From the Guidelines
Individuals with egg allergies can safely receive influenza vaccines without additional precautions beyond standard vaccination practices, as the risk of an allergic reaction is no greater than for those without egg allergies. According to the most recent and highest quality study 1, the presence of an egg allergy is not a contraindication to receiving influenza vaccine, and precautions such as special observation periods or restriction of administration to particular medical settings are not warranted.
Key Considerations
- The amount of egg protein in vaccines is typically minimal, and most people with egg allergies can safely receive these vaccines.
- Routine prevaccination questions regarding anaphylaxis after receipt of any vaccine are appropriate, and standard vaccination practice should include the ability to respond to rare acute hypersensitivity reactions.
- Some vaccines, such as cell-based or recombinant influenza vaccines (like Flucelvax or Flublok), contain no egg protein and may be preferred options for those with severe egg allergies.
Administration Guidelines
- Vaccine administration should be supervised by a healthcare provider who is able to recognize and manage severe allergic reactions.
- No postvaccination waiting period is recommended specifically for egg-allergic persons, but vaccine providers should consider observing patients seated or supine for 15 minutes after administration of any vaccine to decrease the risk for injury should syncope occur, as recommended by 1.
- It is not necessary to inquire about egg allergy before the administration of any influenza vaccine, including on screening forms, as stated in 1.
Severe Allergic Reactions
- A previous severe allergic reaction to influenza vaccine is a contraindication to future receipt of the vaccine, as noted in 1.
- Those with severe egg allergies should be vaccinated in a medical setting under supervision of healthcare providers experienced in recognizing and managing severe allergic reactions, with emergency medications like epinephrine readily available.
From the Research
Precautions for Vaccinating Individuals with Egg Allergy
- Patients with a chicken egg allergy must be carefully handled during influenza epidemics where vaccines produced using embryonated chicken eggs are primarily employed 2.
- The two most common relative contraindications among patients to be vaccinated are the presence of an egg allergy and a previous anaphylactic reaction to vaccination 2.
- High-risk patients should only be vaccinated on the basis of thorough assessment of medical history, and then only with caution 2.
- Emergency routines must include sufficient precautionary measures in case an anaphylactic reaction occurs, and current guidelines for the treatment of anaphylactic reactions should be observed 2.
Safe Administration of Influenza Vaccine
- Patients with egg allergy can safely receive an influenza vaccine in a 2-dose protocol when the vaccine preparation contains no more than 1.2 micrograms/mL egg protein 3.
- Graded vaccination ("split protocol") and overnight surveillance can be considered for high-risk patients 2.
- Coordination of multidisciplinary resources can help safely immunize high-risk populations during an influenza pandemic 4.
- Allergists, with the help of local pediatricians and urgent care centers or hospitals, can effectively mobilize to help protect vulnerable populations during pandemics 4.
Considerations for Vaccination
- The severity of the egg allergy, the egg content of vaccines, and the setting of vaccine administration should be weighed when considering vaccination in a patient with a history of egg allergy 5.
- The risk of anaphylaxis to the influenza vaccine in patients with egg allergy may be lower than previously thought, suggesting that skin testing may not be necessary in many cases 5.
- Egg-allergic patients without anaphylaxis to egg may safely receive the influenza vaccine in a 2-dose, graded fashion without a vaccine skin test 6.