Flu Shot for Egg-Allergic Patients – What to Do? Save

Flu season is upon us. While we try our best to vaccinate as many patients as possible, at times it can be challenging for reasons ranging from patient’s perceptions that the vaccine gives them the flu to others stating they are allergic to vaccine components.

A patient with rheumatoid arthritis told me she has an egg allergy and cannot take the flu shot; what do I tell her?

A quick review of the Advisory Committee on Immunization Practices (ACIP) helped answer this question and others. There have been several important updates for the US 2016-2017 influenza season, including new recommendations for patients with egg allergies:

• Patients with mild-to-moderate egg allergies (i.e. hives only) can safely receive any influenza vaccine formulation that is appropriate for the patient’s age.
• Patient’s with history of more severe egg allergy (e.g. respiratory distress, cardiovascular changes, GI symptoms or required emergent medical attention) can still receive any flu vaccine formulation under the supervision of a healthcare provider who can manage severe allergic conditions (i.e. administer epinephrine if needed).

Previously, it was recommended that these patients be observed for 30 minutes post-vaccination. These updates are less stringent than previous iterations and allow us more flexibility when we encounter patients with an egg allergy history.

Choosing which formulation to administer to our immunocompromised patients was also made easier this year, as the live attenuated influenza vaccine is not recommended due to concerns about lack of efficacy.

ACIP encourages vaccinating everyone by the end of October, if possible, but it’s never too late to vaccinate.