Guideline Update for Influenza Vaccine in Patients With Egg Allergy

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Use of non-egg-based influenza vaccines in egg-allergic individuals in the age groups for which they are approved is acceptable but not medically necessary.
Use of non-egg-based influenza vaccines in egg-allergic individuals in the age groups for which they are approved is acceptable but not medically necessary.

Patients with an egg allergy do not need to avoid or take special precautions when receiving the influenza vaccine, according to a new guideline published in the Annals of Allergy, Asthma, and Immunology.

This update by the Joint Task Force on Practice Parameters (JTFPP) emphasizes that patients with an egg allergy should still receive their annual influenza vaccine with no special precautions. "When someone gets a flu shot, health care providers often ask if they are allergic to eggs," said allergist Matthew Greenhawt, MD, chair of the ACAAI Food Allergy Committee and lead author of the practice parameter. "We want health care providers and people with egg allergy to know there is no need to ask this question anymore, and no need to take any special precautions. The overwhelming evidence since 2011 has shown that a flu shot poses no greater risk to those with egg allergy than those without."

The authors note that previous studies have shown that patients with egg allergy (including life-threatening allergies) have received a flu shot without experiencing allergic reactions. This is because the vaccine does not contain enough egg protein (ovalbumin) to trigger an allergic reaction, even among those with the most severe egg allergy. The ovalbumin content in all inactivated influenza vaccines (IIV) is <1µg per dose. Anaphylaxis can occur with any vaccine at an incidence rate of 1 per million regardless of the type of vaccine or the presence of an allergy. 

For the 2017–2018 influenza season, the updated guidance states that:

  • Influenza vaccines should be administered to individuals with egg allergy of any severity, just as they would be to individuals without egg allergy
  • No special precautions beyond those recommended for the administration of any vaccine to any patient are necessary for administration of influenza vaccine to egg allergic individuals
  • Use of non-egg-based influenza vaccines (ccIIV3, RIV3, or RIV4) in egg allergic individuals in the age groups for which they are approved is acceptable but not medically necessary or preferred
  • Live attenuated influenza vaccine (LAIV) may be administered to patients with egg allergy of any severity in the age group for which it is approved (ages 2–49 years), in particular, countries and seasons when LAIV is recommended as an agent (based on effectiveness in prior seasons)

The authors conclude by stating that "Vaccine providers and screening questionnaires do not need to ask about the egg allergy status of recipients of influenza vaccine." 

Reference

Greenhawt M, Turner PJ, Kelso JM. Administration of influenza vaccines to egg allergic recipients: a practice parameter update 2017Ann Allergy Asthma Immunol. 2018 Jan;120(1):49-52.

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