Can individuals with an egg allergy receive the shingles vaccine, such as Zostavax (zoster vaccine live) or Shingrix (recombinant zoster vaccine)?

Shingles Vaccines for Individuals with Egg Allergy

Individuals with egg allergy can safely receive the shingles vaccines (Shingrix or Zostavax) without special precautions, as neither vaccine contains egg protein as a contraindication.

Understanding Shingles Vaccines and Egg Content

There are two shingles vaccines that have been available in the United States:

1. Shingrix (recombinant zoster vaccine):

   • Non-live, recombinant vaccine
   • Does not contain egg protein
   • Currently preferred vaccine due to higher effectiveness
   • No contraindication for egg-allergic individuals

2. Zostavax (zoster vaccine live):

   • Live-attenuated vaccine
   • While grown in cell cultures, it does not have egg protein as a listed contraindication

Evidence-Based Recommendations

The FDA labeling for Shingrix only lists contraindications for individuals with a history of severe allergic reaction to any component of the vaccine or after a previous dose of the vaccine 1. Egg is not listed as a component of concern.

The Advisory Committee on Immunization Practices (ACIP) does not list egg allergy as a contraindication for zoster vaccines. Unlike certain vaccines such as influenza and yellow fever vaccines which historically had egg-related concerns, zoster vaccines are not produced using egg-based technology that would introduce significant egg protein into the final product.

Comparing with Other Vaccines

It's important to distinguish between different vaccines regarding egg allergy concerns:

• Vaccines with potential egg concerns:

  • Influenza vaccines (some formulations)
  • Yellow fever vaccine

• Vaccines without egg concerns:

  • Shingles vaccines (Shingrix, Zostavax)
  • Measles-mumps-rubella (MMR) vaccines (despite being grown in chick embryo fibroblast tissue culture, they can be safely administered to egg-allergic individuals) 2

Clinical Approach for Vaccination in Egg-Allergic Patients

While egg allergy is not a concern for shingles vaccines specifically, it's worth noting the general approach to vaccination in egg-allergic individuals:

1. Assess severity of egg allergy

   • Mild reactions (e.g., hives only) vs. severe reactions (anaphylaxis, cardiovascular changes, respiratory/GI symptoms) 2

2. For vaccines where egg is a potential concern (NOT shingles vaccines):

   • Have appropriate resuscitative equipment available
   • Consider 30-minute observation period after vaccination 2

3. For Shingrix specifically:

   • Standard vaccination protocols apply
   • No special precautions needed for egg-allergic individuals
   • Complete the recommended 2-dose series for optimal effectiveness 3

Effectiveness and Safety

Shingrix has demonstrated high effectiveness in preventing herpes zoster:

• 70.1% effectiveness with 2 doses in real-world studies 3
• Over 90% efficacy in clinical trials 4
• Effective across age groups, including those >80 years 3

Common Pitfalls to Avoid

1. Don't confuse vaccine contraindications: Egg allergy restrictions that apply to some vaccines (like certain influenza vaccines) don't apply to shingles vaccines.

2. Don't delay vaccination unnecessarily: Withholding shingles vaccination from egg-allergic individuals is not evidence-based and may leave them vulnerable to herpes zoster and its complications.

3. Don't miss the second dose of Shingrix: While a single dose provides some protection (56.9% effectiveness), completing the 2-dose series is important for optimal protection 3.

In conclusion, egg allergy should not be considered a contraindication for receiving either Shingrix or Zostavax shingles vaccines. Shingrix, as the preferred shingles vaccine, can be administered according to standard protocols without special precautions related to egg allergy.