Influenza vaccination in patients with egg allergy - what to do?

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

Overdiagnosis of vaccine allergy is a major public health problem http://buff.ly/1tI9y44

For any patient who is older than 6 months of age and has a known egg allergy of any severity, the recommendation is to consider the administration of an age-appropriate, trivalent inactivated influenza vaccine (TIV) in a single dose followed by a 30-minute observation in a facility prepared to recognize and treat anaphylaxis.

Here are the two groups of patients:

1. Patients with a history of mild reactions to egg (only hives) can receive TIV in a primary care provider’s office.

2. Patients with a history of reactions more severe than only hives after egg ingestion, or who are sensitized (have a positive skin test) to egg but have had no known exposures or reactions to egg, should be referred to an allergist to receive TIV.

The live-attenuated influenza vaccine (LAIV) also contains a low amount of egg protein, but is not recommended in patients with egg allergy because the safety of LAIV in such patients has not been evaluated.



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

Here is the summary in the form of a mnemonic:

O
Only hives - OK with PCP administration

S
Severe reactions/Skin test/sIgE positive with unknown reaction - Specialist referral (allergist)

References:

Influenza vaccination in individuals with egg allergy. UpToDate, 2012.
Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee - figure, CDC.
Prevention and Control of Influenza with Vaccines: Recommendations of the Advisory Committee - text, CDC.
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
First study to show safety of live attenuated influenza vaccine in patients with egg allergy. http://buff.ly/1wES9Zk