Q:

7/22/2012
I was reading a response regarding administration of the flu vaccine to an egg allergic patient. Would your recommendations change after AAAAI news feed published the following articles? Has the CDC OR AAAAI published a statement protecting allergists medico-legally if we were to give the flu vaccine to all patients even those with history of anaphylaxis to egg in 1 dose in our allergy offices? Have you advised PCPs to give the flu vaccine to egg allergic patients with history of hives in their offices?

eNews
Egg Allergy and Influenza Vaccine

A:
Thank you for your inquiry.

For the sake of our readers, I have copied the summary of the reference to which you referred. It is an update to the Immunization (vaccination) Practice Parameters that is concerned specifically with immunization to influenza vaccine in patients who give a history of an allergic reaction to eggs.

Summary
"The risk of an allergic reaction to influenza vaccine in patients with egg allergy is very low, likely due to the very low amount of ovalbumin in the vaccines. Any such theoretical risk is far outweighed by the very real risk of such patients remaining unvaccinated. Thus all patients with egg allergy of any severity, including anaphylaxis, should receive influenza vaccine. Skin testing with the vaccine and dividing the dose are not necessary. The injectable vaccine should be administered in a medical setting where anaphylaxis can be recognized and treated should it occur. For those with a history of hives only after egg ingestion, the vaccine can be administered in the primary care provider's office. For those with more serious reactions to egg ingestion, the vaccine should be administered in an allergist's office."

SOURCE: Adverse reactions to vaccines practice parameter 2012 update: Journal of Allergy and Clinical Immunology Vol. 130, Issue 1, Pages 25-43. (THIS QUOTE IS COPIED WITHOUT REFERENCES)

The summary is self-explanatory and is a reiteration of the essence of this document. I personally think it is important to read the document in its entirety in order to be able to understand the evidence upon which this summary is based.

Having said that, I will try and answer your specific questions:

My recommendations would now be consistent with this document which was published in July of 2012.

My personal interpretation of this document is that it is not intended to be a "medical/legal" text, but rather a summary of the best data we have to guide us in the administration of influenza vaccine with a history of egg allergy. The medical/legal implications of this document would require an attorney, and I think each individual implementing the guidelines will have to make their own judgment as to medical risks in this regard.

Since this document came out in July, and we have not reached the influenza vaccination season, I have not acted upon the recommendations in this document. My sense is that I will take into consideration each patient separately and make judgments accordingly as to which patients I should personally evaluate, using these guidelines for the basis of my judgment.

Thank you again for your inquiry and we hope this response is helpful to you.

Sincerely,
Phil Lieberman, M.D.
AAAAI - American Academy of Allergy Asthma & Immunology