Can a patient with a history of egg allergy receive the Influvac Tetra (influenza vaccine)?

Influenza Vaccination in Patients with Egg Allergy

Yes, a patient with egg allergy can receive Influvac Tetra (influenza vaccine), and in most cases, no special precautions beyond standard vaccination protocols are required. 1

Current Evidence-Based Approach

The most recent CDC Advisory Committee on Immunization Practices (ACIP) guidelines from 2022-23 fundamentally changed the approach to egg-allergic patients. Any licensed, age-appropriate influenza vaccine (including egg-based vaccines like Influvac Tetra) may be administered to persons with egg allergy of any severity. 1, 2

Algorithm Based on Reaction Severity

For patients with mild egg allergy (hives only):

• Administer any age-appropriate influenza vaccine in the standard manner 1, 2, 3
• No skin testing required 2, 3
• No divided-dose protocols needed 3
• Standard 15-minute post-vaccination observation period only 2, 4
• Can be given in any vaccination setting (primary care office, pharmacy, etc.) 3

For patients with severe egg allergy reactions (angioedema, respiratory distress, lightheadedness, recurrent vomiting, or reactions requiring epinephrine):

• Any age-appropriate influenza vaccine can still be used, including egg-based vaccines 1, 2
• Must be administered in an inpatient or outpatient medical setting with supervision by a healthcare provider capable of recognizing and managing severe allergic reactions 1, 2, 3
• Equipment and personnel for rapid recognition and treatment of anaphylaxis must be available 4

Alternative Vaccine Options

While not required, egg-free alternatives exist for patients or providers who prefer them:

Recombinant Influenza Vaccine (RIV4):

• Completely egg-free (manufactured without eggs) 2, 3
• Approved for ages ≥18 years 2, 3

Cell Culture-Based Vaccine (ccIIV4):

• Contains theoretical maximum of 1.7×10⁻⁸ μg/0.5 mL egg protein (essentially negligible) 2, 3
• Approved for ages ≥2 years 3

Key Evidence Supporting This Approach

The evolution from restrictive to permissive guidelines is based on substantial safety data. Research has demonstrated that approximately 4,315 egg-allergic patients safely received 4,872 total doses of influenza vaccine, including 656 patients with severe egg allergy (including anaphylaxis to egg) who safely received 740 doses without significant reactions. 5 This evidence established that egg-allergic individuals are at no increased risk for allergic reactions to influenza vaccine compared to the general population. 5

Critical Pitfalls to Avoid

Do not unnecessarily delay or withhold vaccination due to egg allergy concerns. 2, 3 The historical practice of withholding influenza vaccine from egg-allergic patients is outdated and increases morbidity and mortality risk from influenza itself. 5

Do not perform skin testing with the vaccine before administration. 2, 3 This practice is no longer recommended and adds unnecessary complexity without improving safety. 3

Do not use divided-dose protocols for egg-allergic patients. 3 While older protocols from 2013 described split-dose approaches, 1 current guidelines have moved beyond this based on accumulated safety evidence. 1, 2

Important Distinction: True Contraindications

The only absolute contraindication to influenza vaccination is a previous severe allergic reaction to the influenza vaccine itself (not to eggs), regardless of which component was responsible. 1, 4 If a patient had anaphylaxis to one type of influenza vaccine, alternative formulations (RIV4 or ccIIV4) may be considered under medical supervision. 1, 4

Provider Preparedness Requirements

All vaccination providers must be familiar with their office emergency plan and certified in cardiopulmonary resuscitation. 2, 4 This applies to all vaccinations, not just for egg-allergic patients. 4