Please note: the information below has been updated 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.
The following is a blog post from KFA’s Medical Advisory Team:
UPDATE ON EGG ALLERGY AND THE FLU VACCINE
by Matthew J. Greenhawt, MD, MBA, MSc
Much has changed regarding the perceived safety of influenza vaccine in egg allergic individuals. The Centers for Disease Control (CDC) no longer considers egg allergy a contraindication to receiving an influenza vaccine. This is based on several research studies conducted in recent years, which conclusively show the injectable influenza vaccine is safe for children with egg allergy.
The American Academy of Allergy, Asthma, and Immunology (AAAAI) and the American College of Allergy, Asthma, and Immunology (ACAAI) have also updated the national practice parameter on this topic.
- 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, even when the skin tests are positive.
- While either a single dose or a two-step graded challenge are acceptable ways to vaccinate egg allergic individuals, a single dose has been shown to be safe even in children with a history of anaphylaxis to egg. Therefore, the use of two-step graded challenges are not necessary.
- The amount of egg (ovalbumin) in influenza vaccine is low and has been for the past several years. A 1997 study did note that vaccine ovalbumin content below 1.2 micrograms/mL was well tolerated in egg allergic individuals, and has since served as a “de facto” safe level. Furthermore, this “safe” level was not a designed outcome of the study, and represented what the level of ovalbumin in the vaccine happened to be in the lots used in the study. Ovalbumin in influenza vaccine has never directly been attributed to causing reactions in egg allergic individuals. There is recent data that has shown higher ovalbumin levels were well tolerated. However, all presently marketed injectable influenza vaccine for use in the US contain less than 1.2 micrograms/mL, and this argument is no longer of clinical relevance.
- There is now data supporting that ALL egg allergic patients can safely receive their influenza vaccine, regardless of how severe their egg allergy was in the past. This includes children with anaphylaxis to egg. Moreover, a very recent study has shown that children with severe egg allergy can receive their influenza vaccine as a single dose, as opposed to a two-step graded challenge.
In conclusion, the thinking on the topic of the safety of the administration of the influenza vaccine for egg allergic individuals has changed significantly. Importantly, egg allergic individuals wanting to receive injectable influenza vaccine can do so. The vaccine is no longer contraindicated because of egg allergy, and the vaccine is safe even if there has been a severe past reaction to egg. Either your pediatrician or your allergist (depending on the egg allergy severity) can provide the flu vaccine.
Matthew Greenhawt, MD, MBA, MSc, is assistant professor, Department of Internal Medicine, Division of Allergy & Clinical Immunology and the University of Michigan Food Allergy Center, University of Michigan Medical School and University of Michigan Health System Ann Arbor, Michigan. He is a member of KFA’s Medical Advisory Team. He is co-author of the 2011 special practice parameter update on the safety of influenza vaccine in egg allergic individuals, and co-author of the 2012 practice parameter on adverse reactions to vaccines.