ACAAI Updates Practice Parameters on Flu Shots for Individuals with Egg Allergy

Individuals with an egg allergy do not need to avoid an annual flu shot, according to updated practice parameters recently published in Annals of Allergy, Asthma and Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI).

Despite conflicting reports on the effectiveness of the annual flu vaccine, it remains one of the best ways to avoid becoming infected with influenza. Therefore, health care practitioners are advised to encourage their patients to receive the vaccine each year, especially those patients who are at increased risk for severe complications from influenza as well as individuals who live with or care for persons who are at higher risk for influenza-related complications, including health care personnel, according to the Centers for Disease Control and Prevention (CDC).

Still, some patients choose to avoid the shot, particularly if they are allergic to eggs. The viruses for some licensed preparations are grown in chicken eggs, and it was previously reported that “although influenza vaccines contain only a limited quantity of egg protein, this protein can induce immediate hypersensitivity reactions among persons who have a severe egg allergy.”

However, the CDC have since updated their guidelines to state that the vaccine is safe for individuals in this population; and now, the ACAAI has joined the efforts, as their Joint Task Force on Practice Parameters has updated its practice parameters to state that individuals with egg allergy should receive an annual influenza vaccine. Matthew Greenhawt, MD, chair of the ACAAI Food Allergy Committee and lead author of the practice parameter stated in an official press release that, “[the ACAAI] wants health care providers and people with egg allergy to know there is no need to ask [if an individual is allergic to eggs], and no need to take any special precautions. The overwhelming evidence since 2011 has shown that a flu shot poses no greater risk to those with egg allergy than those without.”

Indeed, the investigators cite several studies where patients with an egg allergy have safely received the flu shot with no adverse reactions, including those who have a life-threatening allergy. Previous parameters have stated that those patients with an egg allergy could safely receive the vaccine at an allergist’s office; however, the new parameters state that this is no longer necessary, nor recommended.

According to the press release, there is no longer a need to:

• See an allergy specialist for the flu shot.
• Give special flu shots that don't contain traces of egg.
• Require longer-than-normal observation periods after the shot, or
• Ask about egg allergy before giving the vaccine.

Allergist John Kelso, MD, ACAAI member and co-author of the practice parameter added in the press release, “There are hundreds of thousands of hospitalizations, and tens of thousands of deaths in the United States every year because of the flu, most of which could be prevented with a flu shot. Egg allergy primarily affects young children, who are also particularly vulnerable to the flu. It's very important that we encourage everyone, including children with egg allergy, to get a flu shot.”

In related news, a recent study on egg-based vaccine manufacturing has called for a move away from the practice, citing research that an egg-adapted mutation lowers vaccine effectiveness. Still, despite its questionable effectiveness, health care experts continue to assert that some protection is better than no protection and still recommend getting a flu shot this season.