Administering Flu Vaccines to Individuals with Egg Allergy
Any person with egg allergy can safely receive influenza vaccination regardless of the severity of their egg allergy, with appropriate precautions based on their specific reaction history. 1
Assessment of Egg Allergy Severity
- First determine if the person can eat lightly cooked egg (e.g., scrambled egg) without reaction - if yes, they can receive any age-appropriate influenza vaccine per usual protocol 1
- For those with confirmed egg allergy, assess the severity based on previous reactions 1:
- Mild reactions (hives only)
- Severe reactions (angioedema, respiratory distress, lightheadedness, recurrent emesis, or reactions requiring epinephrine or emergency medical intervention)
Vaccination Protocol Based on Reaction History
For patients with mild egg allergy (hives only):
- Administer any age-appropriate influenza vaccine (IIV or cell culture-based) 1
- Observe the patient for at least 30 minutes after vaccination 1
- Ensure vaccination is administered by a healthcare provider familiar with potential manifestations of egg allergy 1
For patients with severe egg allergy:
- For adults 18-49 years: Consider recombinant influenza vaccine (RIV), which is egg-free 1
- If RIV is unavailable or the patient is outside this age range, consider referral to an allergist for risk assessment 1
- For children with severe egg allergy, studies have demonstrated that trivalent influenza vaccines can be safely administered using appropriate precautions 2
Important Safety Considerations
- All vaccines should be administered in settings where personnel and equipment for rapid recognition and treatment of anaphylaxis are available 1, 3
- All vaccination providers should be familiar with their office emergency plan and be certified in cardiopulmonary resuscitation 1, 3
- Special measures such as dividing the dose or skin testing with the vaccine are no longer considered necessary 1, 2
- Multiple studies have demonstrated that egg-allergic individuals are no more likely than those without egg allergy to experience anaphylactic reactions to influenza vaccines 4, 2, 5
Common Pitfalls to Avoid
- Do not automatically defer vaccination for patients with egg allergy - the benefits of influenza vaccination generally outweigh the risks 3
- Do not assume all patients reporting egg allergy are truly allergic - those who can eat lightly cooked eggs without reaction are unlikely to be allergic 1
- Do not confuse egg allergy with previous allergic reactions to the influenza vaccine itself, which is a true contraindication to future doses 1
- Avoid unnecessary split-dosing protocols, as research has shown single doses are well tolerated even in those with severe egg allergy 2
Special Populations
- For children with severe egg allergy, studies have shown that influenza vaccines can be safely administered using appropriate precautions 2, 6
- For pregnant women with egg allergy, the same protocols apply, as the benefits of vaccination outweigh the risks 1
- For immunocompromised patients with egg allergy, influenza vaccination is particularly important and can be administered following the same protocols 1