From the Guidelines
Individuals with egg allergies should generally still receive influenza vaccines, with precautions based on their allergy severity, as recommended by the Advisory Committee on Immunization Practices (ACIP) 1. When considering vaccination for individuals with egg allergies, it's crucial to assess the severity of their allergy.
- For those with mild egg allergies (hives only), any licensed, age-appropriate influenza vaccine can be administered in regular settings with standard observation periods.
- People with more severe egg allergies (beyond hives, such as angioedema or respiratory distress) should receive their vaccination in a medical setting where allergic reactions can be recognized and managed, with supervision by healthcare providers experienced in recognizing and treating severe allergic conditions 1. The use of cell-based vaccines like Flucelvax Quadrivalent or recombinant vaccines like Flublok Quadrivalent, which are egg-free alternatives, can be considered for egg-allergic individuals, especially those with severe allergies 1. Prior to vaccination, patients should inform their healthcare provider about their egg allergy and its severity, as this information is critical for determining the appropriate vaccination approach and monitoring strategy 1. It's also important to note that traditional influenza vaccines are grown in chicken eggs and may contain small amounts of egg protein (ovalbumin), which could potentially trigger allergic reactions in sensitive individuals, but the amount of egg protein in these vaccines is typically very small, and studies have shown that even people with severe egg allergies can usually receive egg-based influenza vaccines safely 1.
From the Research
Precautions for Individuals with Egg Allergy Receiving Vaccines
- Individuals with an egg allergy should take precautions when receiving vaccines that contain egg proteins, such as influenza vaccines, due to the risk of allergic reactions 2, 3, 4, 5, 6.
- The risk of anaphylactic reactions to influenza vaccines in patients with egg allergy is considered rare, but the vaccine should still be administered with caution by an allergist 4, 5.
- Patients with a history of egg allergy should be carefully evaluated and vaccinated in a controlled setting, with emergency procedures in place in case of an anaphylactic reaction 2, 3, 6.
- A graded vaccination ("split protocol") and overnight surveillance can be considered for high-risk patients with egg allergy 2.
- Skin testing with the influenza vaccine may not be necessary for patients with egg allergy, as the risk of anaphylaxis may be lower than previously thought 3, 6.
Administration of Influenza Vaccine to Egg-Allergic Persons
- Influenza vaccine can be safely administered to patients with egg allergy in a 2-dose protocol, with the first dose being one tenth and the second dose nine tenths of the recommended dose 3.
- The vaccine should be administered by an allergist with precaution, and patients should be monitored for side effects, including anaphylactic shock, local reaction, and other symptoms 4.
- Patients with egg allergy can receive annual influenza vaccination, and any patient who has an anaphylactic reaction to influenza vaccine should be carefully evaluated by an allergist for guidance on subsequent immunization 5.
Considerations for Vaccination in Patients with Egg Allergy
- 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 6.
- The risk of anaphylaxis to the influenza vaccine in patients with egg allergy may be much lower than previously thought, suggesting that in many cases skin testing may not be necessary 6.