Children and adults with egg allergies do not need to avoid flu shots or take special precautions, and healthcare providers need not ask if patients are allergic to eggs before giving a flu shot, allergy experts said.
Updated practice guidelines from the American College of Allergy, Asthma and Immunology (ACAAI) and the American Academy of Allergy, Asthma & Immunology (AAAAI) state that people with egg allergies should receive an annual flu shot and that no special precautions are required. The guidelines appear in the Annals of Allergy, Asthma and Immunology.
A joint ACAAI and AAAAI task force reviewed findings from recent studies involving thousands of patients with egg allergies, and those studies uniformly showed egg allergic patients to have a similar risk for flu shot reactions as people without egg allergies, said task force member John Kelso, MD, of the Scripps Clinic in San Diego.
Kelso told MedPage Today that as recently as a decade a go, most egg allergic children did not receive flu shots.
Because most influenza vaccines are grown in eggs and contain very small amounts of egg protein, parents of children with egg allergies have historically been told to avoid vaccinating their children or take special precautions when they did.
But recent studies showed inactivated influenza vaccine to be safe for egg allergic recipients, including those with a history of anaphylaxis to egg. These studies include two large, multicenter, prospective cohort trials published in 2015 which showed live attenuated vaccine (LAIV) to be safe for egg-allergic patients.
The studies showed no benefit to taking special precautions, such as pre-vaccine skin testing or stepwise challenge, in egg allergic children and adults, and Kelso said the risks associated with not being vaccinated are now clear.
“There are hundreds of thousands of influenza hospitalizations in the U.S. each year, and tens of thousands of deaths,” he said. “There has been a growing recognition that not vaccinating poses a special risk. The vast majority of egg allergies are in young children and young children are more susceptible to flu.”
This is especially true for kids with egg allergies and asthma, which is a risk factor for severe and fatal influenza.
Recently updated vaccination guidelines by the CDC’s Advisory Committee on Immunization Practices (ACIP) and the American Academy of Pediatrics (AAP) recommend flu shots for egg allergic patients, “without any additional precautions beyond those recommended for any vaccine.”
Kelso said the updated ACAAI/AAAAI guidelines now more closely align with those of ACIP and AAP.
Specific precautions no longer recommended include:
- Getting a flu shot in the office of an allergy specialist
- Using vaccine made without egg
- Requiring longer-than-normal observation following vaccination
- Asking about egg allergy before giving a flu shot
Kelso disclosed no relevant relationships with industry. Co-authors disclosed multiple relevant relationships with industry.