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Egg allergies and intradermal/high dose influenza vaccines

Q: I am aware there are new recommendations for egg allergic patients receiving influenza vaccines. Do these recommendations extend to the Fluzone Intradermal and the Fluzone High Dose vaccines?

A: In the 2011-12 influenza season, the following new recommendations were established for administering influenza vaccine to egg allergic patients: If the patient can eat lightly cooked eggs (like scrambled eggs) then they may receive the influenza vaccine as normal. This is an important point, as some egg allergic patients can eat fully/extensively cooked eggs and still have reactions to raw or only mildly heated eggs.

If the patient has hives when exposed to egg (without other systemic allergic symptoms) then the patient can be given a full dose of vaccine and observed for thirty minutes. The caveat here is that the provider has sufficient experience and equipment to treat an allergic reaction if one does occur. The vaccine dose does not need to be divided.

In the case of more serious symptoms of an allergic reaction, the patient should be referred to a “physician with expertise in management of allergic conditions” for further evaluation. The evaluation would include determination of the patient’s current egg allergy status and the risk benefit ratio of receiving the vaccine. Since 2010 there has been a UNIVERSAL yearly vaccination recommendation in the USA, so this is good news for egg allergic patients and their providers who have been hesitant about influenza vaccination.

For the 2012-2013 season, all influenza vaccines reported an ovalbumin content of less than or equal to 1mcg/0.5ml of vaccine. Fluzone intradermal (which is a lower dose product than standard influenza vaccines) contains 0.02mcg/0.5 cc ovalbumin and Fluzone High Dose contains 0.1mcg/0.5cc. A complete table of ovalbumin concentration by other manufacturers, and useful algorithm can be found here.

There are no recommendations that specifically target a particular trivalent inactivated intramuscular vaccine for use in egg allergic patients. You should use your own judgment about the intradermal vaccine, as it has not been specifically mentioned in the current egg allergy recommendations.

Egg allergic patients should not receive the live attenuated vaccine.

Visit www.cdc.gov/flu for more information about the 2012-2013 influenza season.

 
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