Flu Vaccine Practice Guideline: Egg-Based Vaccines Safe for Those with Egg Allergy

Health care providers can administer egg-based influenza vaccines to people with egg allergy without taking precautions, according to a newly-updated influenza vaccine practice parameter from the Influenza Vaccine and Egg Allergy Practice Parameter Workgroup commissioned by Joint Task Force on Practice Parameters (JTFPP).

The guidelines, published in the January 2018 issue of the Annals of Allergy, Asthma & Immunology, outlined the updated recommendations for the administration of influenza vaccines to patients with egg allergy with 4 summary statements.¹

1. Influenza vaccines should be administered to individuals with egg allergy of any severity, just as they would be to individuals who do not have an egg allergy.

Previously, most influenza vaccines were contraindicated in those with egg allergy due to increased risk of influenza-related complications, according to the guidelines. The updated recommendations indicate that egg-based vaccines do not contain enough egg protein to cause reactions, even in the most severely allergic recipients.

The revised practice guidelines are based on data from 28 studies including 4315 patients with egg allergies, and 656 patients with severe egg allergy. According to the results, most administration of egg-based inactivated influenza vaccine did not cause any serious adverse reactions, with no reported cases of anaphylaxis. Low rates of minor reactions such as hives have occurred but at no greater rate than those occurring in non-alleric patients, the guidelines stated.

2. 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.

Previously recommended precautions, such as choice of a specific vaccine based on ovalbumin content, skin testing with the vaccine, and divided or grading dosing, are unnecessary. Similarly, patients with egg allergies do not need specific waiting periods or special medical settings for the administration of the influenza vaccine.

The guidelines noted that, although rare, anaphylaxis can occur after the administration of any vaccine to any patient. Health care providers should have procedures in place for anaphylaxis management and patients who have had an anaphylactic reaction to influenza vaccination itself should be evaluated by an allergist before subsequent vaccinations.

3. 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.

Although non-egg based vaccines may be administered to recipients with egg allergies, there is no medical reason to do so, the guidelines stated.

4. 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).

According to recently-published studies, 955 children with egg allergy, including 412 with a history of anaphylaxis with egg ingestion, have been safely vaccinated with LAIV. However, LAIV is not recommended for use during the 2017-2018 season due to efficacy concerns.

The authors concluded that precautions for egg-allergic vaccine recipients are not warranted and may pose a barrier to immunization. Additionally, health care providers administering vaccines do not need to ask the recipient about potentially egg allergies.

Reference

• Greenhawt M, Turner PJ, Kelso JM. Administration of influenza vaccines to egg allergic recipients: A practice parameter update 2017. Annf All Asthma Immunol. January 2018. Doi: http://dx.doi.org/10.1016/j.anai.2017.10.020