Influenza vaccine and egg-allergic children- 2012-2013

It is that time of the year again when we need to start immunizing the children against influenza. This vaccine in prepared using hen eggs; therefore there is a risk of exposure to egg when the vaccine is given. Documented reactions to the vaccine in egg-sensitive individuals are rare. The Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics have issued recommendations when considering using the influenza vaccine in the egg-allergic child.  The CDC recommendations can be found in the Morbidity and Mortality Weekly Report August 17, 2012/61(32);613-618. The AAP News ‘Guidelines for the 2012-’13 flu season’ was published online August 1, 2012. The AAP guidance is the same as that from the CDC.

The guidance from both sources is similar and essentially unchanged from what was done last year (2011-2012 flu season).

For the child with egg-allergy-

1.    The trivalent inactivated influenza vaccine (TIV) is preferred.

2.    The live-attenuated influenza vaccine has not been studied in egg-allergic children.

3.    The TIV should be given with precautions in the egg-sensitive population (defined as allergic reactions confined to the skin- urticarial/hives).

  •     Appropriate resuscitative equipment must be available in the office (as is done for any vaccination)
  •     The child should be observed for 30 minutes in the office after the vaccination (this is the standard observation time for allergen immunotherapy)

4.    Allergy services should be contacted prior to giving the influenza vaccine to any child who has a severe egg allergy. A severe egg allergy is defined as;

  •     Cardiovascular compromise
  •     Respiratory changes
  •    Gastrointestinal changes
  •     Or the need to give epinephrine for an egg exposure

5.    Note

  •   Tolerance to foods containing egg (heated egg) does not exclude the possibility of an egg allergy.
  •    Those who can tolerate lightly cooked egg (scrambled) without a reaction are unlikely to be egg allergic




This algorithm for the administration of the flu vaccine is for the egg allergic child. This diagnosis requires symptoms that occur with egg exposure and a positive allergy test to confirm the diagnosis. Having a positive allergy to egg without a history of symptoms from exposure is not defined by this algorithm. Children with atopic dermatitis (eczema) and egg sensitization should be able to have the vaccination.

FEL 9-13-2012

September 13, 2012 · fleickly · No Comments
Tags:  · Posted in: Egg Allergy, Influenza vaccine