Administering influenza vaccine to egg allergic recipients: A focused practice parameter update

The well-proven benefits of influenza immunization can now be made available to persons with a history of egg allergy. Individuals with diagnosed or suspected egg allergy who need an influenza vaccination should be evaluated by an allergist/immunologist for evaluation of egg allergy and for administration of the 2010-2011 trivalent influenza vaccine (TIV) if clinically indicated. Studies have suggested that influenza vaccines can be administered to patients with a history of anaphylaxis to egg without adverse effects. However, such studies are limited in number, and reactions to influenza vaccines in egg allergic persons can occur. Caution is warranted in patients with a history of anaphylaxis or where the severity of their clinical reactivity is uncertain, particularly when the ovalbumin content of the vaccine is unknown. Therefore, consultation with an allergist experienced in food allergy and anaphylaxis is strongly recommended. For the 2010-2011 influenza season, the routine practice of skin testing to the TIV is no longer recommended. Both the 2-dose (10%, 90%) and single-dose methods are appropriate for administering influenza vaccine to egg allergic individuals. Egg allergic individuals can receive TIV without prior skin testing to the vaccine, with the vaccine being administered via a 2-step graded challenge: first administer 10% of the age-appropriate dose, with a 30-minute observation after administration for symptom development. If no symptoms develop, the remaining 90% can be administered, with a 30-minute observation for symptom development. The same TIV product brand should be used for booster vaccinations if possible, but it is not necessary to use the same lot. Egg allergic individuals can receive TIV without prior skin testing to the vaccine as a single, age-appropriate dose without use of graded challenge. Individuals should be observed for 30 minutes after injection for evidence of a systemic reaction. The same TIV product brand should be used for booster vaccinations, but the same lot is not necessary.