Which vaccine is contraindicated in a child with an egg allergy and requires assessment by an Allergy (allergy)/Immunology (immunology) specialist before vaccination?

Yellow Fever Vaccine Requires Allergy/Immunology Assessment in Children with Egg Allergy

Yellow fever vaccine is the answer—it should not be administered to children with a history of severe egg allergy (hives, angioedema, allergic asthma, or systemic anaphylaxis to egg proteins) unless an allergy evaluation and testing with the vaccine are performed first. 1

Vaccine-Specific Recommendations for Egg Allergy

Yellow Fever Vaccine (Contraindicated Without Specialist Assessment)

• Do not administer to patients with a history of hives, angioedema, allergic asthma, or systemic anaphylaxis to egg proteins unless an allergy evaluation and testing with the vaccine are performed first 1
• This is the only vaccine among the options listed that requires mandatory specialist assessment before administration in egg-allergic children 1

MMR Vaccine (Safe)

• MMR is safe for children with egg allergy, even those with a history of severe reactions 1
• No special precautions, observation periods, or allergy specialist referral are needed 1
• Can be administered routinely despite egg allergy 1

Influenza Vaccine (Generally Safe with Precautions)

• Current guidelines state that any person with egg allergy can safely receive influenza vaccination regardless of severity 2
• The 2018 AAP guidelines explicitly state: "It is not necessary to inquire about egg allergy before the administration of any influenza vaccine" 1
• The presence of egg allergy is not a contraindication to receive IIV or LAIV 1
• Standard vaccination practice should include ability to respond to rare acute hypersensitivity reactions 1

Important evolution in guidance: Older 2011 guidelines were more restrictive, recommending specialist referral for severe egg reactions 1. However, more recent 2018-2024 guidelines have liberalized recommendations based on accumulating safety evidence 1, 2.

Pneumococcal Vaccine (Not Egg-Based)

• Pneumococcal vaccines do not contain egg protein and are not contraindicated in egg allergy
• No special precautions needed for egg-allergic patients

Clinical Algorithm for Egg-Allergic Children

For Yellow Fever:

1. If severe egg allergy history (anaphylaxis, angioedema, respiratory distress) → mandatory allergy/immunology referral before vaccination 1
2. Specialist performs risk assessment and may conduct vaccine testing 1
3. If vaccination proceeds, must occur in medical setting with anaphylaxis management capability 1

For Influenza:

1. Administer any age-appropriate influenza vaccine regardless of egg allergy severity 1, 2
2. Observe for 30 minutes post-vaccination (standard practice for all vaccines) 2
3. Ensure setting has equipment/personnel for anaphylaxis management 1, 2
4. For adults 18-49 years with severe egg allergy, consider egg-free recombinant vaccine (RIV) if preferred 2

For MMR:

• Administer routinely without special precautions 1

Key Safety Considerations

• All vaccines should be administered in settings where personnel and equipment for rapid recognition and treatment of anaphylaxis are available 1, 2
• Vaccination providers should be familiar with office emergency plans and certified in cardiopulmonary resuscitation 1, 2
• A previous severe allergic reaction to any influenza vaccine itself (not egg) is a contraindication to future influenza vaccination 1, 3

Common Pitfalls to Avoid

• Do not unnecessarily delay or avoid influenza vaccination in egg-allergic children—this creates a barrier to immunization for a vaccine that is now proven safe 1
• Do not perform skin testing or split-dose protocols for influenza vaccine—these are no longer recommended and constitute unnecessary barriers 2
• Do not confuse egg allergy with vaccine component allergy—these are distinct entities requiring different management 1
• Do not apply influenza vaccine guidelines to yellow fever vaccine—yellow fever requires specialist assessment while influenza does not 1