A parent inquires:

My son is allergic to eggs. Before we moved here, his old pediatrician wouldn’t give him a flu shot, telling us that he could have a serious reaction to the vaccine. My son just started kindergarten and I don’t want him to get the flu! Any advice other than washing his hands frequently?


Pediatric allergist Dr. Deborah Gentile (Pediatric Alliance — Allergy, Asthma, and Immunology Division) responds:


Only about 1.3% of all children and 0.2% of all adults are allergic to eggs. The diagnosis of egg allergy can be confirmed by a consistent medical history of adverse reactions to eggs and egg-containing foods, plus skin and/or blood testing for immunoglobulin E antibodies to egg proteins. Persons who are able to eat lightly cooked egg (e.g., scrambled egg) without reaction are unlikely to be allergic. Egg-allergic persons might tolerate egg in baked products (e.g., bread or cake). Therefore, tolerance to egg-containing foods does not exclude the possibility of egg allergy. Egg allergies can range in severity.

Most flu shots and the nasal spray flu vaccine are manufactured using egg-based technology.  Because of this, they contain a small amount of egg proteins, such as ovalbumin. However, studies that have examined the use of both the nasal spray vaccine and flu shots in egg-allergic and non-egg-allergic patients indicate that severe allergic reactions in people with egg allergies are unlikely. A recent CDC study found the rate of anaphylaxis after all vaccines is 1.31 per one million vaccine doses given.

CDC and its Advisory Committee on Immunization Practices (ACIP) have updated their guidelines on egg allergy and receipt of influenza (flu) vaccines. People diagnosed with egg allergies can and should receive annual flu vaccination with confidence regarding their safety.

Here are the new recommendations for flu vaccination of children and adults with egg allergy:

> Persons with a history of egg allergy who have experienced only hives after exposure to egg should receive flu vaccine. Any licensed and recommended flu vaccine (i.e., any form of IIV or RIV) that is otherwise appropriate for the recipient’s age and health status may be used.

> Persons who report having had reactions to egg involving symptoms other than hives, such as angioedema, respiratory distress, lightheadedness, or recurrent emesis; or who required epinephrine or another emergency medical intervention, may similarly receive any licensed and recommended flu vaccine (i.e., any form of IIV or RIV) that is otherwise appropriate for the recipient’s age and health status.  The selected vaccine should be administered in an inpatient or outpatient medical setting (including, but not necessarily limited to hospitals, clinics, health departments, and physician offices). Vaccine administration should be supervised by a health care provider who is able to recognize and manage severe allergic conditions.

> A previous severe allergic reaction to flu vaccine, regardless of the component suspected of being responsible for the reaction, is a contraindication to future receipt of the vaccine.


Read Tuesday’s PediaBlog post “It’s That Time Again!” about getting prepared for the 2017-2018 flu season.