5. Review. No abstract available.
PMID: 17588979 [PubMed - indexed for MEDLINE]

2: van der Wouden JC, Bueving HJ, Poole P.
Preventing influenza: an overview of systematic reviews.
Respir Med. 2005 Nov;99(11):1341-9. Epub 2005 Aug 19. Review.
PMID: 16112852 [PubMed - indexed for MEDLINE]

3: Bueving HJ, van der Wouden JC, Raat H, Bernsen RM, de Jongste JC, van
Suijlekom-Smit LW, Osterhaus AD, Rimmelzwaan GF, Molken MR, Thomas S.
Influenza vaccination in asthmatic children: effects on quality of life and
symptoms.
Eur Respir J. 2004 Dec;24(6):925-31.
PMID: 15572533 [PubMed - indexed for MEDLINE]

4: Bueving HJ, Bernsen RM, de Jongste JC, van Suijlekom-Smit LW, Rimmelzwaan GF,
Osterhaus AD, Rutten-van Molken MP, Thomas S, van der Wouden JC.
Does influenza vaccination exacerbate asthma in children?
Vaccine. 2004 Nov 15;23(1):91-6.
PMID: 15519712 [PubMed - indexed for MEDLINE]

5: Christy C, Aligne CA, Auinger P, Pulcino T, Weitzman M.
Effectiveness of influenza vaccine for the prevention of asthma exacerbations.
Arch Dis Child. 2004 Aug;89(8):734-5.
PMID: 15269071 [PubMed - indexed for MEDLINE]

Your local library can probably obtain copies for you. I briefly read through the abstracts. The results seem sort of mixed. Some found that the vaccine helped, some didn't. One found that the vaxed children were sicker, others found they were healthier.

The influenza vaccine doesn't seem to be terrifically effective, alas. Read some of the other threads on the topic.

[PGTlatte]

My son was high risk for asthma having had repeated respiratory infections from birth. I agreed to the flu shot his first flu season after I was scared into it. He didn't seem to have any reaction to it. So I thought I had done something good for him.

He was sick all winter long with one thing after another, and he did go on to be officially diagnosed with reactive airway disease the next summer and need daily nebulizer treatments and singular. He had also been highly dependent on Zantac for GERD from birth and was still just as dependent on it at 20 months.

He also had major digestive problems, sleep problems, hyperactivity, constant meltdowns, and sensory integration issues. After much prompting by some online angels, I figured out without the ped's help that he was very very allergic to the dairy in my diet he was getting through my breastmilk. Got rid of the dairy and no longer needed the Zantac, or the Singulair, or the nebulizer treatments of inhaled steroid. Went on to allergy testing, and got rid of eggs, and his sensory symptoms went away. His digestion and sleep and hyperactivity also improved some. Got rid of the ped who didn't believe in any of this. He still had digestive problems and meltdowns and was very very hyper. Went on to learn that his medical history was very similar to that of many autistic children. Found an alternative doctor who did the testing described in Children With Starving Brains, and helped us treat him to get his gut working. And we treated him with chelation. And lots of mercury came out, and he got pretty much all the way better after that !!! And do you know where I believe a lot of the mercury came from ? That flu shot. This was in 2003 and it said right on the insert that it was in there, and I was more afraid of the respiratory problems he had been having and that he could be in real danger from the flu.

Looking back, I definitely would not get that flu shot, or any of the shots again (and haven't for his little brother). My son's respiratory problems were cause by 1.overuse of antibiotics when he was very young due to a birth defect and 2. he was allergic to the dairy and eggs in my diet. Once we got rid of the dairy, and rebuilt his gut and immune system, he has never had more than a runny nose since then, and that was over two years ago.

I would skip the shot and look for other reasons your child may be susceptible to respiratory problems, and work on removing anything you can remove and supporting his immunity naturally.

Originally Posted by Caden's Mom

Has anyone encountered this with asthmatic kids or kids that are at high risk of asthma? Are there any books or links to read about asthma and the flu vax?

[davi]

Originally Posted by Caden's Mom

DS is at high risk for asthma and has shown a propensity to it already. He tends to get croupy with nearly every cold, blah, blah (note: the doctor thinks this in addition to me).

I *know* that the flu vax is going to be a battle with DS's ped. They are a huge pro-flu vax practice. This is one of the vaxes that I do not trust (not that I trust any of them very much) and always refuse for myself and refused for DS last year. I do not want to let him have it (not to mention it has egg in it and DS is allergic to egg). However, I'm nervous to say the least that he could get the flu and it could be more serious due to his risk for asthma. For the first time, in regards to this vax, I'm wondering if the risk is worth the benefit.

So, my questions. Has anyone encountered this with asthmatic kids or kids that are at high risk of asthma? Are there any books or links to read about asthma and the flu vax?

my dd1 has very very severe asthma. she spent the better parts of her 2nd & 3rd years of life hospitalized in an intensive care unit as we could nOT get it under control. the biggest risk with asthmatics, obviously is the air flow which is compromised EVERY time they get even a cold. typically, you will have your child use a peak-flow meter which will often show you when your child's airways are becoming inflamed prior to noticing any type of wheeze.

that has been a VERY useful tool for us throughout cold & flu season. we know to adjust her meds before she even exhibits signs of respiratory difficulty. she has indeed had the flu & to be honest other than also getting a fever, it really was no worse for her than a common cold.
we do not give her flu vax. to me, it just doesn't make sense. i feel safer knowing that we have a nebulizer at home & her rescue meds if she should need them (and now at 8 years old, we FINALLY have her asthma in a good place) than risk a potential (possibly respiratory) allergic reaction to the vax. i would read more about the risks of the flu itself before deciding to vax my asthmatic babe. especially considering the allergens you already know he reacts to.

i really hope this makes sense, and i hope it can help you get a start.

[Caden's Mom]

Are there any recommendations on how to support his immunity naturally? Cod liver oil, vit C, and bf of course?

Thanks all, I will definitely look for the articles.

And it does make sense, totally, all of it. I'm not sure what else we could be missing that would put him further at risk for asthma. He does have FA and possibly EA but those seem really well managed for now. ANd for all the he does have a ton of allergies, he is a pretty healthy kid. No colds since July *knock on wood*

[dymanic]

Originally Posted by Caden's Mom

Has anyone encountered this with asthmatic kids or kids that are at high risk of asthma?

Yes. Viral infections of the upper respiratory tract are among the most common triggers for asthma. An ambulance ride at two in the morning (why is it always two in the morning?), with a terrified youngster fighting desperately to breathe, can give you a whole new perspective on this. I've been on that ride, and we weren't dealing with anything nearly as virulent as flu, either. If it had been flu, I really think we might have lost him. It was close enough as it was. Confidence born of familiarity with less serious flareups, and the capacity for administering nebulized bronchodilators and supplemental oxygen led "Doctor Dad" to seriously overestimate his ability to manage the situation, and thus delay a 911 call that really should have been made at least a couple of hours sooner. It was amazing how fast the kid improved once the IV steroids were on board.

It was that incident that made it clear that the frequent bouts with minor illnesses we had seen over years were primarily asthma flareups, triggered by some pathogen of such low virulence as to otherwise have likely gone virtually unnoticed, and implementing a regimen of foradil, pulmacort, and singular produced immediate and dramatic improvement: a kid who used to miss several days of school every six weeks or so hasn't missed more than two in two years. It's a tradeoff, particularly with the pulmacort, which, as a corticosteroid, has an immunosuppresive effect. It's not a side-effect; what the drug is intended to do is to inhibit the inflammation which is a key aspect of a normal cell-mediated immune response. The cell-mediated response -- including the inflammation -- helps the body marshal a defense, but, like most things, it carries a cost; a risk. In a non-asthmatic person, the benefit may outweigh the risk, whereas in an asthmatic, it may not. Keep in mind that when you become ill, most of what you experience as "symptoms" are more the results of your body's own efforts to defeat the invader at all costs than of anything the bug is doing. A vigorous immune response isn't such a great thing if you can't keep breathing long enough to enjoy the benefits.

Another way to limit the cell-mediated response, of course, is by stimulating a strong humoral response, which is what the vaccine is intended to do. Not everyone agrees as to how effective a strategy this is, or how much risk it carries, and I don't think these questions are likely to be resolved here -- but I wouldn't be too quick to equate "no vax" with "no risk", especially if you have a kid with asthma.

[cloak]

Here's the Cochrane review. There's no evidence the flu shot helps at all.
http://www.cochrane.org/reviews/en/ab000364.html

[amah]

I would NOT get the flu shot if your child has an egg allergy. That is actually one of the contraindications the CDC gives for the shot so there should be no problem with your doc. My son got the flu shot at 10 months - before we knew about his egg allergy and had a terrible reaction - unexplained hives and GI problems for about a month afterwards. He also seemed to withdraw and stop developing for about 6 months. Luckily, he did not get the seconf flu shot infants usually get because we learned he was allergic to eggs and luckily his development picked back up about 6 months later.

If you do get a the flu shot, make sure you get a mercury free one!

[nicolebeth]

I reiterate the egg allergy thing--I have a friend whose DD had to have the MMR in the office (due to an egg allergy), and who was expressly told by the doctor NOT to give her a flu shot (my friend wanted to give her one). It is possible the first flu shot sensitized her to eggs, too. So, I'm surprised that the doctor would recommend it for your DS given the known egg allergy.

I'm interested in these responses because DD has some symptoms of asthma as well, and her ped's office recommends the flu shot for her (which we won't be getting). DD did have the "preservative-free" one a few times, but once she aged out of that one, we stopped doing them (and we didn't continue to give them to DS either, even though he's still under 3).

[PGTlatte]

For us, the way has been to strictly avoid everything he is allergic to, avoid antibiotics, eat mostly fresh unprocessed foods, and limit sugar. I personally believe that sunshine, fresh air, getting enough sleep, and a positive mental environment are also helpful.

Originally Posted by Caden's Mom

Are there any recommendations on how to support his immunity naturally?

[dymanic]

Originally Posted by cloak

Here's the Cochrane review. There's no evidence the flu shot helps at all.
http://www.cochrane.org/reviews/en/ab000364.html

And here's a recent study that shows it is:

http://pediatrics.aappublications.or...ract/120/3/467

Every time we've discussed Cochrane in detail here, we've ended up more or less agreeing that the effectiveness of flu vaccines in general is somewhere in the neighborhood of thirty percent -- so it ends up being about whether that amount of benefit justifies the risk (the latter tending to be measured using a much more liberal standard of evidence).

Like I said, we're not going to resolve the dispute here. Relative risks and benefits vary from one individual to another, and for a child with severe asthma, influenza is a life-threatening proposition. I wonder what the results of the above study would have looked like if the cohort had been limited to asthmatic kids?

[Deborah]

I believe one of these studies found that kids vaxed for influenza actually were sick more and also more intensely. Can't remember which study was which--menopause memory!

Bueving HJ, Bernsen RM, de Jongste JC, van Suijlekom-Smit LW, Rimmelzwaan GF, Osterhaus AD, Rutten-van Molken MP, Thomas S, van der Wouden JC.
Does influenza vaccination exacerbate asthma in children?
Vaccine. 2004 Nov 15;23(1):91-6.
PMID: 15519712 [PubMed - indexed for MEDLINE]

5: Christy C, Aligne CA, Auinger P, Pulcino T, Weitzman M.
Effectiveness of influenza vaccine for the prevention of asthma exacerbations. Arch Dis Child. 2004 Aug;89(8):734-5.
PMID: 15269071 [PubMed - indexed for MEDLINE]