Can individuals with egg allergies receive the flu vaccine?

Flu Vaccine Administration in Egg-Allergic Individuals

Yes, individuals with egg allergies can safely receive the flu vaccine without any special precautions beyond standard vaccination protocols. 1

Current Evidence-Based Recommendations

Egg allergy is NOT a contraindication to influenza vaccination, regardless of severity. The most recent ACIP guidelines (2024-25) explicitly state that all persons aged ≥6 months with egg allergy should receive influenza vaccine, and any influenza vaccine (egg-based or non-egg-based) that is otherwise appropriate for the recipient's age and health status can be used. 1

Key Practice Changes

The evidence has fundamentally shifted over the past decade. While older vaccine labels list severe egg allergy as a contraindication, ACIP now recommends unlabeled use specifically for persons with egg allergy history, including those with anaphylaxis to eggs. 1

No special precautions are warranted:

• No need to inquire about egg allergy on screening forms 1
• No requirement for divided doses 1
• No need for extended observation periods beyond standard practice 1
• No restriction to specialized medical settings 1
• No requirement for skin testing with the vaccine 1

Clinical Algorithm for Administration

Step 1: Assess Allergy History

• Determine if the patient has had a previous allergic reaction specifically to influenza vaccine itself (not to eggs) 1
• If yes to vaccine reaction: refer to allergist before proceeding 1
• If only egg allergy history: proceed with vaccination 1

Step 2: Select Appropriate Vaccine

Any age-appropriate influenza vaccine can be administered 1:

• Standard-dose egg-based IIV (inactivated influenza vaccine) 1
• Cell culture-based vaccine 1
• Recombinant influenza vaccine (RIV) - completely egg-free, available for adults 18+ years 2
• Live attenuated influenza vaccine (LAIV) 1

Step 3: Administer Using Standard Protocol

• Give the full age-appropriate dose in a single administration 1
• No dose splitting required 1

Step 4: Post-Vaccination Observation

Standard observation applies to all patients (not specific to egg allergy):

• Ensure personnel and equipment for managing anaphylaxis are available 1, 2
• Providers must be familiar with emergency response plans and certified in CPR 2
• Consider 15-minute observation for all patients to reduce syncope-related injury 2

Evidence Supporting Safety

The evidence base is robust and consistent:

• Approximately 4,315 egg-allergic patients have safely received 4,872 total doses of influenza vaccine 3
• This includes 656 patients with severe egg allergy (including anaphylaxis to egg) who safely received 740 doses 3
• Vaccine recipients with egg allergy are at no greater risk for systemic allergic reactions than those without egg allergy 1

Common Pitfalls to Avoid

Do not unnecessarily withhold influenza vaccination from egg-allergic individuals, as this creates a barrier to immunization and leaves patients vulnerable to influenza complications. 1

Do not confuse egg allergy with vaccine allergy. A history of anaphylaxis to eggs does NOT predict anaphylaxis to influenza vaccine. 1 Only a previous severe reaction to the influenza vaccine itself is a contraindication. 1

Do not perform unnecessary skin testing with the vaccine, as this is no longer considered necessary and delays appropriate vaccination. 2

Special Populations

Pregnant Women

• Same protocols apply 2
• Benefits of vaccination outweigh theoretical risks 2

Immunocompromised Patients

• Influenza vaccination is particularly important 2
• Follow same egg allergy protocols 2
• Use inactivated vaccines (not LAIV) for immunocompromised individuals 1

Children

• Pediatric guidelines from the American Academy of Pediatrics align completely with adult recommendations 1
• Strong evidence supports safety in children with egg allergy 1