ACIP approves influenza vaccine among egg-allergic children

The CDC’s Advisory Committee on Immunization Practices updated influenza vaccine recommendations to now include children who are allergic to eggs.

Based on recommendations from the clinical immunization safety assessment hypersensitivity working group of the ACIP, the members voted during the meeting this week to recommend administration of trivalent inactivated influenza vaccine to patients with a history of egg allergy. The recommendation will be included in the ACIP draft guidelines for use of influenza vaccines for the upcoming season.

“What we’re talking about here is giving an influenza vaccine to a patient, typically a child, who has a history of reacting to the ingestion of egg; patients who give convincing histories and for which we have evidence that they are allergic to eggs, and whether or not it’s OK to give them the influenza vaccine,” John Kelso, MD, of Scripps Clinic and the University of California, said. “What we’re not talking about here is evaluating a patient who has actually had a reaction to the influenza vaccine itself or any other vaccine.”

A major consideration of the working group was injecting egg-containing vaccines to those who are allergic to eggs, according to Kelso; however, further analysis of the data revealed no serious reactions in most of the studies.

“It’s likely that there is just not enough ovalbumin in the vaccine to cause a problem,” he said.

Kelso summarized the consensus of the working group as: “Egg allergy of any severity, including anaphylaxis, should not be a contraindication of the administration of the influenza vaccine, but rather a precaution.”

The following summary statements were presented and approved by ACIP based on further wording modifications:

Patients who are egg-allergic should generally receive influenza vaccinations because the risks of not vaccinating outweigh the risks of vaccinating.
Those with a history of suspected egg allergy who need an influenza vaccination should be evaluated by an allergist/immunologist with expertise in food and vaccine allergy.
Skin testing with the influenza vaccine itself in those who are allergic to eggs does not reliably identify patients who are at increased risk of reacting to the vaccine because of their egg allergy.
Administration of influenza vaccines to those who are allergic to eggs should be performed by clinicians experienced in recognizing and managing anaphylaxis and in settings equipped to manage potential adverse reactions.
Patients allergic to eggs who receive influenza vaccine should be observed for at least 30 minutes after receiving the last dose of vaccine.
Both the single-dose and two-dose methods are appropriate for administering influenza vaccine to those who are allergic to eggs.

The ACIP members also decided provide an abbreviated document that would highlight the strains and the recommendations for the number of doses, particularly in children.

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