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Mizuho Spangler, DO, Rob Orman, MD, and Andrew Buelt, DO

Discuss evidence, guidelines and current opinion on administering seasonal influenza vaccination to those with egg allergy.

  • Most inactivated and live attenuated influenza vaccines are made using eggs; therefore, they contain tiny amounts of egg protein.  Because of this, many believe that those allergic to eggs cannot safely receive the vaccine.  There is very little data to support this contraindication.

  • A recent study of 282 children with an egg allergy (115 of whom had a history of anaphylaxis) found that after administering the live attenuated influenza vaccine to them, none  developed anaphylaxis.  In fact, none developed symptoms requiring medical intervention of any sort.

    • Turner PJ, et al. Safety of live attenuated influenza vaccine in atopic
      children with egg allergy. J Allergy Clin Immunol. 2015 Aug;136(2):376-81. doi:
      10.1016/j.jaci.2014.12.1925. Epub 2015 Feb 13. PMID: 25684279

  • Current medical guidelines state that it is safe to administer the influenza vaccine to people with an egg allergy, even if that reaction was anaphylaxis, as long as the provider has proper equipment to manage an allergic reaction should one occur.  According to an UpToDate review titled, “Influenza Vaccination in Individuals with Egg Allergy,” the amount of egg protein in vaccinations has decreased significantly over the years.  All egg-based vaccines now have low ovalbumin levels.  UpToDate states that no serious reactions have been reported after the administration of egg-based live or inactivated influenza vaccines in recipients with egg allergy.

  • All patients greater than 6 months of age who have an egg allergy may receive annual immunization with an influenza vaccine.  The same guidelines developed for those not allergic to eggs should be used.  As with any vaccine, an allergic reaction to the influenza vaccine may occur; these reactions can be caused by the immunizing agent itself or the other proteins that are introduced into the vaccine during the production process.

REFERENCES:

  1. Turner PJ, et al. Safety of live attenuated influenza vaccine in atopic
    children with egg allergy. J Allergy Clin Immunol. 2015 Aug;136(2):376-81. doi:
    10.1016/j.jaci.2014.12.1925. Epub 2015 Feb 13. PMID: 25684279

  2. Kelso JM, et al. Update on influenza vaccination of egg allergic patients. Ann Allergy Asthma Immunol. 2013 Oct;111[4]:301-2 PMID: 24054370

  3. Kelso JM. et al. Adverse reactions to vaccines practice parameter 2012 update. J Allergy Clin Immunol. 2012 Jul;130[1]:25-43 PMID 22608573

  4. Kelso JM. Administering influenza vaccine to egg-allergic persons.Expert Rev Vaccines. 2014 Aug;13[8]:1049-57 PMID: 24962036

  5. Des Roches A, et al. Egg-allergic patients can be safely vaccinated against influenza.J Allergy Clin Immunol. 2012 Nov;130[5]:1213-1216.e1 PMID: 23021881

  6. James JM et al. Safe administration of influenza vaccine to patients with egg allergy. J Pediatr. 1998 Nov;133[5]:624-8PMID 9821418

Centers for Disease Control and Prevention (CDC). Estimated influenza illnesses and hospitalizations averted by influenza vaccination – United States, 2012-13 influenza season. MMWR Morb Mortal Wkly Rep. 2013 Dec 13;62[49]:997-1000PMID 24336131