Who Should Not Get A Flu Vaccine
Talk to a board-certified allergist about the flu vaccine if your child has ever had a:
- Life-threatening allergic reaction after a dose of flu vaccine
- Severe allergy to any part of a flu vaccine
If you or your child has an egg allergy and you are still concerned about getting the flu shot, talk with an allergist.
If Youve Had A Severe Allergic Reaction To The Flu Vaccine
You should not get a flu shot if the flu vaccine itself ever caused you to have a severe, life-threatening allergic reaction called anaphylaxis, says Dr. Gordon. Again, this can happen whether you have an allergy to eggs or not.
Because anaphylaxis progresses quickly and can be fatal, the risk of a repeat episode from getting the vaccine far outweighs your risk of getting the flu.
Its important to understand the risks that come with any vaccine, but you can rest easy knowing that just 1.35 out of one million people have experienced one of these severe allergic reactions to the flu vaccine.
The other piece of good news is that among this small population, the anaphylaxis was most often triggered by an allergy to one of the other vaccine components, not to the egg.
The bottom line is, there is no reason for someone with a suspected egg allergy to not get the flu vaccine, says Dr. Lang.
The best thing you can do to put yourself in a safe situation is to inform the medical professional administering your flu shot of your allergies ahead of time.
What Is Known About The Safety Of Egg
In the only case report of a death following influenza vaccine in 1969 , few details have been published, and the causative relationship with egg allergy is unclear. More useful information has been obtained from recent prospective studies using H1N1 or seasonal influenza vaccines where the amount of residual egg ovalbumin has been limited to 1ug/dose or less. A recent review of 28 studies comprising 4,315 subjects with egg allergy showed no severe reactions after influenza vaccination as summarized in Table 1 . Mild and occasional side-effects such as local itching, mild hives, throat irritation, wheezing or abdominal pain have been observed but not anaphylaxis. Comparison of graded administration of vaccination has shown no differences in the rate of adverse reactions . Results of allergy testing with the vaccine prior to administration have shown no correlation with outcomes in terms of adverse reactions .
Table 1a: Major studies of influenza vaccination of egg-allergic individuals: parenteral vaccines
*Last accessed 14 April 2017
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Is The Flu Vaccine Safe For People With Egg Allergy
Yes. If you have a current or past egg allergy, you can get the flu vaccine, even if you have had severe allergic reactions to egg. The same is true for children.
The following organizations recommend getting the flu shot every year, even if you have an egg allergy:
- Asthma and Allergy Foundation of America
- Centers for Disease Control and Prevention
- American Academy of Pediatrics
- American Academy of Allergy, Asthma, and Immunology
- American College of Allergy, Asthma, and Immunology
You can get any flu vaccine, even if you have a history of mild or severe egg allergy. You can get the shot or nasal spray. You no longer need to be observed in a doctors office for 30 minutes after getting the vaccine if you have or had an egg allergy.
AAFA recommends the following:
- Ages 6 months to 4 years should get the flu shot.
- Ages 4 and older: If your asthma is under control with no symptoms, you can get the flu shot or the nasal spray vaccine.
- Ages 4 and older: If you have recent asthma episodes or wheezing, get the flu shot.
The Following Vaccines May Contain Residual Egg Protein
Egg allergy is common, with up to 8.9% of Australian infants having challenge proven allergy to raw egg and likely a smaller proportion reacting to well cooked egg . Most outgrow their allergy by primary school, although with occasional persistence or development of new egg allergy during adult life. Some vaccines are grown in eggs . Older vaccination guidelines recommended avoidance of influenza vaccination in egg-allergic individuals based on case reports of anaphylaxis 30 years ago when the amounts of egg protein were much higher than currently . To enhance safety, attempts have been made in recent years to limit the amount of egg ovalbumin in the pandemic and seasonal inactivated influenza vaccines to less than 1 ug of egg protein per vaccine dose.
- Seasonal inactivated influenza vaccine
- Pandemic inactivated influenza vaccine .
- Yellow Fever vaccine
- Q fever vaccine
The amount of residual egg protein in Yellow fever and Q fever vaccines is generally higher than in seasonal influenza and H1N1 vaccines, although administration of these vaccines to egg allergic individuals has been described . Egg allergic patients in whom Yellow fever or Q fever vaccines are indicated should be referred to an allergy/immunology specialist for assessment. The remaining discussion pertains to egg-allergic individual in whom seasonal/pandemic influenza vaccination is indicated.
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Experts: Flu Vaccines Are Safe For Those With Egg Allergies
WATERTOWN, N.Y. Experts have confirmed that flu vaccines are safe for even those with egg allergies.
Based on new research from the American Academy of Allergy Asthma and Immunology, individuals with a confirmed egg allergy can safely receive the flu vaccine.
The AAAAI stated that this was previously a concern as most types of the influenza vaccine contain a small amount of egg protein. Before administering the vaccine to patients, health providers have often asked patients if they have an egg allergy.
However, the Joint Task Force on Practice Parameters of the American Academy of Allergy Asthma and Immunology, American College of Allergy Asthma and Immunology and the American Academy of Pediatrics stated that no special precautions are required to egg-allergic patients. This is regardless of the severity of the allergy.
New guidelines additionally state that screening for egg allergies is no longer necessary, which include forms. However, patients and parents should tell providers if they or their child had an adverse reaction to a prior dose of the influenza vaccine. Providers are required to follow normal precautions for administering any vaccine while giving the flu vaccine.
Nasal Flu Vaccines May Be Safe For Kids With Egg Allergies
– Nasal-spray flu vaccines appear to be safe for children over age two who have egg allergies or asthma, say UK researchers.
No systemic or severe allergic reactions were seen among 282 egg-allergic children who received the vaccine. Eight kids had mild reactions, such as a runny nose and 26 reported coughing or wheezing up to three days after the vaccine.
Intranasal live attenuated influenza vaccine is cultured in chicken eggs and contains traces of egg proteins.
“On the basis of this data, we do think the intranasal flu vaccine is safe in children with egg allergy,” said Paul Turner, who led the new study, in an email.
“We still need to analyze our data with regards to safety in children who also have asthma, but the preliminary data indicates that children with well-controlled asthma who are well at the time of vaccination do not experience any significant respiratory problems following LAIV,” said Turner, an allergy and immunology researcher at Imperial College London.
Egg allergy is one of the most common food allergies in childhood, affecting an estimated 2% of preschool-age children, Turner and his colleagues write in the Journal of Allergy and Clinical Immunology February 13.
The U.S. Centers for Disease Control recommends nasal flu vaccines for healthy children between two and eight years old, but also excludes those with asthma or allergies to eggs.
Nasal flu vaccines cost around 40 dollars in the U.S., which is about 10 dollars more than flu shots.
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Who Can Receive Fluzone High
In the United States, Fluzone High-Dose Quadrivalent is licensed only for people 65 years and older. Fluzone High-Dose Quadrivalent is not recommended for people with a history of severe allergic reaction to the vaccine or to ingredients other than eggs. Information about vaccine ingredients is located in package inserts from each manufacturer.
So Can You Still Get The Flu Shot If Youre Allergic To Eggs
Yes, absolutely. An egg allergy isnt a problem for , says infectious disease expert Amesh A. Adalja, M.D., senior scholar at the Johns Hopkins Center for Health Security. The amount of egg protein thats in a vaccine isnt enough to trigger a severe reaction.
Its been known for a long time that people who get any vaccine can have an allergic reaction to some part of the vaccine, Dr. Schaffner says. It was long thought that it might be due to the eggs, but in the last 10 years, there have been a number of studies by allergists that have shown that the traces of egg protein in flu vaccine are not the cause of these allergic reactions, he says.
All people with egg allergies used to have to be observed for an allergic reaction for 30 minutes after they got the flu vaccine, the CDC says, but now the organization just recommends that people with a history of a severe reaction to egg get vaccinated in an inpatient or outpatient medical setting, like a hospital, clinic, health department, or doctors office, under the supervision of a health care provider who is able to spot and manage severe allergic conditions.
There are egg-free flu vaccines available, like cell-based flu vaccines and recombinant flu vaccines, but those are being made for different reasons, not because of people who are allergic to eggs, Dr. Adalja says.
Overall, though, if youre allergic to eggs, definitely still get your flu shot. We need to put that whole to rest, Dr. Schaffner says.
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Severe Allergic Reactions To Vaccination Are Very Rare
The risk of a severe allergic reaction to vaccination , to inactivated influenza vaccine is very low, estimated at 1.35 per million doses . Immunisation guidelines recommend an observation period of 15 minutes or 20 minutes post-vaccination. The first symptoms of anaphylaxis may occur 20 minutes or longer after vaccination. However, because anaphylaxis is a very rare event it is not considered routine practice for vaccinated individuals to be observed beyond these specified times.
Vaccination providers should be able to recognise and manage anaphylaxis.
If Adverse Reactions To Vaccination Occur
If a sudden collapse occurs after immunisation a vaso-vagal event needs to be distinguished from anaphylaxis
If the diagnosis is in doubt the vaccine recipient should be managed for anaphylaxis which includes the administration of intra-muscular adrenaline . Guidelines to anaphylaxis management can be found at www.resus.org.au/glossary/anaphylaxis-guideline-9-2-7/ andwww.allergy.org.au/health-professionals/papers/acute-management-of-anaphylaxis-guidelines
After the event, adverse events following immunisation should be reported to the Therapeutic Goods Administration in Australia and Medsafe in New Zealand .
It is important to document the timing of onset, the nature and severity of symptoms experienced, the likelihood of whether the adverse event occurred as a direct result of vaccination and details regarding underlying health issues . Blood for tryptase measurements should be taken if possible to assist in the confirmation of possible anaphylaxis.Conclusions
These recommendations are based on current available evidence, and subject to change as additional evidence becomes available.
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Do All Flu Shots Contain Egg Protein
If youre still concerned about egg allergies, there are two flu vaccine brands this year that are completely egg-free: Flucelvax Quadrivalent and Flublok Quadrivalent. They dont contain egg protein because they are made using newer manufacturing processes that dont require growing flu viruses inside of eggs.
Ascia Guidelines For Vaccinating The Egg
The Australasian Society of Clinical Immunology and Allergy concurs with these views. Our recommendations specifically apply to vaccines containing no more than 1 ug ovalbumin per dose and are summarized below.
- Based on prospective and retrospective studies of influenza vaccination in those with and without egg allergy , the presence of egg allergy does not increase the risk of allergic reactions to the influenza vaccine.
- The entire vaccine can be administered in community vaccination clinics as a single dose followed by the recommended 15 or 20 minute waiting period.
- In making this recommendation, we are aware that some guidelines recommend a longer waiting period of 30 minutes in those with past egg anaphylaxis and that occasionally allergic reactions to vaccination may commence later than 20-30 minutes after administration The immediate availability of medical practitioner care is recommended and staff should be familiar with the recognition and treatment of anaphylaxis.
- In individuals who have had anaphylaxis following administration of the influenza vaccine itself, further vaccination should be avoided without specialist allergy assessment.
- If there is significant parental or health professional anxiety, the vaccine may be administered in primary care settings with a longer waiting period of 30 minutes.
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What Are The Ingredients In Most Flu Vaccines
These are some of the components found in most egg-based vaccines:
Adjuvants are ingredients like aluminum salts that boost the bodys immune response to the flu shot.
Stabilizers like sugar and gelatin ensure that the vaccine is stable after its made and that it doesnt lose effectiveness while its not being used.
Formaldehyde is used in the manufacturing process to inactivate live flu viruses. Most of it is taken out before the vaccine is packaged and distributed. We actually make formaldehyde naturally in our bodies, and the amount of formaldehyde in vaccines is so small in comparison that its not a safety concern.
Antibiotics like neomycin are used to prevent bacteria from contaminating the vaccine. Antibiotics that people are most likely to be allergic to like penicillin arent used in vaccines.
Egg protein can be found in some flu vaccines. If youre allergic to eggs, you should still get your flu shot.
Preservatives prevent dangerous bacteria and fungi from contaminating vaccines. One example is thimerosal, which is found in vaccine vials that contain multiple doses.
Latex is another component you should be aware of. While its not in the flu vaccine liquid itself, its sometimes used to make the rubber stopper of the vaccine vial or the plunger of the syringe used to give you the shot. Allergic reactions to latex from a flu shot are rare, but if you have a latex allergy, be sure to mention it to your healthcare provider.
Flu Shot Safe For Those With Egg Allergies: Panel
This article was published more than 10 years ago. Some information may no longer be current.
People with egg allergies in Canada are getting a green light to get flu shots.
A panel of experts which issues advice on which vaccines Canadians ought to get has changed its stance on flu shots and egg allergies.
Flu vaccine is made in chicken eggs and people allergic to eggs have long been told they should forgo the annual shots.
But a series of recent studies have looked at the issue and have found the shots can be safely given to people with egg allergies.
The new advice from the National Advisory Committee on Immunization relates to injectable flu shots only .
The panel says there isn’t enough evidence at this time to determine whether the nasal spray flu vaccine a live virus vaccine sold as FluMist is also safe for people with egg allergies. But it notes a study is under way looking at that question.
The new advice is contained in NACI’s 2011-2012 statement on seasonal flu immunization.
It suggests that doctors don’t need to give people with egg allergies a skin test first to see if they can tolerate the vaccine. Instead, they suggest one of two options for people with egg allergies, depending on their individual risk of having a severe reaction to egg protein.
People with a lower risk of a severe reaction can be given the vaccine in a single dose, but should be observed for 30 minutes after getting the shot in case a reaction develops, the statement says.
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Should My Child With An Egg Allergy Get The Flu Shot
An egg allergy is the second most common food allergy in the U.S. after a milk allergy. Egg allergies affect about 1.3% of all children and 0.2% of all adults.
Some signs or symptoms of an egg allergy include:
- Tight, hoarse throat, or trouble swallowing
- Swelling of the tongue, affecting the ability to talk or breathe
- Vomiting or stomach cramps
- Pale or blue coloring of skin
- Dizziness or feeling faint
- Anaphylaxis a potentially life-threatening reaction that can impair breathing and send the body into shock
If your child has an egg allergy, the Centers for Disease Control and Prevention recommends flu vaccination. If your child has a severe allergic reaction to egg, your child should be vaccinated in a medical setting under the supervision of a health care provider who can recognize and manage severe allergic conditions.
The risk of adverse reaction to flu vaccination in people with an egg allergy is low, with 10 cases of anaphylaxis in 7.4 million doses of the flu vaccine, according to the CDC. Most cases of anaphylaxis were not related to the egg protein present in the vaccine.
However, if your child has had a previous severe allergic reaction to the flu vaccine, a flu vaccination is not recommended, according to the CDC.
The best way to prevent flu is by getting vaccinated each year.
Adela Taylor, M.D., is an allergist in Eau Claire and Rice Lake, Wisconsin.
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