Flu Vaccine and Egg Allergy

Chris-BarryToday’s post comes from Chris Barry, PA-C, MMSc. Barry is a nationally certified physician assistant specializing in pediatrics. He is a member of the American Academy of Pediatrics, American Academy of Physician Assistants, North Carolina Academy of Physician Assistants and currently serves as the Medical Liaison from the American Academy of Physician Assistants to the American Academy of Pediatrics. Barry currently serves as one of ENC’s Health Professional Advisors.


It’s hard to believe, but it’s almost that time of year again—flu season. Flu season typically runs from late fall through late winter, but the exact timing can vary from year to year. The safest, most effective method to prevent influenza infection is vaccination. The flu vaccine is recommended for all children, starting at 6 months of age.

There are relatively few contraindications to administering the flu vaccine. The full list of flu vaccine recommendations, dosing and contraindications is listed on the CDC website.

Because most flu vaccines contain residual egg proteins from the manufacturing process, people with egg allergies were previously unable to receive the flu vaccine due to the theoretical concerns of anaphylaxis. This caused many children to not receive this important vaccine.

A 2013 study published in Annals of Asthma, Allergy, and Immunology shows that the flu vaccine can be safely given to children with egg allergies, even those who have severe reactions to eggs (1). Updated guidelines have been issued, stating that children with a history of egg allergy who have experienced only hives after exposure to egg should receive the influenza vaccine. Inactivated or recombinant flu vaccine is recommended for these children, due to lack of data with the live, attenuated nasal flu vaccine. Flu vaccines should be administered in settings, such as their healthcare provider’s office, in which personnel and equipment are available to manage anaphylaxis. Vaccine recipients should be observed for at least 30 minutes for signs of a reaction after administration of each vaccine dose. By one estimate, an additional 150,000-250,000 children would now be eligible to receive the flu vaccine, under the updated guidelines (2).

Children with more severe reactions to eggs, such as anaphylaxis, should be referred to an allergy specialist before vaccine administration. Children with a previous history of severe allergic reaction to the flu vaccine should not receive the flu vaccine.

In summary, a recent study provides strong evidence that egg allergic patients can safely receive the flu vaccine as a single dose without prior vaccine skin testing, provided they are observed for 30 minutes afterward in a medical setting (1).

– Chris Barry, PA-C, MMSc

1. Kelso JM, Greenhawt MJ, Li JT. Update on influenza vaccination of egg allergic patients. Ann Allergy Asthma Immunol. 2013; 111(4):301.
2. Des Roches A, Paradis L, Gagnon R et al. Egg-allergic patients can be safely vaccinated against influenza. J Allergy Clin Immunol. 2012; 130(5):1213-1216.

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