Update on Egg Allergy and the Flu Vaccine

Please note: the information below has been updated in 2017 according to the latest recommendation on the flu shot for those with an egg allergy. It is safe for ALL people with an egg allergy to receive an annual flu shot. This is true no matter how severe your egg allergy was in the past. This includes anaphylaxis (a severe allergic reaction) to egg.


Much has changed about the perceived safety of influenza vaccine in egg allergic individuals. The Centers for Disease Control (CDC), American Academy of Pediatrics, and American Allergy and College of Allergy, Asthma, and Immunology no longer considers egg allergy a reason to avoid the flu vaccine. This decision came after several new research studies in the past 4 years showed once and for all the injectable influenza vaccine is safe for children with egg allergy. 

 

In the past three years, the recommendations for flu vaccine and egg allergy have changed by:

  • America Academy of Pediatrics AAP)
  • The American Academy of Allergy, Asthma, and Immunology (AAAAI) 
  • The American College of Allergy, Asthma, and Immunology (ACAAI)  
  • The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control

Here are the main points:

  • Skin testing to the vaccine is no longer advised, and is not necessary to receive the vaccine. Several studies have shown that this does not help predict who will develop a reaction to the vaccine. This is true even when the skin tests are positive. Bottom line—there is no reason for your child to be tested to the influenza vaccine because of egg allergy.
  • The vaccine can be dispensed as a single dose. A two-step graded challenge dosing is no longer recommended. A single dose has proven to be safe even in children with a history of anaphylaxis to egg.
  • The amount of egg (ovalbumin) in influenza vaccine is very low and has been for the past several years. The levels have hovered at or below 1 microgram/mL, which are far less than in the past, when high egg content was felt to be a potential issue. Keep in mind: ovalbumin in influenza vaccine has never proven to cause reactions in egg allergic individuals. (Adverse effects if the vaccine may be due to other ingredients known to trigger allergic reactions.) Recent studies show that ovalbumin levels higher than 1.2 micrograms/mL were well tolerated. 

This argument is no longer of clinical relevance. The CDC published this information.

  • It is safe for ALL egg allergic patients to receive their influenza vaccine. This is true regardless of how severe their egg allergy was in the past. This includes children with anaphylaxis to egg. These individuals can receive their influenza vaccine as a single dose. 

    fluvax

 

The AAAAI and ACAAI 2013 Practice Parameter update states that the vaccine is safe to give in any setting. There is no special waiting time or other precautions. But the setting must have procedures in place to treat anaphylaxis.

Other important points:

  • If your child has a history of reaction to the flu vaccine itself, this is a different scenario than someone with an egg allergy who has not ever reacted to the flu vaccine. Children who have reacted to the actual vaccine should not get the flu vaccine. 
  • The package inserts for the influenza vaccine may still have the original wording that suggests persons with egg allergy should not receive the vaccine. (The CDC has no control over what companies may print). The contraindications with egg allergy will still be there. But the CDC now states it’s safe to administer the flu shot to children with an egg allergy.

In conclusion, the thinking on the safety of the flu vaccine for those with egg allergy has changed a lot in recent years. Importantly, egg allergic individuals wanting to receive injectable influenza vaccine can now do so. The vaccine is no longer contraindicated because of egg allergy. The vaccine is safe even if there has been a severe past reaction to egg. Depending on the egg allergy severity, health care provider who can recognize and treat a severe allergic reaction can provide the flu vaccine.

 

Medical Advisory Review October 2014

 

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