What precautions should be taken for individuals with an egg allergy when receiving vaccines, such as influenza vaccines, that are produced using chicken eggs (ovalbumin)?

Precautions for Individuals with Egg Allergy When Receiving Vaccines

Individuals with egg allergy who experience only hives after egg exposure can safely receive influenza vaccines with appropriate precautions, while those with more severe egg allergic reactions should be referred to an allergist before vaccination. 1

Assessment of Egg Allergy Severity

Before administering egg-containing vaccines, determine the severity of egg allergy:

1. Mild egg allergy (hives only):

   • Can receive trivalent inactivated influenza vaccine (TIV) with precautions
   • Ask if the person can eat lightly cooked egg (e.g., scrambled eggs) without reaction
   • Note: Tolerance to egg in baked products does not exclude egg allergy 1

2. Severe egg allergy:

   • Symptoms include angioedema, respiratory distress, lightheadedness, recurrent emesis
   • History of requiring epinephrine or emergency medical intervention
   • These individuals should be referred to an allergist before vaccination 1

Vaccination Protocol for Egg-Allergic Individuals

For individuals with mild egg allergy (hives only):

1. Use TIV rather than live attenuated influenza vaccine (LAIV) 1
2. Administer vaccine by a healthcare provider familiar with potential manifestations of egg allergy
3. Observe for at least 30 minutes after vaccination for signs of reaction
4. Ensure vaccination occurs in a setting where personnel and equipment for anaphylaxis management are available 1

For individuals with severe egg allergy:

1. Refer to a physician with expertise in allergic conditions for risk assessment before vaccination
2. Consider consulting an allergist who may implement specialized protocols 1

Egg Content in Vaccines

Most influenza vaccines are produced using embryonated chicken eggs and contain varying amounts of egg protein (ovalbumin) 2:

• Different influenza vaccine brands contain varying levels of ovalbumin
• Some newer manufacturing methods produce vaccines with lower egg protein content
• Cell culture-based and recombinant influenza vaccines may be options for those with severe egg allergy 1

Common Pitfalls and Caveats

1. Avoid unnecessary avoidance: Many patients who report egg allergy may not be truly egg-allergic. Those who can eat lightly cooked eggs without reaction are unlikely to have significant egg allergy 1

2. Don't delay vaccination: The benefits of protecting against influenza outweigh the small risk of reaction in most egg-allergic individuals 1

3. Unnecessary procedures: Dividing doses or skin testing with the vaccine is generally not necessary for those with mild egg allergy 1

4. Setting matters: All vaccinations should be administered in settings where personnel and equipment for managing anaphylaxis are available 1

5. Other egg-containing vaccines: Yellow fever vaccine should be approached with caution in egg-allergic individuals 1

6. Non-egg allergens: Remember that allergic reactions to vaccines may be caused by other components besides egg protein, such as gelatin or antimicrobial agents 1

The Advisory Committee on Immunization Practices (ACIP) guidelines provide clear recommendations for safely administering influenza vaccines to egg-allergic individuals while minimizing risk of adverse reactions. Following these protocols allows most egg-allergic individuals to receive needed vaccinations safely.