Influenza Vaccination for Patients with Egg Allergy
Any licensed, age-appropriate influenza vaccine can be administered to patients with egg allergy without special precautions, regardless of allergy severity. 1, 2, 3
Current ACIP Recommendations (2022-2023)
The most recent CDC/ACIP guidelines have significantly simplified the approach to egg-allergic patients:
- All patients with egg allergy may receive any licensed, recommended influenza vaccine that is otherwise appropriate for their age and health status. 1, 2
- This represents a major shift from older 2013 guidelines that required complex algorithms based on reaction severity 1
Vaccine Options by Severity of Egg Allergy
Mild Egg Allergy (Hives Only)
- Administer any age-appropriate influenza vaccine using standard protocols 2, 3
- No extended observation period beyond the standard 15 minutes recommended for all vaccines 2, 3
- No skin testing required 2, 3
- No divided-dose protocols needed 3
Severe Egg Allergy (Angioedema, Respiratory Distress, Hypotension, Recurrent Vomiting, or Required Epinephrine)
- Any age-appropriate influenza vaccine can still be used, but must be administered in a medical setting supervised by healthcare providers capable of recognizing and managing severe allergic reactions 1, 2, 4
- This includes inpatient or outpatient settings such as hospitals, clinics, health departments, or physician offices 1
Egg-Free Vaccine Options (Not Required, But Available)
While not necessary, completely egg-free alternatives exist:
- Recombinant Influenza Vaccine (RIV4/Flublok Quadrivalent): Completely egg-free, approved for ages ≥18 years 1, 2, 3, 5
- Cell Culture-Based Vaccine (ccIIV4/Flucelvax Quadrivalent): Contains theoretical maximum of 1.7×10⁻⁸ μg/0.5 mL egg protein, approved for ages ≥6 months 1, 2, 3
Key Clinical Considerations
- Patients who can eat lightly cooked eggs (e.g., scrambled eggs) without reaction are unlikely to be truly allergic 1, 3
- A previous severe allergic reaction to influenza vaccine itself (not eggs) is a contraindication to future influenza vaccination 2, 4
- All vaccination providers should be familiar with their office emergency plan and have equipment for rapid recognition and treatment of anaphylaxis available 1, 2
Common Pitfalls to Avoid
- Do not unnecessarily delay vaccination due to egg allergy concerns 2, 3
- Do not perform skin testing before vaccine administration 2, 3
- Do not use divided-dose protocols 3
- Do not restrict to egg-free vaccines only unless patient preference or specific circumstances warrant it 3
Evolution of Guidelines
The 2013 ACIP guidelines required a complex algorithm differentiating between hives-only reactions versus severe reactions, with specific pathways for RIV3 use in ages 18-49 years 1. The 2022 guidelines have eliminated this complexity, recognizing that the risk of anaphylaxis to influenza vaccine in egg-allergic patients is much lower than previously thought 1, 2.