What influences vaccine administration in a 70-year-old patient with a history of egg allergy?

From the Guidelines

Vaccine administration in a 70-year-old patient with egg allergy should proceed with caution but is generally safe for most vaccines, with the recommendation to use any licensed, recommended influenza vaccine that is otherwise appropriate for their age and health status, as stated by the Advisory Committee on Immunization Practices (ACIP) 1. The patient's history of egg allergy may require special consideration, but it is not a contraindication to vaccination.

• Most vaccines, including influenza vaccines, can be safely administered to patients with egg allergies regardless of severity.
• Annual influenza vaccination is particularly important for this age group, and both the inactivated influenza vaccine (IIV) and recombinant influenza vaccine (RIV) are options, with RIV being completely egg-free.
• For standard influenza vaccines containing trace egg protein, no special precautions are needed beyond the standard 15-minute observation period, as recommended by ACIP 1. However, if the patient has had severe allergic reactions to eggs (anaphylaxis), vaccination should occur in a medical setting with staff prepared to manage allergic reactions, as suggested by the 2018 ACIP recommendations 1. The MMR and MMRV vaccines, though grown in chick embryo fibroblasts, contain negligible egg protein and are safe for egg-allergic individuals. Age-appropriate vaccines for a 70-year-old would include pneumococcal vaccines (PCV20 or PCV15 followed by PPSV23), zoster vaccine (Shingrix), Tdap or Td booster, and possibly hepatitis vaccines depending on risk factors, all of which are not contraindicated by egg allergy. It is essential to note that a previous severe allergic reaction to influenza vaccine, regardless of the component suspected of being responsible for the reaction, is a contraindication to future receipt of the vaccine, as stated in the 2019 ACIP recommendations 1.

From the Research

Influences on Vaccine Administration

The administration of vaccines in a 70-year-old patient with a history of egg allergy is influenced by several factors, including:

• The severity of the egg allergy 2, 3
• The egg content of the vaccines 2, 4
• The setting of vaccine administration 5, 6
• The patient's medical history, including any previous anaphylactic reactions to vaccinations 5, 6

Considerations for Egg Allergy

Patients with a history of egg allergy may be at increased risk of anaphylactic reactions to vaccines produced using embryonated chicken eggs 5, 6. However, studies have shown that the risk of anaphylaxis to the influenza vaccine in patients with egg allergy may be lower than previously thought 2, 6.

• A graded vaccination ("split protocol") and overnight surveillance can be considered in this group of patients 5
• Skin testing with the vaccine before administration may not be necessary in many cases 2, 4

Recommendations for Vaccine Administration

• Patients with egg allergy can safely receive an influenza vaccine in a controlled setting, with precautions in place in case of an anaphylactic reaction 5, 6, 4
• The vaccine should be administered in a setting where emergency treatment is available, and the patient should be monitored for signs of an allergic reaction 5, 6