Q:

11/8/2012
Do you think it is a good idea for healthcare providers who give the flu vaccine to still ask "Do you have a h/o allergy to egg?" before giving a flu vaccine? I have been staying up-to-date with reading all the articles about flu vaccine and egg allergy, most of which are being pumped out by University of Michigan allergy clinic. It does not seem like there is ANY correlation between likelihood of having a probable allergic reaction to a flu vaccine and having egg allergy. So, when is this annoyance of having to ask about egg allergy on the flu vaccine questionnaire going to stop?

A:

Thank you for your inquiry.

I am sending your inquiry to Dr Greenhawt, and will forward his response as soon as we receive it.

Thank you again.

Sincerely,
Phil Lieberman, M.D.

We received a response from Dr. Matthew Greenhawt. Thank you again for your inquiry, and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.

Response from Dr. Matthew Greenhawt:
This is a great question. I think that we can confidently say that the injectable trivalent influenza vaccine (TIV) is safe for egg allergic individuals, irrespective of a past severe reaction to egg. These individuals can receive the vaccine without vaccine skin testing, and as a single dose. Several recent studies have demonstrated these concepts. Neither the JTFPP nor the ACIP guidelines recommend that TIV be withheld in egg allergic individuals. These guidelines do differ slightly in the recommendations of what setting is best for certain egg allergic individuals to receive the vaccine (e.g., at the primary care provider office or at the allergist office).

Answering your question requires us to consider that various types of health care providers offer TIV vaccination. The questionnaire item was designed to screen-out egg allergic individuals when TIV was contraindicated in this population. Though this recommendation has changed, the questionnaire item still has some application. In the JTFPP guidelines, it advised that egg allergic individuals not receive TIV at walk-in pharmacy based clinic, employee-health or other type of clinic where there was not direct office-based physician supervision (e.g. mass walk-in flu shot clinics not held at a physician's office where there is full access to one's medical record, such as may be offered by a large employer or a hospital occupational health service). Therefore, the questionnaire item serves a purpose to identify egg allergic individuals and prevent them from receiving TIV outside of either their primary care provider's or allergist's office. Keep in mind that the ACIP still recommends that only patients with a history of just hives with egg consumption receive TIV in the primary care office setting, and that more severe egg allergic individuals be vaccinated at the allergist.

In the primary care physician office setting, there is very little need to ask this item on a questionnaire. The egg allergy history should be in the medical record and the provider ordering the vaccine should have reviewed that and determined if TIV was OK to administer in his/her office. However, there is a chance that the allergy history may be overlooked, especially if that provider is not the primary party managing the allergy, so the questionnaire item may then serve some purpose as a double-check mechanism to make sure that the individual's allergy history is reviewed and that TIV can be administered in that particular setting.

In an allergy clinic, obviously, such a questionnaire would clearly not be necessary. However, it should be recognized that this questionnaire may required by the provider's health care system, irrespective of the overwhelming evidence that it is unnecessary to ask. Over time, I do expect that this specific item will not be included on future versions of this questionnaire, but this may require further evidence demonstrating that it is safe to provide TIV to egg allergic individuals in a non-physician office setting.  

Matthew Greenhawt

AAAAI - American Academy of Allergy Asthma & Immunology