How to administer influenza vaccine in egg-allergic patients

2014 update: Influenza Vaccine and Egg Allergy: Nearing the End of an Evidence-based Journey http://buff.ly/1tHY0wd

Both TIV (trivalent inactivated influenza vaccine) and LAIV (live-attenuated influenza vaccine) are produced in eggs. However, influenza vaccine can be administered in a single dose and it is well tolerated by nearly all recipients who have egg allergy. More conservative approaches, such as skin testing or a 2-step graded challenge, are no longer recommended for patients with mild reactions.

Mild reaction or severe reaction?

As a precaution, clinicians should determine if the presumed egg allergy is based on a mild or severe reaction.

Mild reactions are defined as hives alone.

Severe reactions involve cardiovascular changes, respiratory and/or gastrointestinal (GI) tract symptoms, or reactions that require the use of epinephrine.



Recommendations regarding influenza vaccination for persons who report allergy to eggs - Advisory Committee on Immunization Practices (ACIP), 2011--12 influenza season. CDC.

When to consult an allergist?

Clinicians should consult with an allergist for children with a history of severe reaction. Severe allergic reactions to eggs involve cardiovascular changes, respiratory and/or gastrointestinal (GI) tract symptoms, or reactions that require the use of epinephrine.

Most vaccine administration to people with egg allergy can happen without the need for referral. Only 1% of children have IgE–mediated sensitivity to egg, and of those, a very small minority have a severe allergy.

Standard preconditions

Standard immunization practice should include the ability to respond to acute hypersensitivity reactions. Therefore, influenza vaccine should be given to people with egg allergy with the following preconditions:

- Appropriate resuscitative equipment must be readily available

- Ovalbumin content up to 0.7 micrograms/0.5 mL per vaccine dose has been well tolerated. Click here for ovalbumin content of TIV. LAIV vaccine is not recommended for egg allergic individuals.

- After immunization, the vaccine recipient should be observed in the office for 30 minutes, the standard observation time after receiving immunotherapy.

- For children who need a second dose, the same product brand is preferred, if possible, but it does not need to be from the same lot as the first dose.

References:

Recommendations for Prevention and Control of Influenza in Children, 2011–2012. PEDIATRICS Vol. 128 No. 4 October 1, 2011, pp. 813 -825, (doi: 10.1542/peds.2011-2295)

Diagram: Precautions for administering influenza vaccine to presumed egg-allergic recipients.

Ovalbumin content of TIV

Most egg-allergic children can be vaccinated with a low ovalbumin influenza vaccine without prior vaccine testing http://goo.gl/VA7Xt

Trivalent influenza vaccine is safe even in children with histories of severe egg allergy, single dose was well tolerated. Annals, 2012.

The Flu Vaccine Is Safer Than We Knew - Even for children with egg allergies http://buff.ly/1dUj8qK

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